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Impulsive Decision Reduction Training for Youth With a Patterned History of Making Risky and Impulsive Decisions: A Case Report
Background:
Individuals with panic disorder (PD) often exhibit a proclivity to conclude that an imminent catastrophe looms, drawing such conclusions from limited physical information. Reflection impulsivity, characterized by decision-making without adequate information, likely affects this bias. This study examines the relationship between reflection impulsivity and self-report impulsive features in individuals with PD.
Methods:
Fifty patients with PD and 50 healthy controls (HC) participated to this study. Reflection impulsivity was assessed using the Information Sampling Task (IST), while trait impulsivity was measured using the Barratt Impulsiveness Scale (BIS). Participants also completed the Beck Anxiety Inventory, Panic and Agoraphobia Scale (P&A), and Anxiety Sensitivity Index-3 (ASI-3).
Results:
Individuals with PD exhibited higher reflection impulsivity compared to HC. Increased reflection impulsivity correlated positively with PD severity as assessed by the P&A and cognitive concerns measured by ASI-3. No significant correlations were found with physical or social concerns. PD patients had higher BIS scores than HC. Higher trait impulsivity was linked to recurrent emergency department visits among PD patients.
Discussion:
The findings of this study reveal the notion of increased impulsivity among individuals with PD and its relationship with cognitive concerns, as well as recurrent visits to the emergency department stemming from panic attacks.
Decision field theory provides for a mathematical foundation leading to a dynamic, stochastic theory of decision behavior in an uncertain environment. This theory is used to explain (a) violations of stochastic dominance, (b) violations of strong stochastic transitivity, (c) violations of independence between alternatives, (d) serial position effects on preference, (e) speed–accuracy tradeoff effects in decision making, (f) the inverse relation between choice probability and decision time, (g) changes in the direction of preference under time pressure, (h) slower decision times for avoidance as compared with approach conflicts, and (i) preference reversals between choice and selling price measures of preference. The proposed theory is compared with 4 other theories of decision making under uncertainty.
Objective:
Higher rates of delay discounting have been consistently linked to maladaptive health behaviors, including substance use and overeating, among adults. Despite adolescence representing a critical period for the escalation of these risky health behaviors, little is known about the developmental course of delay discounting or how this construct relates to important health outcomes in youth. The current study examined change in delay discounting over time using a latent growth curve approach and the relation between growth in this construct and changes in substance use and body-mass index over a 6-year period.
Method:
Participants included 247 adolescents (44% female) with a mean age of 13 at the initial assessment.
Results:
Findings suggest that, on average, rates of delay discounting are stable across adolescence; however, there are significant individual differences around this trajectory. Moreover, youth who demonstrate significant increases in delay discounting over time are also more likely to experience more rapid escalations of both substance use and Body Mass Index across adolescence.
Conclusions:
Results indicate that delay discounting is an important trans-disease process among adolescents. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Many behaviors posing significant risks to public health are characterized by repeated decisions to forego better long-term outcomes in the face of immediate temptations. Steeply discounting the value of delayed outcomes often underlies a pattern of impulsive choice. Steep delay discounting is correlated with addictions (e.g., substance abuse, obesity) and behaviors such as seatbelt use and risky sexual activity. As evidence accumulates suggesting steep delay discounting plays a causal role in these maladaptive behaviors, researchers have begun testing methods for reducing discounting. In this first systematic and comprehensive review of this literature, the findings of 92 articles employing different methodologies to reduce discounting are evaluated narratively and meta-analytically. Although most of the methods reviewed produced significant reductions in discounting, they varied in effect sizes. Most methods were ideal for influencing one-off choices (e.g., framing and priming manipulations), although other successful manipulations, such as episodic future thinking, could be incorporated into existing therapies designed to produce longer-lasting changes in decision-making. The largest and longest-lasting effects were produced by learning-based manipulations, although translational research is needed to determine the generality and clinical utility of these methods. Methodological shortcomings in the existing literature and suggestions for ameliorating these issues are discussed. This review reveals a variety of methods with translational potential, which, through continued refinement, may prove effective in reducing impulsive choice and its associated maladaptive decisions that negatively impact quality of life. (PsycINFO Database Record
Susceptibility to social influence is associated with a host of negative outcomes during adolescence. However, emerging evidence implicates the role of peers and parents in adolescents' positive and adaptive adjustment. Hence, in this chapter we highlight social influence as an opportunity for promoting social adjustment, which can redirect negative trajectories and help adolescents thrive. We discuss influential models about the processes underlying social influence, with a particular emphasis on internalizing social norms, embedded in social learning and social identity theory. We link this behavioral work to developmental social neuroscience research, rooted in neurobiological models of decision making and social cognition. Work from this perspective suggests that the adolescent brain is highly malleable and particularly oriented toward the social world, which may account for heightened susceptibility to social influences during this developmental period. This chapter underscores the need to leverage social influences during adolescence, even beyond the family and peer context, to promote positive developmental outcomes. By further probing the underlying neural mechanisms as an additional layer to examining social influence on positive youth development, we will be able to gain traction on our understanding of this complex phenomenon.
Background
The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations.
Objective
The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency.
Methods
Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE.
Results
2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.
Conclusion
This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.
Research on executive control during the teenage years points to shortfalls in emotion regulation, coping, and decision making as three linked capabilities associated with youth's externalizing behavior problems. Evidence gleaned from a detailed review of the literature makes clear that improvement of all three capabilities is critical to help young people better navigate challenges and prevent or reduce externalizing and related problems. Moreover, interventions can successfully improve these three capabilities and have been found to produce behavioral improvements with real-world significance. Examples of how successful interventions remediate more than one of these capabilities are provided. Future directions in research and practice are also proposed to move the field toward the development of more comprehensive programs for adolescents to foster their integration.
RationaleDelay discounting, or the devaluation of delayed outcomes, appears to play an etiological role in tobacco and other substance-use disorders. Objectives
No human studies to our knowledge have been designed to examine whether experimental reductions in delay discounting produce concomitant reduction in drug use. Methods
Using methods from prior studies on delay discounting and obesity, we examined the effects of episodic future thinking (EFT; a form of mental prospection) on delay discounting and cigarette self-administration in smokers. ResultsConsistent with prior data, EFT significantly reduced both delay discounting (Cohen’s d effect size = 0.65) and the number of cigarette puffs earned in a cigarette self-administration task (d = 0.58). Conclusions
The effects of EFT on delay discounting generalize to smokers; EFT also reduces laboratory-based cigarette self-administration. Potential mechanisms of EFT’s effects are discussed as well as implications of EFT for clinical treatment of substance-use disorders.
Background:
A youth version of the UPPS Impulsivity Scale (UPPS-R-C) was previously shown to predict drinking initiation among pre-adolescents. The goals of the current study were to confirm the structure of the UPPS-R-C using a sample of treatment-seeking adolescents and to examine the scales' relations with alcohol use, marijuana use, and problems related to substance use.
Method:
Participants (N=120; ages 12-18; M=15.7) completed questionnaires at treatment intake. Confirmatory factor analysis (CFA) of the UPPS-R-C was conducted using a 5-factor model with factors corresponding to negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking. Relations between UPPS-R-C factors and binge drinking, marijuana use, and problems resulting from substance use were examined using path analysis.
Results:
CFA suggested the 5-factor model provided adequate fit to the data. The hypothesized path model was partially supported, positive urgency was associated with frequency of binge drinking, and both negative urgency and frequency of binge drinking was associated with problems due to substance use. Other hypothesized paths were not significant. Although not hypothesized, negative urgency was associated with frequency of marijuana use and lack of perseverance was associated with problems due to use.
Conclusions:
Results suggest that the UPPS-R-C can be used with a treatment-seeking sample of adolescents. Furthermore, negative urgency, positive urgency, and lack of perseverance may be indicative of more severe substance use problems in a treatment setting.
Parent-adolescent relationship quality and delay discounting may play important roles in adolescents' sexual decision making processes, and levels of self-control during adolescence could act as a buffer within these factors. This longitudinal study included 219 adolescent (55 % male; mean age = 12.66 years at Wave 1; mean age = 15.10 years at Wave 2) and primary caregiver dyads. Structural equation modeling (SEM) was utilized to determine whether delay discounting mediated the association between parent-adolescent relationship quality and adolescents' risky sexual behavior and how this mediated association may differ between those with high versus low self-control. The results revealed parent-adolescent relationship quality plays a role in the development of risky sexual behavior indirectly through levels of delay discounting, but only for adolescents with low self-control. These findings could inform sex education policies and health prevention programs that address adolescent risky sexual behavior.
Despite evident heightened adolescent risk-taking in real-life situations, not all experimental studies demonstrate that adolescents take more risks than children and adults on risky decision-making tasks. In the current 4 independent meta-analyses, neurodevelopmental imbalance models and fuzzy trace theory were used as conceptual frameworks to examine whether adolescents engage in more risk-taking than children and adults and whether early adolescents take more risks than children and mid-late adolescents on behavioral risk-taking tasks. Studies with at least 1 of the aforementioned age comparisons met the inclusion criteria. Consistent with imbalance models and fuzzy trace theory, results from a random-effects model showed that adolescents take more risks (g = .37) than adults, and early adolescents take more risks (g = .15) than mid-late adolescents. However, inconsistent with both perspectives, adolescents and children take equal levels of risk (g = -.00), and early adolescents and children also take equal levels of risk (g = .04). Meta-regression analyses revealed that, consistent with imbalance models, (a) adolescents take more risks than adults on hot tasks with immediate outcome feedback on rewards and losses; however, contrary to imbalance models but consistent with fuzzy trace theory, (b) adolescents take fewer risks than children on tasks with a sure/safe option. Shortcomings related to studies using behavioral risk-taking tasks are discussed. We suggest a hybrid developmental neuroecological model of risk-taking that includes a risk opportunity component to explain why adolescents take more risks than children in the real world but equal levels of risks as children in the laboratory. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Context effects occur when a choice between 2 options is altered by adding a 3rd alternative. Three major context effects-similarity, compromise, and attraction-have wide-ranging implications across applied and theoretical domains, and have driven the development of new dynamic models of multiattribute and multialternative choice. We propose the multiattribute linear ballistic accumulator (MLBA), a new dynamic model that provides a quantitative account of all 3 context effects. Our account applies not only to traditional paradigms involving choices among hedonic stimuli, but also to recent demonstrations of context effects with nonhedonic stimuli. Because of its computational tractability, the MLBA model is more easily applied than previous dynamic models. We show that the model also accounts for a range of other phenomena in multiattribute, multialternative choice, including time pressure effects, and that it makes a new prediction about the relationship between deliberation time and the magnitude of the similarity effect, which we confirm experimentally. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
The Timeline Followback (TLFB), a retrospective calendar-based measure of daily substance use, was initially developed to obtain self-reports of alcohol use. Since its inception it has undergone extensive evaluation across diverse populations and is considered the most psychometrically sound self-report measure of drinking. Although the TLFB has been extended to other behaviors, its psychometric evaluation with other addictive behaviors has not been as extensive as for alcohol use. The present study evaluated the test-retest reliability of the TLFB for cocaine, cannabis, and cigarette use for participants recruited from outpatient alcohol and drug treatment programs and the general community across intervals ranging from 30 to 360 days prior to the interview. The dependent measure for cigarette smokers and cannabis users was daily use of cigarettes and joints, respectively, and for cocaine users it was a "Yes" or "No" regarding cocaine use for each day. The TLFB was administered in different formats for different drug types. Different interviewers conducted the two interviews. The TLFB collected highly reliable information about participants' daily use of cocaine, cannabis, and cigarettes from 30, 90, to 360 days prior to the interview. Findings from this study not only suggest that shorter time intervals (e.g., 90 days) can be used with little loss of accuracy, but also add to the growing literature that the TLFB can be used with confidence to collect psychometrically sound information about substance use (i.e., cocaine, cannabis, cigarettes) other than alcohol in treatment- and nontreatment-seeking populations for intervals from ranging up to 12 months prior to the interview. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Proposes a new construct called consideration of future consequences (CFC), which is hypothesized to be a stable individual difference in the extent to which people consider distant vs immediate consequences of potential behaviors. Following a description of the construct itself, a measure of this individual difference is developed and validated. Data collected from 7 samples of college students indicates that the measure has acceptable reliability and validity. In addition, evidence of the role of CFC in regulating affective responses to negative events is reviewed. The utility of the CFC construct is demonstrated in 2 studies. The 1st study shows that CFC affects the extent to which individuals are influenced by a persuasive communication; the 2nd demonstrates that CFC predicts health and environmental behaviors better than do other related constructs. Areas of application and future research are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Among adolescents and adults, there appear to be at least four different personality traits that dispose individuals to rash or ill-advised action: sensation seeking, negative urgency, lack of planning, and lack of perseverance. The four are only moderately correlated and they appear to play different roles in dysfunction. It is important to determine whether the traits are present among preadolescents because of their possible influence on subsequent development. The authors developed assessments of the four traits for preadolescent children and found evidence supporting (a) the internal consistency of each trait measure, (b) the convergent and discriminant validity of the four measures using the multitrait, multimethod technique, and (c) the hypothesis that the different traits correlated with different dysfunctional behaviors as predicted by theory. Pending further validation efforts, it appears to be the case that researchers may be able to distinguish among different dispositions to rash action prior to adolescence.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
The Alcohol Timeline Followback (TLFB) has been shown to be a psychometrically sound assessment instrument for obtaining retrospective daily estimates of alcohol consumption. These evaluations, however, have been limited to face-to-face paper-and-pencil interviews. As use of the TLFB method has increased, investigators have reported using the method to collect follow-up data by telephone. Also, as with many assessment instruments, a computerized version of the TLFB method has been developed. The psychometric characteristics of the TLFB method under these administration conditions have not been evaluated. This paper presents results from two studies showing that the Alcohol TLFB method can obtain reliable drinking data when administered over the telephone and by computer.
This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction "sends the wrong message." Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.
This study tests the contextual social-cognitive model, which has served as the basis for the Coping Power program, an indicated preventive intervention with at-risk preadolescent boys at the time of transition from elementary to middle school. The contextual social-cognitive model assumes that aggressive children have distortions in their social-cognitive appraisals and deficiencies in their social problem solving skills and that their parents have deficiencies in their parenting behaviors. To test this model, boys were identified as being at risk on the basis of fourth grade and fifth grade teachers' ratings of children's aggressive and disruptive behaviors, and interventions were delivered at the end of elementary school and the beginning of middle school. The intervention effect on delinquency, substance use, and school behavior outcomes was at least partially mediated through intervention-produced changes in child and parent variables that were targets for the intervention. These analyses provided unique support for the assumptions in the contextual social-cognitive model that changes in these mediating processes, even among high-risk boys, can have a meaningful impact on later negative outcomes.
Adolescent substance abuse is a serious problem for which effective interventions are needed. To conduct trials of new therapies, investigators need reliable means of identifying potential participants and of measuring outcomes. The objective of this study was to determine the 1-week test-retest reliability of the CRAFFT screening test and of the timeline follow-back (TLFB) calendar method for measuring alcohol, cannabis, and other drug use.
Ninety-three 12- to 18-year-old patients presenting for routine medical care to three urban adolescent clinics were administered the CRAFFT screen in both lifetime and past-year versions and a 90-day TLFB. Both measures were completed on the day of the clinic visit and again 1 week later. We computed kappa coefficients and the intraclass correlation coefficient (ICC) for the CRAFFT and computed the ICC separately for TLFB self-reports of alcohol and cannabis.
For the CRAFFT, kappa for individual items ranged from 0.31 to 0.86, and the ICC was 0.93 (95% confidence interval, 0.90-0.95). However, the total score of the lifetime CRAFFT at time 2 was significantly lower than at time 1; there was no difference in time 1 and time 2 total scores for the past-year version. The ICCs for past-90-days TLFB variables were as follows: drinking days, 0.92; drinks per occasion, 0.87; cannabis days, 0.83; and joints per occasion, 0.76. Past-30-day and past-60-day intervals compared favorably to past-90-day intervals.
The CRAFFT screen is a reliable means of screening adolescents for substance abuse, although we recommend using the past-year version. The TLFB is a reliable method of quantifying adolescents' alcohol and cannabis use at intervals of 30, 60, or 90 days.
https://deepblue.lib.umich.edu/bitstream/2027.42/139712/1/mtf-overview2016.pdf
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This paper describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (a) functional analysis of behavior hroblems, (b) prosocial activity sampling, (c) cognitive monitoring and restructuring, (d) emotion regulation training, (e) problem-solving training, and (f) communication training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
Background:
Behavioral measures of impulsive behavior include the dimensions of behavioral disinhibition, decision-making, and lapses of attention. These behaviors are associated with a range of risky activities during adolescence, including cigarette smoking; however, few studies have evaluated their associations with tobacco treatment outcomes. The current study examined the relationship between impulsive behavior and contingency management treatment outcomes for adolescent smokers.
Methods:
Data from two contingency management smoking cessation trials were combined (N = 189 adolescents). Participants provided breath carbon monoxide (CO) samples with incentives delivered contingent (i.e., active treatment [AT] condition) or non-contingent (i.e., control treatment [CT] condition) on CO level. Dimensions of impulsive behavior were assessed pre- and post-treatment using the Go/Stop Task, a measure of delay discounting, a continuous performance task, while self-reported impulsivity was assessed with the Barratt Impulsiveness Scale-Adolescent. Relationships between impulsive behavior and treatment outcomes (efficacy and adherence) were assessed using linear mixed effects models.
Results:
Participants in the AT condition had significantly lower program CO levels at each treatment phase. Delay discounting in the AT condition predicted CO levels, with those discounting the most lowering their breath CO levels the least. Delay discounting also predicted program adherence across both conditions.
Conclusions:
Delay discounting may be the most relevant dimension of impulsive behavior to predict outcomes for adolescent smokers completing CM programs, both in terms of successful reductions in smoking and program adherence. Suggestions are made to reduce the effects of delay discounting for adolescent smokers using this treatment approach.
Innovative technologies are increasingly used in order to address gaps in access to child behavioral health care. Telemental health is one technological modality in which child behavioral services can be practiced successfully across psychiatry, psychology, and developmental medicine. The authors discuss relevant issues related to delivering telemental health, including why this modality is necessary for delivery, what models and evidence for telemental health exist, when it should be considered across legal/regulatory and ethical considerations, where telemental health services are delivered, who is involved in delivery, and how best telemental health practices may be implemented with diverse youth.
Discounting of larger future rewards in favor of smaller immediate rewards is known as delay discounting. High delay discounting or a bias towards immediate gratification impedes self-regulation and is associated with maladaptive eating behaviors. Children in general show greater delay discounting than adults. Obese children in particular, have greater difficulty delaying gratification for edible rewards. Episodic future thinking (EFT) which is mental self-projection to pre-experience future events reduces delay discounting and reduces energy intake in overweight/obese adults. However, these EFT effects have not been examined in children. We evaluated the effects of EFT versus control episodic recent thinking (ERT) on delay discounting and ad libitum energy intake while thinking about episodic cues in 42 overweight/obese 9 to 14year olds. Results showed that EFT led to less delay discounting and lowered energy intake, and EFT had the greatest effect on reducing energy intake in children with a higher desire to restrict food intake. This suggests that EFT may be useful in pediatric obesity treatment programs to help children regulate energy intake.
Copyright © 2015 Elsevier Ltd. All rights reserved.
The choice of small immediate rewards as opposed to larger delayed rewards, or delay discounting, is an important dimension of impulsive decision making. The inability to delay gratification is related to obesity, as well as other maladaptive behaviors such as substance abuse, problem drinking, smoking, pathological gambling, and risky HIV behaviors. One way to reduce delay discounting (DD) may be to use prospective imagery in the form of episodic future thinking (EFT) during inter-temporal decision making. We have recently shown that EFT reduces DD and ad libitum energy intake in obese individuals. However, no studies have examined whether the magnitude of the EFT effect differs between lean and overweight/obese individuals. We conducted a within-subject design experiment to compare the efficacy of EFT versus a control task in reducing DD between lean (N = 24) and overweight/obese (N = 24) women. Participants attended two sessions in which they engaged in either EFT or control episodic thinking during a DD task. We also examined whether individual differences such as trait time perspective, behavioral inhibition or behavioral activation moderated the EFT effect on DD. Results showed EFT reduced DD similarly for lean and overweight/obese individuals. The EFT effect was moderated by behavioral activation. This suggests EFT is just as effective in reducing impulsive decision making in obese individuals as it is in lean individuals and may be useful in reducing other impulsive obesity related behaviors.
Background:
Previous research demonstrates the role of attentional bias in addictive behaviors. Impulsivity is thought to affect the strength of attentional biases, and thus, attentional biases might be one mechanism by which impulsivity affects addictive behaviors. However, whether or not impulsivity is related to attentional biases across different conceptualizations of impulsivity and attentional biases has yet to be examined as an initial test of such causal models.
Methods:
The authors completed a meta-analysis of 13 published research studies examining the relationship between substance-related attentional bias and different conceptualizations of impulsivity.
Results:
There was a small and significant effect size between impulsivity and substance-related attentional bias (r=0.20), which was moderated by impulsivity measurement type (Qb=5.91, df=1, p<0.05): there was a stronger relationship between behavioral impulsivity and substance-related attentional bias (r=0.22) than trait impulsivity and substance-related attentional bias (r=0.10). Different components of behavioral impulsivity and trait impulsivity did not affect the relationship.
Conclusions:
This study is the first systematic and empirical demonstration of the relationship between substance-related attentional bias and impulsivity and suggests viability of future examinations of casual models relating these constructs. Since trait and behavioral conceptualizations differentially relate to substance-related attentional bias, the current review further supports research suggesting how disaggregation of multidimensional constructs can lead to more robust relationships.
Discusses problem-solving skills training and parent management training for conduct disorder (CD) for children (aged 2-13 yrs). The treatment provided include cognitive problem-solving skills training (PSST) and parent management training. These are provided individually to children and families rather than in group format. Parent-management training (PMT) refers to procedures in which parents are trained to alter their child's behavior in the home. PMT focuses on altering parent-child interactions and includes several characteristics. It also focuses on child performance at school. Both PSST and PMT emphasize changing how individuals perform. Both draw heavily on learning theories and research findings. Treatment is assessed and evaluated. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
(i) To evaluate the role of pre-existing weakness in working memory ability (WM) as a risk factor for early alcohol use as mediated by different forms of impulsivity and (ii) to assess the adverse effects of progressive alcohol use on variations in WM over time.
A community sample of 358 adolescents [48% males, meanage(baseline) = 11.4 ± 0.87 years] from a longitudinal cohort design, assessed annually over 4 consecutive years with less than 6% attrition.
Repeated assessments were conducted for the following key variables: WM (based on performance on four separate tasks), frequency of alcohol use (AU) and three forms of impulsivity, namely sensation seeking (SS), acting without thinking (AWT) and delay discounting (DD). Latent growth curve modeling procedures were used to identify individual trajectories of change for all key variables.
Weakness in WM (at baseline) predicted significantly both concurrent alcohol use and increased frequency of use over the four waves (P < 0.05). This effect was entirely mediated by two forms of impulsivity, AWT and DD, both of which were characterized by underlying weakness in WM. No individual variation was observed in the slopes of WM, which suggests that individual variations in alcohol use were not associated with changes in WM in our early adolescent sample.
Early adolescent alcohol use may be a consequence of (pre-existing) weaknesses in working memory (WM) rather than a cause of it. Efforts to reduce early alcohol use should consider the distinct roles of different impulsivity dimensions, in addition to WM, as potential targets of intervention.
In two studies, the authors further validated measures of the construct of positive urgency (the tendency to act rashly while in a positive mood), tested its distinctness from negative urgency, and placed the two constructs in an overall framework for understanding multiple dispositions to rash action. Using a multitrait, multimethod design, they documented convergent validity for positive urgency across two methods of assessment and discriminant validity between positive urgency and each of four other impulsivity-like traits. Using confirmatory factor analysis, they provided support for a 3-factor understanding of disposition to rash action: a mood-based disposition, of which positive and negative urgency are facets; a deficits-in-conscientiousness disposition, of which lack of planning and lack of perseverance are facets; and sensation seeking. They demonstrated that positive and negative urgency differentially predicted, respectively, positive mood-based rash action and negative mood-based rash action.
To assess correlations and agreement between timeline follow-back (TLFB)-assisted self-report and blood samples for cannabis use.
Secondary analysis of a randomized trial.
Copenhagen, Denmark.
One hundred and three patients from the CapOpus trial with cannabis use disorder and psychosis, providing 239 self-reports of cannabis use and 88 valid blood samples.
Delta-9-tetrahydrocannabinol (THC), 11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) detected in plasma using high-performance liquid chromatography with tandem mass spectrometry detection. Self-report of cannabis-use last month by TLFB. Pearson's r, sensitivity and specificity calculated as measures of correlation or agreement.
Correlations were strong; r = 0.75 for number of days and r = 0.83 for number of standard joints in the preceding month when excluding outliers. Including outliers, coefficients were moderate to strong (r = 0.49). There were differences in subgroups, mainly inconsistent, depending on inclusion or exclusion of outliers. Sensitivity and specificity for TLFB detecting the presence or absence of cannabis use were 95.7% [95% confidence interval (CI) 88.0-99.1%) and 72.2% (95% CI 46.5-90.3%), respectively. Using 19 days as cut-off on TLFB, they were 94.3% (95% CI 86.0-98.4%) and 94.4% (95% CI 72.2-99.9%), respectively. Area under the receiver operating characteristic (ROC) curve was 0.96.
Timeline follow-back (TLFB)-assisted self-report of cannabis use correlates highly with plasma-delta-9-tetrahydrocannabinol in patients with comorbid cannabis use disorder and psychosis. Sensitivity and specificity of timeline follow-back appear to be optimized with 19 days as the cut-off point. As such, timeline follow-back may be superior to analysis of blood when going beyond 19 days of recall.
Delayed reward discounting (DRD) is a behavioral economic index of impulsivity and numerous studies have examined DRD in relation to addictive behavior. To synthesize the findings across the literature, the current review is a meta-analysis of studies comparing DRD between criterion groups exhibiting addictive behavior and control groups.
The meta-analysis sought to characterize the overall patterns of findings, systematic variability by sample and study type, and possible small study (publication) bias.
Literature reviews identified 310 candidate articles from which 46 studies reporting 64 comparisons were identified (total N=56,013).
From the total comparisons identified, a small magnitude effect was evident (d= .15; p< .00001) with very high heterogeneity of effect size. Based on systematic observed differences, large studies assessing DRD with a small number of self-report items were removed and an analysis of 57 comparisons (n=3,329) using equivalent methods and exhibiting acceptable heterogeneity revealed a medium magnitude effect (d= .58; p< .00001). Further analyses revealed significantly larger effect sizes for studies using clinical samples (d= .61) compared with studies using nonclinical samples (d=.45). Indices of small study bias among the various comparisons suggested varying levels of influence by unpublished findings, ranging from minimal to moderate.
These results provide strong evidence of greater DRD in individuals exhibiting addictive behavior in general and particularly in individuals who meet criteria for an addictive disorder. Implications for the assessment of DRD and research priorities are discussed.
It has been hypothesized that reward-seeking and impulsivity develop along different timetables and have different neural underpinnings, and that the difference in their timetables helps account for heightened risk-taking during adolescence. In order to test these propositions, age differences in reward-seeking and impulsivity were examined in a socioeconomically and ethnically diverse sample of 935 individuals between the ages of 10 and 30, using self-report and behavioral measures of each construct. Consistent with predictions, age differences in reward-seeking follow a curvilinear pattern, increasing between preadolescence and mid-adolescence, and declining thereafter. In contrast, age differences in impulsivity follow a linear pattern, with impulsivity declining steadily from age 10 on. Heightened vulnerability to risk-taking in middle adolescence may be due to the combination of relatively higher inclinations to seek rewards and still maturing capacities for self-control.
Age differences in future orientation are examined in a sample of 935 individuals between 10 and 30 years using a delay discounting task as well as a new self-report measure. Younger adolescents consistently demonstrate a weaker orientation to the future than do individuals aged 16 and older, as reflected in their greater willingness to accept a smaller reward delivered sooner than a larger one that is delayed, and in their characterizations of themselves as less concerned about the future and less likely to anticipate the consequences of their decisions. Planning ahead, in contrast, continues to develop into young adulthood. Future studies should distinguish between future orientation and impulse control, which may have different neural underpinnings and follow different developmental timetables.
As part of a broad focus on service accountability, increased attention has been devoted to the assessment of consumer judgments of treatment acceptability. Current treatment acceptability measures are limited by item complexity and time-intensiveness. These limitations were addressed with the modification of an existing instrument (Intervention Rating Profile; Witt & Elliott, Journal of Abnormal Child Psychology, 13, 59-67, 1985). Psychometric support was found for the revised measure (Abbreviated Acceptability Rating Profile; AARP) in an initial sample of parents (N = 60) who rated child treatments. Results were replicated in a cross-validation study of a second independent sample of parents (N = 80). A third sample of subjects was used to assess the time-intensiveness and readability of the AARP. The usefulness of the modified instrument is discussed.
Thinking about the future is an integral component of human cognition - one that has been claimed to distinguish us from other species. Building on the construct of episodic memory, we introduce the concept of 'episodic future thinking': a projection of the self into the future to pre-experience an event. We argue that episodic future thinking has explanatory value when considering recent work in many areas of psychology: cognitive, social and personality, developmental, clinical and neuropsychology. Episodic future thinking can serve as a unifying concept, connecting aspects of diverse research findings and identifying key questions requiring further reflection and study.
We present a temporal map of key processes that occur during decision making, which consists of three stages: 1) formation of preferences among options, 2) selection and execution of an action, and 3) experience or evaluation of an outcome. This framework can be used to integrate findings of traditional choice psychology, neuropsychology, brain lesion studies, and functional neuroimaging. Decision making is distributed across various brain centers, which are differentially active across these stages of decision making. This approach can be used to follow developmental trajectories of the different stages of decision making and to identify unique deficits associated with distinct psychiatric disorders.
This article presents a cognitive-motivational theory (CMT) of the mechanisms associated with three basic dimensions of personality vulnerability to alcoholism, impulsivity/novelty seeking, harm avoidance, and excitement seeking. CMT describes the interrelationships between activity in basic motivational systems and attentional, decision-making and working memory processes as the mechanisms associated with variation in each personality trait. Impulsivity/novelty seeking reflects activity in both appetitive and inhibitory motivational systems, greater attention to reward cues, and increased emotional reactivity to reward and frustration. Harm avoidance reflects individual differences in fearfulness and activity in specific inhibitory systems. Excitement seeking reflects the need to engage in appetitive behaviors in less predictable environments to experience positive affect. CMT also describes the impact of working memory and the specific motivational processes underlying each trait dimension on the dynamics of decision making from the perspective of decision field theory.
There is a longstanding association between substance-use disorders (SUDs) and the psychological construct of impulsivity. In the first section of this review, personality and neurocognitive data pertaining to impulsivity will be summarised in regular users of four classes of substance: stimulants, opiates, alcohol and 3,4-methylenedioxymethamphetamine (MDMA). Impulsivity in these groups may arise via two alternative mechanisms, which are not mutually exclusive. By one account, impulsivity may occur as a consequence of chronic exposure to substances causing harmful effects on the brain. By the alternative account, impulsivity pre-dates SUDs and is associated with the vulnerability to addiction. We will review the evidence that impulsivity is associated with addiction vulnerability by considering three lines of evidence: (i) studies of groups at high-risk for development of SUDs; (ii) studies of pathological gamblers, where the harmful consequences of the addiction on brain structure are minimised, and (iii) genetic association studies linking impulsivity to genetic risk factors for addiction. Within each of these three lines of enquiry, there is accumulating evidence that impulsivity is a pre-existing vulnerability marker for SUDs.
This article proposes a framework for theory and research on risk-taking that is informed by developmental neuroscience. Two fundamental questions motivate this review. First, why does risk-taking increase between childhood and adolescence? Second, why does risk-taking decline between adolescence and adulthood? Risk-taking increases between childhood and adolescence as a result of changes around the time of puberty in the brain's socio-emotional system leading to increased reward-seeking, especially in the presence of peers, fueled mainly by a dramatic remodeling of the brain's dopaminergic system. Risk-taking declines between adolescence and adulthood because of changes in the brain's cognitive control system - changes which improve individuals' capacity for self-regulation. These changes occur across adolescence and young adulthood and are seen in structural and functional changes within the prefrontal cortex and its connections to other brain regions. The differing timetables of these changes make mid-adolescence a time of heightened vulnerability to risky and reckless behavior.
Making smarter, healthier and safer decisions: Impulsive Decision Reduction Training for Youth (IDRT-Y)
- L A Hulvershorn
- Z W Adams
- P R Finn
Manual for the administration of Impulsive Decision Reduction Training (IDRT)
- P R Finn
Impulsive Decision Reduction Training (IDRT) reduces binge drinking and increases future orientation in young adult binge drinkers
- P R Finn
- Z W Adams
- E J Farmer
- L A Hulvershorn
Timeline follow-back
- Sobell