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Successful Remote Treatment of a Client with Hikikomori Using Internet- Delivered Cognitive Therapy for Social Anxiety Disorder: A Case Study
Hikikomori (prolonged social withdrawal) has been discussed as a hidden worldwide epidemic and a significant social and healthcare issue. Social anxiety disorder is the most common psychiatric disorder preceding the onset of Hikikomori. Although studies exist suggesting the effectiveness of family-support interventions, little is known about psychotherapeutic approaches for Hikikomori individuals. Here, we present a case of Hikikomori wherein an internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD) worked effectively in improving the client's social anxiety symptoms and social interaction behaviors. This case study demonstrates the principle that evidence-based psychological interventions focusing on social anxiety can be effective for clients with Hikikomori. Furthermore, the online mode of treatment delivery, along with a variety of relevant modules, may facilitate clients' engagement with treatment at home. The findings suggest that iCT-SAD might be a promising option for Hikikomori clients who have social anxiety problems, within the recommended stepped-intervention approach.
Timing along the cardiac cycle modulates neural signals of reward-based learning.
Natural fluctuations in cardiac activity modulate brain activity associated with sensory stimuli, as well as perceptual decisions about low magnitude, near-threshold stimuli. However, little is known about the relationship between fluctuations in heart activity and other internal representations. Here we investigate whether the cardiac cycle relates to learning-related internal representations - absolute and signed prediction errors. We combined machine learning techniques with electroencephalography with both simple, direct indices of task performance and computational model-derived indices of learning. Our results demonstrate that just as people are more sensitive to low magnitude, near-threshold sensory stimuli in certain cardiac phases, so are they more sensitive to low magnitude absolute prediction errors in the same cycles. However, this occurs even when the low magnitude prediction errors are associated with clearly suprathreshold sensory events. In addition, participants exhibiting stronger differences in their prediction error representations between cardiac cycles exhibited higher learning rates and greater task accuracy.
Information needs of stroke survivors and their family members regarding post-stroke cognition: a scoping review protocol.
OBJECTIVE: The aim of this review is to map current evidence describing the information needs of stroke survivors and family members regarding cognition. INTRODUCTION: Managing cognitive changes is the most frequently reported unmet need among stroke survivors; hence, there is an urgent need to improve support for post-stroke cognitive impairment. While there is evidence that psychoeducation may help stroke survivors and their family members develop awareness about cognitive impairment and self-management strategies, it is unclear what information stroke survivors and their family members want to receive and how their needs change over time. INCLUSION CRITERIA: This review will consider peer-reviewed articles describing information needs relating to the following cognitive domains: memory, language, attention, executive function, praxis, and number processing. Stroke survivors and/or their family members must comprise at least 50% of the study population and must be aged at least 18 years. Quantitative, qualitative, and mixed methods studies will be included. METHODS: The review will be conducted in line with the JBI methodology for scoping reviews. A full literature search will be conducted in MEDLINE (PubMed), PsycINFO (Ovid), Embase, CINAHL (EBSCOhost), and Scopus using a search strategy developed in consultation with an expert university librarian. Articles will be screened by title, abstract, and full text; then, data will be extracted by 2 independent reviewers. The reference lists of included articles will be hand-searched for additional material. Data analysis and reporting will involve qualitative (textual narrative synthesis) and quantitative (descriptive statistics) methods.
Domain-specific cognitive impairments, mood and quality of life 6 months after stroke.
PURPOSE: To identify which acute and 6-month domain-specific cognitive impairments impact mood, participation, and stroke-related quality of life 6 months post-stroke. MATERIALS AND METHODS: A prospective cohort of 430 stroke survivors completed the Oxford Cognitive Screen (OCS) acutely and 6 months post-stroke. Participants completed the Stroke Impact Scale (SIS) and Hospital Depression and Anxiety Scale (HADS) at 6 months. Multivariable regression analyses assessed whether severity of, and domain-specific, cognitive impairment acutely and at 6 months was associated with composite 6-month SIS scores, each SIS subscale, and HADS scores. RESULTS: Increased severity of acute and 6-month cognitive impairment was associated with lower 6-month SIS composite scores independent of age, sex, education years, and stroke severity (both p
Introducing the Tele-OCS: Preliminary evidence of validity for a remotely administered version of The Oxford Cognitive Screen
Background Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors. Methods 40 stroke survivors (M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen’s d estimates were used to compare performance between modalities. Results We found that the proportion of OCS subtasks impaired did not differ across modalities (d <.001). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (<1 point difference on average). These statistical differences did not affect impairment classifications. Conclusions The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.
Lifehistory Trade-Offs Influence Women’s Reproductive Strategies
Objective: In a UK national census sample, women from the upper and lower socioeconomic (SES) classes achieve parity in completed family size, despite marked differences in both birth rates and offspring survival rates. We test the hypothesis that women adopt reproductive strategies that manipulate age at first reproduction to achieve this. Methods: We use a Monte-Carlo modeling approach parameterized with current UK lifehistory data to simulate the reproductive lifehistories of 64,000 individuals from different SES classes, with parameter values at each successive time step drawn from a statistical distribution defined by the census data. Results: We show that, if they are to achieve parity with women in the higher socioeconomic classes, women in lower socioeconomic classes must begin reproducing 5.65 years earlier on average than women in the higher SES classes in order to offset the higher class-specific mortality and infertility rates that they experience. The model predicts very closely the observed differences in age at first reproduction in the census data. Conclusions: Opting to delay reproduction in order to purse an education-based professional career may be a high risk strategy that many lower SES women are unwilling and unable to pursue. As a result, reproducing as early as possible may be the best strategy available to them.
Rebound activation of 5-HT neurons following SSRI discontinuation.
Cessation of therapy with a selective serotonin (5-HT) reuptake inhibitor (SSRI) is often associated with an early onset and disabling discontinuation syndrome, the mechanism of which is surprisingly little investigated. Here we determined the effect on 5-HT neurochemistry of discontinuation from the SSRI paroxetine. Paroxetine was administered repeatedly to mice (once daily, 12 days versus saline controls) and then either continued or discontinued for up to 5 days. Whereas brain tissue levels of 5-HT and/or its metabolite 5-HIAA tended to decrease during continuous paroxetine, levels increased above controls after discontinuation, notably in hippocampus. In microdialysis experiments continuous paroxetine elevated hippocampal extracellular 5-HT and this effect fell to saline control levels on discontinuation. However, depolarisation (high potassium)-evoked 5-HT release was reduced by continuous paroxetine but increased above controls post-discontinuation. Extracellular hippocampal 5-HIAA also decreased during continuous paroxetine and increased above controls post-discontinuation. Next, immunohistochemistry experiments found that paroxetine discontinuation increased c-Fos expression in midbrain 5-HT (TPH2 positive) neurons, adding further evidence for a hyperexcitable 5-HT system. The latter effect was recapitulated by 5-HT1A receptor antagonist administration although gene expression analysis could not confirm altered expression of 5-HT1A autoreceptors following paroxetine discontinuation. Finally, in behavioural experiments paroxetine discontinuation increased anxiety-like behaviour, which partially correlated in time with the measures of increased 5-HT function. In summary, this study reports evidence that, across a range of experiments, SSRI discontinuation triggers a rebound activation of 5-HT neurons. This effect is reminiscent of neural changes associated with various psychotropic drug withdrawal states, suggesting a common unifying mechanism.
Thinking beyond the ventral stream: Comment on Bowers et al.
Bowers et al. rightly emphasise that deep learning models often fail to capture constraints on visual perception that have been discovered by previous research. However, the solution is not to discard deep learning altogether, but to design stimuli and tasks that more closely reflect the problems that biological vision evolved to solve, such as understanding scenes and preparing skilled action.
Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing (Preprint)
BACKGROUND Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. OBJECTIVE The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. METHODS Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. RESULTS In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. CONCLUSIONS Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use.
A randomised controlled trial to compare clinical and cost-effectiveness of an online parent-led treatment for child anxiety problems with usual care in the context of COVID-19 delivered in Child and Adolescent Mental Health Services in the UK (Co-CAT): a study protocol for a randomised controlled trial.
BACKGROUND: In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children's mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have been relaxed. Anxiety problems are a common reason for referral to CAMHS, children with pre-existing anxiety problems are particularly vulnerable in the context of COVID-19, and there were concerns about increases in childhood anxiety as schools reopened. The proposed research will evaluate the clinical and cost-effectiveness of a brief online parent-led cognitive behavioural treatment (CBT) delivered by the OSI (Online Support and Intervention for child anxiety) platform with remote support from a CAMHS therapist compared to 'COVID-19 treatment as usual' (C-TAU) in CAMHS and other children's mental health services throughout the COVID-19 pandemic. METHODS: We will conduct a two-arm, multi-site, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI with therapist support compared to CAMHS and other child mental health services 'COVID-19 treatment as usual' (C-TAU) during the COVID-19 outbreak and to explore parent and therapists' experiences. DISCUSSION: If non-inferiority is shown, the research will provide (1) a solution for efficient psychological treatment for child anxiety disorders while social distancing (for the COVID-19 context and future pandemics); (2) an efficient means of treatment delivery as 'normal service' resumes to enable CAMHS to cope with the anticipated increase in referrals; and (3) a demonstration of rapid, high-quality evaluation and application of online interventions within NHS CAMHS to drive forward much-needed further digital innovation and evaluation in CAMHS settings. The primary beneficiaries will be children with anxiety disorders and their families, NHS CAMHS teams, and commissioners who will access a potentially effective, cost-effective, and efficient treatment for child anxiety problems. TRIAL REGISTRATION: ISRCTN ISRCTN12890382 . Registered prospectively on 23 October 2020.
Opportunities for Immigrants’ Acculturation and Identification Varieties
This article elucidates how members of the two largest immigration groups living in Germany (i.e., immigrants with a Russian or Turkish background) deal with and integrate values and practices deriving from their ethnocultural minority group and the larger society. A special emphasis of this article is on how context conditions form opportunities for varieties of acculturation and identification. The pattern of results suggests a taxonomy of immigrants’ acculturation, consisting of Blended Integration, Alternating Integration, Separation, and Dis‐Integration. This taxonomy is based on immigrants’ integration of cultural aspects, while it proved to be analytically useful to conceptualize their national self‐allocation as an additional dimension. Immigrants’ development of these different varieties was found to be linked to their perceptions of compatibility and acceptance by the larger society. Relative to immigrants with a Turkish background, immigrants with a Russian background experience less deep incompatibilities between values and practices deriving from the cultural groups, thus having more latitude for acculturation and integration. In contrast, immigrants with a Turkish background experience more challenges to acculturation and integration as a result of being confronted more frequently with incompatibilities and experience less societal acceptance. Further conceptual and societal implications are discussed.
Tolerance as a function of disapproval and respect: The case of Muslims
The article assesses a disapproval–respect model of tolerance according to which tolerance is made possible when disapproval of others' beliefs, preferences, or practices is balanced by respect for them as equal fellow citizens. Employing a sample of Muslims living in Germany, we predicted and found that such respect was more predictive of outgroup toleration when respondents disapproved rather than approved of the outgroups' beliefs, preferences, or practices. Moreover, respondents who displayed the critical combination of extreme disapproval and full respect indeed showed outgroup toleration. A parallel pattern of results was observed for willingness to engage in intergroup cooperation. Practical implications are discussed.
Dual Identification and the (De‐)Politicization of Migrants: Longitudinal and Comparative Evidence
AbstractThe article examines the role of dual identification with both the ethnocultural ingroup and the society of residence in the politicization of migrants. The researchers employed a longitudinal and comparative research design with members of the two largest, but sociologically very different, migrant groups in Germany as research participants (i.e. Turkish migrants and Russian migrants). In line with prior work that has shown that, among members of aggrieved groups, dual identity functions as a politicized collective identity, we found that dual identification fostered political engagement among Turkish migrants. In contrast, Russian migrants reported no substantial grievances, and dual identification negatively affected their subsequent political engagement. The contributions of these findings to an articulation of research on politicization with research on intergroup conflict and a more comprehensive understanding of political phenomena driven by dual identification are discussed. Copyright © 2014 John Wiley & Sons, Ltd.
Disapproved, but Tolerated: The Role of Respect in Outgroup Tolerance
We conducted two studies to test the hypothesis that respect for disapproved outgroups increases tolerance toward them. In Study 1, we employed a panel sample of supporters of the Tea Party movement in the United States and found that Tea Party supporters’ respect for homosexuals and Muslims as equal fellow citizens positively predicted Tea Party supporters’ tolerance toward these groups. There was no indication that alternative recognition processes (i.e., achievement recognition or need recognition) played a similar role in the development of tolerance. Study 2 replicated the respect–tolerance link with the experimental method and a more comprehensive measure of tolerance. In particular, it demonstrated that the link also holds with regard to tolerance in the public or political sphere. The wider implications of our research for societal pluralism are discussed.
The meaning of respect under varying context conditions
The concept of respect figures prominently in several theories on intergroup relations. Previous studies suggested that the experience of being respected is primarily related to the feeling of being recognized as an equal, as opposed to social recognition of needs or achievements. Those studies focused, however, on either minority groups or ad hoc groups, thereby possibly giving equality recognition an advantage. This article extends previous findings by comparing societal groups situated in various contexts. We examined eight groups from four countries. We anticipated and found that the link between respect and equality recognition was stronger for groups that are in the position of minorities compared to groups associated with majorities. Owing to the moral and legal force of the norm of equality, disadvantaged minorities in particular might be able to improve their societal position by founding their claims on the equality principle. Need recognition, in contrast, was less influential for minority groups than for majority groups. While we observed these context-dependent variations, an internal meta-analysis showed that feeling recognized as an equal was, overall, the strongest indicator for feeling respected. This suggests that demands for respect could often be addressed by establishing relationships in society that are based on mutual recognition as equals, while the implications of achievement and need recognition should additionally be considered in specific contexts.