Behav. Sci., Volume 7, Issue 3 (September 2017) – 25 articles

Non-Invasive Brain Stimulation (NIBS) is a relatively new therapeutic approach that has shown beneficial effects in Autism Spectrum Disorder (ASD). One question to be answered is how enduring its neuromodulatory effect could be. Twenty-four patients with ASD (mean age: 12.2 years) received 20 sessions of NIBS over the left dorsolateral prefrontal cortex (L-DLPFC). They were randomized into two groups with two (G1) or three (G2) clinical evaluations before NIBS. Both groups had a complete follow-up at six months after the intervention, with the aim of determining the short-term outcome using the total score on the Autism Behavior Checklist, Autism Treatment Evaluation Checklist, and the Autism Diagnostic Interview. Transcranial Direct Current Stimulation (tDCS) was used in ASD patients aged <11 years, and repetitive Transcranial Magnetic Stimulation (rTMS) for 11–13-year-olds. Observation points were at one, three, and six months after completing all the sessions of NIBS. A significant reduction in the total score on the three clinical scales was observed and maintained during the first six months after treatment, with a slight and non-significant tendency to increase the scores in the last evaluation. Twenty sessions of NIBS over the L-DLPFC improves autistic symptoms in ASD children, with a lasting effect of six months. Full article

The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were “type 2 diabetes,” “self-management,” “diabetes self-management education (DSME),” “family support,” “social support,” and “uncontrolled glycaemia.” Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care. Full article

I deal with perception and action (e.g., movements) using results from synergetics, a comprehensive mathematical theory of the self-organized formation (emergence) of spatial, temporal, or functional structures in complex systems. I illustrate basic concepts such as order parameters (OPs), enslavement, complexity reduction, circular causality first by examples of well-known collective, spontaneous modes of human behavior such as rhythmic clapping of hands, and so forth, and then by face recognition. The role played by OPs depends on context. In the case of face (or pattern) recognition an OP represents the concept of an individual face (action of mind) and it enslaves the action (firing rates) of neurons (body). This insight allows me to interpret syndromes as order parameters playing their mind/body double role. I present criteria for the identification of OPs and discuss their general properties including error correction and remedy of deficiencies. Contact is made with a recent paper by Sabine Koch on embodied aesthetics. My approach includes the saturation of attention at various time scales (ambiguous figures/fashion). Adopting a psychological perspective, I discuss some ingredients of beauty such as proportionality and symmetry, but also the importance of irregularities. Full article

Growing up in urban areas represents a possible risk factor in the genesis of psychopathologies. The aim of the present study was to investigate the link between urbanicity variables and indicators for psychiatric disorders. We investigated a potential association between primary emotional traits and urbanicity variables in 324 individuals from Germany and 713 individuals from China. Higher scores in the urbanicity index in childhood were inversely associated with FEAR and SADNESS only in adult Chinese females. These effects seemed to be driven by living in Chinese mega-cities, because a parallel sample from Germany and China (contrasting upbringing in cities with the categories <10,000 inhabitants, ≥10,000 inhabitants (but <100,000), and ≥100,000 inhabitants) resulted in weaker, but more similar effects in females in both countries. Additional associations could be observed with higher PLAY and urban upbringing in Chinese males. The results seem surprising, given an expectation of adverse emotional effects from growing up in todays’ mega-cities compared to rural areas. Although we do not want to over-interpret our findings (given rather small correlations and multiple testing issues), they should encourage researchers to consider including urbanicity variables in personality neuroscience and personality oriented clinical psychiatric research. Full article

A continuous and increasing crisis that present-day China is facing is environmental degradation. The cultivation of citizens who have environmentally friendly behaviours has been deemed as a fundamental way to solve environmental crises. However, the main focus of environmentalism studies has been urban residents, whereas rare research attention was put on rural Chinese. This paper focuses on environmentally significant behaviours in rural China and aims to clarify the practice of five environmentally significant behaviours and two motivations underlying these behaviours. In total, 508 rural residents in 51 villages of Ningyang county were interviewed. Analytical results derived from survey data showed that environmentally significant behaviours are widely conducted in rural areas. However, these behaviours are mainly motivated by economic gains rather than environmental considerations. In addition, based on the norm-activation theory and considering the influences of demographic factors, the formation of environmentally motivated behaviours were quantitatively analysed. Analytical results indicated that the more people worried about environmental deterioration, the more likely they were to form environmentally motivated behaviours, and people who ascribe the most important environmental responsibility to the government are less likely to form environmentally motivated behaviours. Increasing people’s anxiety towards the environment, decreasing people’s dependency on the government in protecting the environment, and using females, the elderly, and people with low income and education levels as the main targets of environmental education are suggested to promote environmentally motivated behaviours in rural China. Full article

There is a growing body of research on resilience in family carers of people with dementia, but carers’ voices are noticeably absent from it. The aim of this study was to explore carers’ definitions of resilience and their opinions on the factors associated with resilience. Twenty-one in-depth interviews were conducted in Australia with people who were currently, or had previously been, caring for a family member with dementia. Transcripts were analysed thematically and three themes emerged: the presence of resilience, the path to resilience, and characteristics of the resilient carer. Although carers struggled to define resilience, the vast majority considered themselves resilient. Carers identified a range of traits, values, environments, resources, and behaviours associated with resilience, but there was no consensus on the relative importance or causal nature of these factors. Carers also considered resilience to be domain- and context-specific, but did not agree on whether resilience was a trait or a process. These findings highlight both the importance of including carers’ voices in resilience research and the limitations of the extant literature. There is much to be done to develop a field of carer resilience research that is theoretically sound, methodologically rigorous, and reflects the lived experience of carers. A model is provided to prompt future research. Full article

The neural underpinning of art creation can be gleaned following brain injury in professional artists. Any alteration to their artistic productivity, creativity, skills, talent, and genre can help understand the neural underpinning of art expression. Here, two world-renown and influential artists who sustained brain injury in World War I are the focus, namely the French artist Georges Braque and the Austrian artist Oskar Kokoschka. Braque is particularly associated with Cubism, and Kokoschka with Expressionism. Before enlisting, they were already well-known and highly regarded. Both were wounded in the battlefield where they lost consciousness and treated in European hospitals. Braque’s injury was in the left hemisphere while Kokoschka’s was in the right hemisphere. After the injury, Braque did not paint again for nearly a whole year while Kokoschka commenced his artistic works when still undergoing hospital treatment. Their post-injury art retained the same genre as their pre-injury period, and their artistic skills, talent, creativity, and productivity remained unchanged. The quality of their post-injury artworks remained highly regarded and influential. These neurological cases suggest widely distributed and diffuse neural control by the brain in the creation of art. Full article

Background: Research findings suggest that attitudes towards psychotherapy predict willingness to seek therapy. However, understanding how medical students think about using and referring their patients for psychotherapy is limited. Aims: The aims of this study are to measure medical students’ attitudes towards professional help seeking, and to investigate the reasons for whether or not they would refer their patients to psychotherapy in their future role as doctors. Method: The participants were 127 medical students in their first and second year of the MBBS4 programme at the Cyprus campus of St George’s University of London, who completed a self-report measure of attitudes towards psychotherapy and a semi-structured interview. Findings: Participants showed general positive attitudes towards psychotherapy, but were reluctant to use or refer their patients, largely due to perceived stigma and accessibility. Conclusions: Medical students should be further trained in order to become more confident in using psychotherapy and referring their patients. Full article

Existing research suggests that there is an overlap between binge eating disorder (BED) and the construct of ‘food addiction’ (FA). The objective of this study was to determine the overlapping features of BED and FA through a comparison of the individual scales of commonly used tools including the Binge Eating Scale (BES) and the Yale Food Addiction Scale (YFAS) in a sample of Australian adults. Adults (>18 years of age) were invited to complete an anonymous online survey on FA. Binge eating was assessed through the BES and addictive eating behaviours were assessed through the YFAS (n = 1344). The prevalence and severity of both FA and binge eating increased across weight categories. The overall correlation between the total score from the BES and FA symptoms was r = 0.76, p < 0.001; for females it was r = 0.77, p < 0.001, and for males it was r = 0.65, p < 0.001. Total BES score and the BES emotion factor were most often associated with FA symptoms, as was demonstrated to produce stronger correlations with FA symptoms. In contrast, the BES behaviour factor was less strongly associated to FA with the majority of correlations <0.6. This study demonstrates the overlap between BED and FA, and highlights the possible unique differences between the forms of disordered eating. Full article

Four data sets from studies included in the Reproducibility Project were re-analyzed to demonstrate a number of flawed research practices (i.e., “bad habits”) of modern psychology. Three of the four studies were successfully replicated, but re-analysis showed that in one study most of the participants responded in a manner inconsistent with the researchers’ theoretical model. In the second study, the replicated effect was shown to be an experimental confound, and in the third study the replicated statistical effect was shown to be entirely trivial. The fourth study was an unsuccessful replication, yet re-analysis of the data showed that questioning the common assumptions of modern psychological measurement can lead to novel techniques of data analysis and potentially interesting findings missed by traditional methods of analysis. Considered together, these new analyses show that while it is true replication is a key feature of science, causal inference, modeling, and measurement are equally important and perhaps more fundamental to obtaining truly scientific knowledge of the natural world. It would therefore be prudent for psychologists to confront the limitations and flaws in their current analytical methods and research practices. Full article

The Dutch Fatigue In Teenagers on the interNET (FITNET) study claimed that after 6 months, internet based cognitive behaviour therapy in adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), led to a 63% recovery rate compared to 8% after usual care, and that this was maintained at long term follow up (LTFU). Our reanalysis shows that their post-hoc definition of recovery included the severely ill, the unblinded trial had no adequate control group and it used lax selection criteria as well as outcomes assessed via questionnaires rather than objective outcomes, further contributing to exaggerated recovery figures. Their decision not to publish the actometer results might suggest that these did not back their recovery claims. Despite these bias creating methodological faults, the trial still found no significant difference in recovery rates (“~60%”) at LTFU, the trial’s primary goal. This is similar to or worse than the documented 54–94% spontaneous recovery rates within 3–4 years, suggesting that both FITNET and usual care (consisting of cognitive behaviour and graded exercise therapies) are ineffective and might even impede natural recovery in adolescents with ME/CFS. This has implications for the upcoming costly NHS FITNET trial which is a blueprint of the Dutch study, exposing it to similar biases. Full article

Cognitive bias tests are frequently used to assess affective state in nonhumans. We adapted the ambiguous-cue paradigm to assess affective states and to compare learning of reward associations in two distantly related species, an American black bear and three Western lowland gorillas. Subjects were presented with three training stimuli: one that was always rewarded (P), one that was never rewarded (N) and one that was ambiguous (A) because its reward association depended on whether it had been paired with P (PA pairing) or N (NA pairing). Differential learning of NA and PA pairs provided insight into affective state as the bear and one gorilla learned NA pairs more readily, indicating that they focused on cues of reinforcement more than cues of non-reinforcement, whereas the opposite was true of one gorilla. A third gorilla did not learn either pairings at above chance levels. Although all subjects experienced difficulty learning the pairings, we were able to assess responses to A during probe trials in the bear and one gorilla. Both responded optimistically, but it was difficult to determine whether their responses were a true reflection of affective state or were due to preferences for specific stimuli. Full article

The Inventory Déjà Vu Experiences Assessment (IDEA) is the only screening instrument proposed to evaluate the Déjà vu (DV) experience. Here, we intended to validate the Italian version of IDEA (I-IDEA) and at the same time to investigate the incidence and subjective qualities of the DV phenomenon in healthy Italian adult individuals on basis of an Italian multicentre observational study. In this study, we report normative data on the I-IDEA, collected on a sample of 542 Italian healthy subjects aging between 18–70 years (average age: 40) with a formal educational from 1–19 years. From September 2013 to March 2016, we recruited 542 healthy volunteers from 10 outpatient neurological clinics in Italy. All participants (i.e., family members of neurological patients enrolled, medical students, physicians) had no neurological or psychiatric illness and gave their informed consent to participate in the study. All subjects enrolled self-administered the questionnaire and they were able to complete I-IDEA test without any support. In total, 396 (73%) of the 542 healthy controls experienced the DV phenomenon. The frequency of DV was inversely related to age as well as to derealisation, jamais vu, precognitive dreams, depersonalization, paranormal activity, remembering dreams, travel frequency, and daydreams (all p < 0.012). The Italian version of IDEA maintains good properties, thus confirming that this instrument is reliable for detecting and characterising the DV phenomenon. Full article

Background: Culture plays an important role in shaping individuals’ health behaviors. This qualitative research examines the relationship between African Americans’ ethnic and mainstream cultures and their health behaviors (i.e., food intake and physical activity). Methods: This study used in-depth semi-structured interview format with a group of 25 African Americans to examine the influence of ethnic and mainstream culture on African Americans’ food intake and physical activity. Thematic analysis was used to identify common themes and patterns related to African Americans’ health behaviors as well as to report these patterns within data. Results: The present study found that African Americans position both their ethnic and mainstream culture as important influences on their health behaviors pertaining to food intake and physical activity. Most participants reported taking advantage of “the best of both worlds” by engaging in picking and choosing healthy behaviors from both cultures to which they belong, and they perceived preparing healthy makeovers as a way to optimize their health. They also identified a range of practical considerations that can facilitate or hinder engagement in healthy eating and physical activity (e.g., affordability, social support). Participants discussed a number of other positive (e.g., resilience, spirituality) and negative (e.g., experience of discrimination) influences on health behaviors. Conclusions: African Americans consider both their ethnic and mainstream cultures important in shaping their health behaviors. These cultural influences need to be understood in the context of other psycho-socio-environmental factors that affect individuals’ health behaviors. The current study has practical implications for designing health promotion programs for African Americans. Full article

Background: While positive and negative affect are inversely linked, people may experience and report both positive and negative emotions simultaneously. However, it is unknown if race alters the magnitude of the association between positive and negative affect. The current study compared Black and White Americans for the association between positive and negative affect. Methods: We used data from MIDUS (Midlife in the United States), a national study of Americans with an age range of 25 to 75. A total number of 7108 individuals were followed for 10 years from 1995 to 2004. Positive and negative affect was measured at baseline (1995) and follow-up (2004). Demographic (age and gender), socioeconomic (education and income) as well as health (self-rated health, chronic medical conditions, and body mass index) factors measured at baseline were covariates. A series of linear regressions were used to test the moderating effect of race on the reciprocal association between positive and negative affect at baseline and over time, net of covariates. Results: In the pooled sample, positive and negative affect showed inverse correlation at baseline and over time, net of covariates. Blacks and Whites differed in the magnitude of the association between positive and negative affect, with weaker inverse associations among Blacks compared to Whites, beyond all covariates. Conclusion: Weaker reciprocal association between positive and negative affect in Blacks compared to Whites has implications for cross-racial measurement of affect and mood, including depression. Depression screening programs should be aware that race alters the concordance between positive and negative affect domains and that Blacks endorse higher levels of positive affect compared to Whites in the presence of high negative affect. Full article

Background: The last few decades saw an intense development in information technology (IT) and it has affected the ways organisations achieve their goals. Training, in every organisation is an ongoing process that aims to update employees’ knowledge and skills towards goals attainment. Through adequate deployment of IT, organisations can effectively meet their training needs. However, for successful IT integration in training, the employees who will use the system should be positively disposed towards it. This study predicts employees’ intention to use the e-training system by extending the technology acceptance model (TAM) using interactivity and trust. Methods: Two hundred and fourteen employees participated in the study and structural equation modelling was used in the analysis. Results: The findings of the structural equation modelling reveal that interactivity, trust, perceived usefulness and perceived ease of use have direct and positive effects on employees’ intention to use e-training. It was also shown that perceived ease of use had no effects on perceived usefulness, while trust has the strongest indirect effects on employees’ intention. In addition, the results of Importance-Performance Map Analysis (IPMA), which compares the contributions of each construct to the importance and performance of the model, indicate that to predict intention to use e-training, priorities should be accorded to trust and perceived usefulness. Full article

(1) Background: With the new edition of the Diagnostic and Statistical Manual of Mental disorders, 5th Edition (DSM-5), numerous parallels have been drawn between recurrent binge eating (RBE) and substance use disorders, with many authors examining RBE or binge eating disorder (BED) as a “food addiction”. The present study aims to clarify the relationship between recurrent binge eating (RBE) and illicit substance use (ISU) through investigating the temporal association between the two problems. (2) Methods: This study was embedded within a larger longitudinal study of non-clinical adult women recruited from Australian tertiary institutions. Participants responded at year 2 and year 4 of follow-up to the Eating Disorder Examination—Questionnaire. ISU was measured using a modified questionnaire taken from the Australian Longitudinal Study on Women’s Health. (3) Results: RBE and ISU co-morbidity was 5.88% in this non-clinical sample, and having one condition increased the likelihood of the other. The two conditions had a different trajectory over two years whereby ISU participants had significant risk of developing RBE in addition to or in place of their ISU but the reverse was not found for RBE participants. (4) Conclusion: This unidirectional relationship suggests that in spite of the similarities of RBE and ISU they may be distinct with respect to their co-morbidity over time. Full article

People often feel awkward and ill at ease when faced with the opportunity for communication at the end of life, thus the overall theme for the articles in this special issue is the creation of more awareness and knowledge regarding the depth, breadth, and importance of current research exploring family communication at the end of life. This introductory essay attempts to accomplish the following: (1) discuss the importance of talk regarding death; (2) highlight the formative role of family interactions on the death and dying process; and (3) outline the articles in this special issue. Scholars contributing to this special issue on “Family Communication at the End of Life” have provided evidence that communication is important between and for terminally ill individuals, family members, and healthcare/palliative care specialists. Overall, research exploring communication at the end of life is especially relevant because every person experiences the death and loss of loved ones, and ultimately faces the reality of their own death. Full article

Dietary interventions are the cornerstone of obesity treatment. The optimal dietary approach to weight loss is a hotly debated topic among health professionals and the lay public alike. An emerging body of evidence suggests that a higher level of adherence to a diet, regardless of the type of diet, is an important factor in weight loss success over the short and long term. Key strategies to improve adherence include designing dietary weight loss interventions (such as ketogenic diets) that help to control the increased drive to eat that accompanies weight loss, tailoring dietary interventions to a person’s dietary preferences (and nutritional requirements), and promoting self-monitoring of food intake. The aim of this paper is to examine these strategies, which can be used to improve adherence and thereby increase the success of dietary weight loss interventions. Full article

Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: “virtual reality”, “eating disorders”, “binge eating”, and “bulimia nervosa”. From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge–purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior. Full article

People with dementia are not dying; they are experiencing changes in the brain. This paper utilizes a symbolic interaction theoretical perspective to outline communicative alternatives to polypharmacy. There is a growing interest in sociological interventions to untangle the “disordered discourses” associated with dementia. Such practices challenge common stigmas attached to dementia as an “ongoing funeral” or “death certificate.” Changing the expectations, attitudes and communication patterns of family care partners can positively impact them and the person living with dementia at the end of life. This paper delineates multiple non-verbal communication interventions (e.g., the trip back in time, dementia citizenship and sensory engagement modalities) to explore techniques to engage persons with advanced dementia. Full article

The freedom of a decision is not yet sufficiently described as a psychological variable. We present a model of functional decision freedom that aims to fill that role. The model conceptualizes functional freedom as a capacity of people that varies depending on certain conditions of a decision episode. It denotes an inner capability to consciously shape complex decisions according to one’s own values and needs. Functional freedom depends on three compensatory dimensions: it is greatest when the decision-maker is highly rational, when the structure of the decision is highly underdetermined, and when the decision process is strongly based on conscious thought and reflection. We outline possible research questions, argue for psychological benefits of functional decision freedom, and explicate the model’s implications on current knowledge and research. In conclusion, we show that functional freedom is a scientific variable, permitting an additional psychological foothold in research on freedom, and that is compatible with a deterministic worldview. Full article

Although there is great interest in the improving the ability to track patients’ change over time in routine clinical care settings, no standardized transdiagnostic measure is currently available for busy clinicians to apply. The Clinical Global Impression (CGI) scales are simple measures widely used as outcomes in psychiatric clinical trials. However, the CGI suffers from poorly defined scoring anchors. Efforts to improve the anchors by enhancing the anchor descriptions have proven useful but are limited by being disease-specific, thereby acting as a barrier to the routine clinical adoption of the CGI. To inform the development of more broadly applicable CGI scoring anchors, we surveyed 24 clinical trial investigators, asking them to rank-order seven elements that inform their CGI-Severity (CGI-S) scoring. Symptom severity emerged as the most important element in determining CGI-S scores; the functional status of the patient emerged as a second element. Less importance was given to self-report symptom scores, staff observations, or side effects. Relative rankings of the elements’ importance did not differ by investigators’ experience nor time usually spent with patients. We integrated these results with published illness-specific CGI anchors to develop the Transdiagnostic CGI (T-CGI), which employs standardized scoring anchors applicable across psychiatric illnesses. Pending validity and reliability evaluations, the T-CGI may prove well-suited for inclusion in routine clinical settings and for incorporation into electronic medical records as a simple and useful measure of treatment efficacy. Full article

Background: Despite cognitive behavioural therapy (CBT) being regarded as the first-line treatment option for bulimia nervosa (BN), barriers such as its time-consuming and expensive nature limit patient access. In order to broaden treatment availability and affordability, the efficacy and convenience of CBT could be improved through the use of online treatments and selective emphasis on its most ‘potent’ components of which behavioural techniques form the focus. Method: Twenty-six individuals with BN were enrolled in an online CBT-based self-help programme and 17 completed four weeks of regular eating and food-monitoring using the online Food Diary tool. Participants were contacted for a weekly check-in phone call and had their bulimic symptom severity assessed at five time points (baseline and weeks 1–4). Results: There was a significant decrease in the frequency of self-reported objective binge episodes, associated loss of control and objective binge days reported between pre- and post-treatment measures. Significant improvements were also observed in most subscales of the Eating Disorder Examination-Questionnaire. Conclusion: This study provides encouraging preliminary evidence of the potential of behavioural techniques of online CBT in the treatment of BN. Online therapy with this focus is potentially a viable and practical form of treatment delivery in this illness group. These preliminary findings support the need for larger studies using control groups. Full article