Cognitive-behavioural outreach for an adolescent experiencing social anxiety, panic and agoraphobia: A single-case experimental design.

PROBLEM: Previous research suggests that the adult-focussed Clark and Wells (1995) model of social anxiety disorder (SAD) can be used to guide clinic-based treatment for adolescents. This single-case study (N = 1) investigated whether this model could also guide community-based outreach work for a 16-year-old female who was unable to attend clinic-based appointments due to social anxiety comorbid with panic and agoraphobia. METHODS: An experimental A-B-A design was used with three assessment-formulation sessions and 12 intervention sessions, focussing on exposure, cognitive restructuring, attention training, behavioural experiments and imagery rescripting. The Revised Child Anxiety and Depression Scale (RCADS), the Session Rating Scale (SRS) and the Goal Based Outcome form were administered at regular intervals. FINDINGS AND CONCLUSIONS: Social anxiety and panic scores reduced below the clinical threshold and the young person was able to leave home, travel independently (short-term goal) and re-engage with her social-family life (medium-term goal). SRS scores suggest that the intervention was acceptable and the therapeutic alliance was maintained throughout. In summary, this case study suggests that the Clark and Wells (1995) model of SAD can be used to guide community-based outreach work with adolescents unable to leave their home. Limitations and ideas for future research are discussed.

Dispositional Mindfulness and Its Relationship With Distress and Functioning in Adolescents With Chronic Pain and Low-Level Pain.

Objective: Dispositional mindfulness is the general tendency to pay attention to present-moment awareness without judgment. The main aim of this cross-sectional study was to determine (a) whether dispositional mindfulness is associated with psychological distress in adolescents with chronic pain and low-level pain, and (b) whether it accounts for unique variance in distress after controlling for key variables from the pain literature. A secondary aim was to explore the relationship between dispositional mindfulness and functioning. Method: 54 adolescents seeking help for chronic pain and 94 "healthy" adolescents with recent low-level pain from the general population completed the same battery of measures, including the Child and Adolescent Mindfulness Measure of dispositional mindfulness. Results: As predicted, dispositional mindfulness was associated with mood and anxiety in both groups and also accounted for unique variance in mood and anxiety in standard regression models after controlling for group, age, pain-intensity, pain-catastrophizing, and pain-acceptance. Dispositional mindfulness did not differ significantly across the two groups and did not predict physical functioning. However, it did account for unique variance in social functioning. Conclusions: Dispositional mindfulness may be an important construct to consider in the context of adolescents experiencing mood and anxiety problems in both low-level and chronic pain samples. Further research should aim to replicate these findings in larger clinical samples and explore the predictive power of dispositional mindfulness using longitudinal designs.

The influence of goal-state access cost on planning during problem solving.

Two problem-solving experiments investigated the relationship between planning and the cost of accessing goal-state information using the theoretical framework of the soft constraints hypothesis (Gray & Fu, 2004; Gray, Simms, Fu, & Schoelles, 2006). In Experiment 1, 36 participants were allocated to low, medium, and high access cost conditions and completed a problem-solving version of the Blocks World Task. Both the nature of planning (memory based or display based) and its timing (before or during action) changed with high goal-state access cost (a mouse movement and a 2.5-s delay). In this condition more planning before action was observed, with less planning during action, evidenced by longer first-move latencies, more moves per goal-state inspection, and more short (≤ 0.8 s) and long (>8 s) "preplanned" intermove latencies. Experiment 2 used an eight-puzzle-like transformation task and replicated the effect of goal-state access cost when more complex planning was required, also confirmed by sampled protocol data. Planning before an episode of move making increased with higher goal-state access cost, and planning whilst making moves increased with lower access cost. These novel results are discussed in the context of the soft constraints hypothesis.

Improving memory after interruption: exploiting soft constraints and manipulating information access cost.

Forgetting what one was doing prior to interruption is an everyday problem. The recent soft constraints hypothesis (Gray, Sims, Fu, & Schoelles, 2006) emphasizes the strategic adaptation of information processing strategy to the task environment. It predicts that increasing information access cost (IAC: the time, and physical and mental effort involved in accessing information) encourages a more memory-intensive strategy. Like interruptions, access costs are also intrinsic to most work environments, such as when opening documents and e-mails. Three experiments investigated whether increasing IAC during a simple copying task can be an effective method for reducing forgetting following interruption. IAC was designated Low (all information permanently visible), Medium (a mouse movement to uncover target information), or High (an additional few seconds to uncover such information). Experiment 1 found that recall improved across all three levels of IAC. Subsequent experiments found that High IAC facilitated resumption after interruption, particularly when interruption occurred on half of all trials (Experiment 2), and improved prospective memory following two different interrupting tasks, even when one involved the disruptive effect of using the same type of resource as the primary task (Experiment 3). The improvement of memory after interruption with increased IAC supports the prediction of the soft constraints hypothesis. The main disadvantage of a high access cost was a reduction in speed of task completion. The practicality of manipulating IAC as a design method for inducing a memory-intensive strategy to protect against forgetting is discussed.

Designing information fusion for the encoding of visual-spatial information.

In a simulated aircraft navigation task, a fusion technique known as triangulation was used to improve the accuracy and onscreen availability of location information from two separate radars. Three experiments investigated whether the reduced cognitive processing required to extract information from the fused environment led to impoverished retention of visual-spatial information. Experienced pilots and students completed various simulated flight missions and were required to make a number of location estimates. Following a retention interval, memory for locations was assessed. Experiment 1 demonstrated, in an applied setting, that the retention of fused information was problematic and Experiment 2 replicated this finding under laboratory conditions. Experiment 3 successfully improved the retention of fused information by limiting its availability within the interface, which it is argued, shifted participants' strategies from over-reliance on the display as an external memory source to more memory-dependent interaction. These results are discussed within the context of intelligent interface design and effective human-machine interaction.