Anger management and temper control: critical components of posttraumatic stress disorder and substance abuse treatment.

Recent studies have shown associations among combat experience, PTSD, anger and hostility, and involvement in violence. Clinical observations of veterans enrolled in the Substance Use/Posttraumatic Stress Disorder Team (SUPT) program at the San Francisco Veterans Affairs Medical Center revealed relatively high levels of anger and aggressive behavior, including physical assaults and property damage. In response to this anger and aggressive behavior, an anger management treatment was added to the SUPT program's treatment of substance abuse and PTSD. Anger management consisted of a 12-week cognitive-behavioral group treatment. Session topics included identifying the physical, emotional, and situational cues to anger, developing individualized anger-control plans, recognizing and altering destructive self-talk, utilizing time-out, practicing conflict resolution techniques, and using the group to discuss and evaluate high-risk anger situations. Special attention was given to self-monitoring anger-escalating behavior (using an anger meter) and avoiding negative consequences. This article describes the components of the anger management treatment. A clinical vignette is also presented to illustrate the benefits of anger management treatment.

Speed of memory scanning is not affected in early HIV-1 infection.

Thirty-seven nondemented HIV-seropositive and 17 seronegative control subjects were administered the Sternberg speed of memory scanning task, a procedure frequently employed to study mental slowing in patients with subcortical dementing disorders. Experimental and control subjects did not differ in speed of memory scanning, as indexed by the slopes of set size-reaction time functions, nor on mean 0-intercepts for the RT functions, which index stimulus detection and motor response time. Intercept values were significantly greater for subjects with a positive alcohol abuse history and for subjects with greater self-reported depression, but slopes were not significantly correlated with substance abuse history or psychological distress. Cognitive slowing in early HIV-1 infection is not a nonspecific effect observed across all measures of information processing speed. Underlying component functions measured must be carefully considered when selecting reaction time tasks for study with HIV-seropositive subjects. The term "subcortical" dementia may be too general a descriptor, and RT task performance may provide an alternative basis for classification of dementia types.

Performance of patients with early HIV-1 infection on the Stroop Task.

HIV-seropositive and seronegative control subjects performed a standard paper-and-pencil version and an experimental reaction time version of the Stroop Color-Word Naming Task. Results indicated that both symptomatic and asymptomatic HIV-positive subjects showed an exaggerated Stroop effect compared to controls, but this increase was only apparent on the RT version of the task. Analysis of components of the effect indicated that HIV-positive subjects showed increased inhibition compared to controls but normal facilitation. These results suggest that HIV-related cognitive slowing has an attentional component, most likely involving controlled processes. In addition, these results emphasize the utility and sensitivity of RT measures in the study of early HIV-1 infection.

Spatial attention in HIV-1 infection: a preliminary report.

In a preliminary study, 30 nondemented human immunodeficiency virus (HIV-1) seropositive subjects without acquired immunodeficiency syndrome and 14 seronegative controls performed a reaction time measure of spatial attention. Compared with controls, seropositive asymptomatic subjects showed normal facilitation of reaction time at short cue-target intervals when attention was precued, but symptomatic subjects were impaired. However, asymptomatic subjects showed no evidence of normal inhibition of attention at the cued location at longer cue-target intervals, suggesting possible subtler spatial attentional deficits in this group. Cognitive slowing in HIV-1 infection may have an attentional component, with possible involvement of both automatic and controlled processes.

Decision-making speed in HIV-1 infection: a preliminary report.

OBJECTIVES: To test the efficacy of reaction time measures derived from cognitive psychology as measures of subclinical cognitive slowing in individuals with HIV-1 infection. DESIGN: Cognitive slowing is the primary deficit in AIDS dementia. One measure of cognitive slowing is decision-making speed, the discrepancy between simple and choice reaction times, which represents an index of central information processing time. METHODS: Nineteen HIV-seropositive and 13 control subjects performed a detection and decision task in a reaction time procedure. All subjects were administered measures of simple and choice reaction time, a control measure of rate of verbal encoding, and measures of psychological distress. RESULTS: Compared with controls, both symptomatic and asymptomatic HIV-seropositive subjects had significantly longer decision times, but performed the control task of rate of encoding normally. Simple reaction times correlated significantly with depression scores, but choice reaction times were unrelated to psychological distress. CONCLUSIONS: The results support mental slowing as the initial cognitive disturbance of HIV-1 infection and emphasize potential use of reaction times as markers of central nervous system involvement in HIV-1 infection.

Inconsistencies in paranoid functioning, premorbid adjustment, and chronicity: question of diagnostic criteria.

Despite the widely held belief that paranoid behavior is associated with good premorbid adjustment, low chronicity, and high current functioning in psychiatric inpatients, inconsistencies in the literature suggest that supportive evidence may be an artifact of the measurement model commonly used to index paranoid status. In a sample of 497 nonorganic inpatients selected from 19 treatment units, paranoid behavior, when measured by a dimensional/cumulative model, was not found to indicate higher functioning and associated relationships, but simply to reflect a narrower class of problem behavior. Only when paranoid status was defined using a traditional model based on the predominance of the defining class of behavior did paranoid subjects demonstrate better premorbid adjustment, lower chronicity, and higher levels of functioning than nonparanoid subjects. Serious problems exist in the use of information obtained from traditional predominance/class models for either theoretical or practical purposes.