Assessment-related anxiety among older adults: associations with neuropsychological test performance.

Anxiety disrupts test performance across academic/testing contexts; however, the impact of anxiety on neuropsychological testing has been examined less frequently among older adults, despite clinical observations of high anxiety and dementia worry among elderly individuals in assessment contexts. The present study examined the impact of trait, state, and test anxiety on measures of processing speed, working memory, verbal memory, and aspects of executive functioning (i.e., set shifting and inhibition). We hypothesized that anxiety specific to neuropsychological assessment would correlate with test performance more consistently than state or trait anxiety. Ninety-three older adults aged 55 to 89 underwent a three-and-a-half-hour comprehensive assessment battery measuring anxiety and neuropsychological test performance. All participants completed the Feelings About Neuropsychological Testing State (FANT-S) and Test (FANT-T) questionnaires, Generalized Anxiety Disorder-seven item (GAD-7), and neuropsychological tests in the domains of processing speed, working memory, verbal memory, and executive functioning. When test scores were regressed on these anxiety measures, increases in test anxiety predicted decreased performance on measures of executive functioning, specifically inhibitory control. State anxiety demonstrated the opposite relationship to performance and predicted increased performance on one measure. Trait anxiety did not predict cognitive assessment performance. Findings were consistent with previous research indicating measures of test anxiety are more sensitive to changes in test performance than measures of trait or state anxiety. Results demonstrated that older adults, even those not referred for a clinical neuropsychological assessment, can show decreased test performance when self-reported anxiety relevant to the neuropsychological assessment context is high.

Visual-Spatial Memory and Recall Test (V-SMART): validity and reliability.

OBJECTIVE: Nonverbal memory decline is a concern associated with aging. Visuospatial memory tests often do not distinguish between learning, recall, or retrieval, yet such distinctions may help clarify the nature of memory difficulties. Further, many visuospatial tests rely on abilities not directly related to memory (e.g. graphomotor skill). The present study examined the feasibility and initial psychometric evidence of the Visual-Spatial Memory and Recall Test (V-SMART). METHOD: Ninety-nine adults (71% women) were recruited from two sources: undergraduate students (n = 37) and healthy older adults (n = 62). Volunteers completed a brief battery of cognitive tests. RESULTS: Internal consistency and interrater reliability were strong. Principal Components Analysis supported the hypothesized learning and recall structure, and correlations with other memory tests supported external validity of the V-SMART as a visuospatial learning measure. Correlations with recall scores were less compelling yet likely reflected the intact recall among this generally healthy sample. CONCLUSIONS: These preliminary findings support the V-SMART as a visuospatial memory test. Evidence for validity was acceptable for learning indices; further examination of recall measures is needed.

Distress tolerance in social versus solitary college student drinkers.

Low distress tolerance has been an inconsistent predictor of alcohol-related consequences in college students, but its relationships to depression and coping motives for alcohol have received stronger support. Research on college students who drink heavily in isolation suggests that this population is more likely to have a greater number and severity of alcohol-related problems, depression, and coping motives. Solitary heavy drinkers were therefore hypothesized to have lower distress tolerance than other drinkers. This study examined differences in self-reported and behavioral distress tolerance across two groups of university students: those who endorsed heavy solitary drinking (20.1%) versus those who endorsed other types of drinking. Students completed a self-report measure (Distress Intolerance Self-Report, or DISR) and behavioral measure of distress tolerance (Paced Auditory Serial Addition Test, or PASAT). Students who reported drinking heavily in isolation differed from other students on the DISR, F(1, 132) = 4.645, p = .033, η(2) = .034, but not on the PASAT, F(1, 132) = 0.056, p = .813. These students also endorsed more coping motives for alcohol. Distress tolerance did not predict drinking consequences directly, yet a mediation model linking distress tolerance to consequences through coping motives supports previous findings of distress tolerance as a distal, indirect predictor of drinking problems. The unique characteristics of solitary binge drinkers and the significance of distress tolerance as an indirect predictor of alcohol-related consequences are discussed.

Alcohol use, drinking consequences, and sensitivity to social cues among college women.

College students who drink vary in the extent to which they experience drinking consequences, prompting a need to identify factors that differentiate higher-risk drinkers from others. The present study investigated whether difficulty in processing subtle social information is related to negative drinking consequences experienced within the past year. Specifically, poor ability to detect subtle non-verbal sarcasm cues was predicted to contribute to drinking consequences. Participants were 39 women, aged 18 to 27 (M=22), who were enrolled in a public, four-year university. Participants completed a video measure of ability to detect sarcastic comments. After controlling for (high school drinking consequences, maximum drinks in the past 3 months, age), poorer performance in the Simple Sarcasm condition (which provided no cues to others' intentions) explained an additional 10.8% of the variance in recent drinking consequences (ΔF (1, 34)=6.15, p=.018). When predicting risky/hazardous alcohol use consequences (e.g., driving intoxicated, fights, unplanned/unprotected sex), Simple Sarcasm again improved prediction by explaining an additional 8.6% of the variance (ΔF (1, 34)=4.75, p=.036). Sarcasm conditions that provided additional cues to others' meanings were unrelated to alcohol consequences. Findings are discussed within the context of neurological (orbito-frontal-subcortical) pathways that are common to social information and alcohol reinforcement processes.

Strategy use on the Ruff Figural Fluency Test.

Although the popularity of including figural fluency tests in cognitive and neuropsychological test batteries has increased in recent years, the spontaneous use of strategies on these measures remains poorly understood. This study addressed three questions pertaining to strategy use on the Ruff Figural Fluency Test (RFFT): (i) how common is strategy use, (ii) what information does strategy use convey, and (iii) can examinees learn to use strategies. Findings revealed that nearly seven out of 10 healthy college students used a strategy at least once while taking the RFFT. The number of strategies used and the number of figures produced using a strategy had modest correlations with select executive function measures (D-KEFS Tower Test, Sorting, and Letter & Category Verbal Fluency) in hypothesized directions. When strategies were demonstrated for subjects who did not spontaneously use them, those subjects were able to subsequently use strategies. These findings suggest that although common, failure to spontaneously use a strategy is not unusual. Further, strategy use may reflect a cognitive asset, particularly regarding planning, reasoning, and cognitive flexibility.

Short-term psychological adjustment of female prison inmates on a minimum security unit.

Although there has been increasing focus on female offenders in recent years, relatively little is known about the psychological pattern of prison adjustment. The present study examined the initial psychological reaction and subsequent pattern of adjustment over 3 weeks for 62 female inmates incarcerated on the minimum security unit of a state prison in the northwestern United States. Mean age was 32.96 years, and 82% of participants were European-American. Shortly following incarceration, women voluntarily completed a clinical and demographic interview and packet of questionnaires, including the Brief Symptoms Inventory. Results indicated female inmates show above-average endorsement of psychological symptoms at initial incarceration, which tend to significantly decline by the second week in prison, with the exception of hostility ratings, which remain relatively constant. Such findings have important implications for the development and implementation of programs to facilitate adjustment to prison.

Methamphetamine use by incarcerated women: comorbid mood and anxiety problems.

OBJECTIVE: Methamphetamine's (MA) impact on psychiatric functioning is not well understood, especially among women. Efforts to understand MA's impact are complicated by the use of other drugs. The purpose of this study is to untangle the relative contributions of MA versus other drugs on psychiatric symptoms. METHOD: Incarcerated women (N = 100) completed diagnostic interviews and a symptom measure to establish psychiatric status. FINDINGS: Nearly all women (83%) had lifetime dependence on > or =1 drugs. The most common drug of dependence was MA (67%), followed by alcohol (32%), cannabis (19%), and cocaine (15%). Over half met lifetime criteria for an affective disorder (53%), and nearly half (46%) met lifetime criteria for an anxiety disorder. Lifetime dependence on MA and a nonstimulant drug was related to current psychiatric symptoms and lifetime mood and anxiety disorder. Lifetime mood and anxiety disorders were generally unrelated to recent MA use. CONCLUSION: Findings highlight the impact of MA use on psychiatric presentation among women. Results suggest that MA impacts psychiatric symptoms independent of lifetime psychiatric diagnoses. Of note was the high incidence of drug dependence and mood and anxiety disorders among this sample of incarcerated women from a rural state. Findings imply important treatment implications for women in prison settings.

Help seeking for alcohol problems in a college population.

Despite the availability of effective treatments for problem drinkers, only a minority seek professional assistance. The authors investigated the influences on help seeking for alcohol-related difficulties in two separate studies. In Study 1, 59 men and 74 women completed questionnaires regarding their alcohol use, related problems, readiness to change, and help-seeking interest. The authors also developed a measure of stigma related to alcohol help seeking. Problem recognition, anxiety symptoms, and stigma predicted a global rating of help-seeking. Students (22 men and 60 women) participated in Study 2, which incorporated a multi-item measure of help-seeking intentions as well as attitude and personality measures. Positive attitudes, less perceived stigma, and greater self-efficacy increased help seeking. The findings highlight the importance of both approach and avoidance factors that affect help-seeking decisions, and the authors suggest directions for further research.

Transition to college: A classification and regression tree (CART) analysis of natural reduction of binge drinking.

Approximately one in five teens that drank heavily in high school reduces or discontinues consumption while in college. Multiple paths might lead to the common outcome of natural reduction in heavy drinking. Statistical modeling of this complex process of natural reduction is a challenge with standard linear statistics. The purpose of this paper is to use a new statistical procedure, Classification and Regression Tree (CART), to model the equifinality of reduction in drinking by college students who drank heavily as adolescents. An appealing aspect of CART is that the resulting tree model that can easily be interpreted and applied by those who work with adolescents during the important transition from high school to college. Of 201 college students who first binged on alcohol while in high school, 71 (35.3%) denied heavy or binge drinking within the previous three months (Natural Reducers). The final model accurately classified 84.6% of the students as either continued heavy drinkers or natural reducers. Sensitivity was modest (accurate identification of 67.6% of the reducers); however, specificity was strong (correct classification of 93.8% of the continued heavy drinkers). The model revealed four pathways to natural reduction in drinking. Predominant in each path was the influence of social factors that maintain continued drinking (e.g., social facilitation outcome expectancies, perception of friends' drinking) or facilitate natural reduction (e.g., regular church attendance). The results support the application of CART to model health behaviors across the transition from adolescence to young adulthood.

Facial recognition performance of female inmates as a result of sexual assault history.

This study examined the effect of sexual assault history on facial recognition performance. Gender of facial stimuli and posttraumatic stress disorder (PTSD) symptoms also were expected to influence performance. Fifty-six female inmates completed an interview and the Wechsler Memory Scale-Third Edition Faces I and Faces II subtests (Wechsler, 1997). Women with a sexual assault exhibited better immediate and delayed facial recognition skills than those with no assault history. There were no differences in performance based on the gender of faces or PTSD diagnosis. Immediate facial recognition was correlated with report of PTSD symptoms. Findings provide greater insight into women's reactions to, and the uniqueness of, the trauma of sexual victimization.

Cognitive impairment in substance abuse.

Conventional wisdom, and even well-reasoned theoretical mechanisms, suggests that the chronic use of psychoactive substances would impair cognitive functioning of individuals. This article summarizes the research literature with regard to specific drugs of abuse. Undoubtedly, acute intoxication and immediate and protracted withdrawal produce transient alterations of cognitions that can persist for weeks to months. Some subtle residual effects remain for up to 1 year for certain drugs. Evidence of irreversible effects is less clear. Even subtle lingering effects can impact treatment efforts, yet they often go undetected or unaddressed.

Natural reduction of binge drinking among college students.

Considerable evidence indicates that alcohol problems can resolve without formal treatment [Addiction 95 (2000) Clin. Psychol.: Sci. Pract. 5 (1998) 1]. Such changes, called "natural recovery," are not infrequent in the general population [Institute of Medicine. (1990). Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press]. The goal of this study was to determine if some college students with a history of binge drinking during high school reduced their bingeing without intervention while in college. A second goal was to identify individual characteristics that differentiate between current and reduced bingers. Ninety-one college students with a history of bingeing in high school and no prior drug treatment completed questionnaires about prior and current drinking. Results revealed that 22% of the students with a history of adolescent bingeing had reduced their alcohol consumption while still in college and without treatment. Key factors that differentiated between groups included marital status, church attendance, and outcome and efficacy expectancies.

College student heavy drinking in social contexts versus alone.

Heavy drinking is common among college students and typically occurs in social contexts. Heavy drinking when alone, however, is less common. The present study hypothesized that students who drink heavily when alone (HD-Alone) would differ from college students who only drink heavily in social contexts (Social HD). Forty-nine HD-Alone students (at least one heavy-drinking episode when alone), 213 Social HDs, and 63 non-heavy drinkers (Non-HDs) were compared on alcohol-related consequences, drinking milestones, alcohol-outcome expectancies, and symptoms of depression. HD-Alone students reported more negative drinking consequences, earlier onset of regular drinking, more alcohol expectancies, less self-efficacy and motivation to reduce drinking, and higher depression scores than Social HDs and Non-HDs. Findings imply individual differences among heavy-drinking college students according to their drinking context.

Change in Alcohol Effect and Self-Efficacy Expectancies During Addiction Treatment.

Alcohol effect expectancies and situational self-efficacy are important factors in addiction relapse. The extent to which these cognitive factors change during alcohol treatment and the relations between change in these two domains may facilitate our understanding of the transition out of addictive lifestyles. To evaluate such change, 101 male and female participants in an abstinence focused inpatient alcohol and drug treatment program completed measures of alcohol effect expectancies (AEQ) and self-efficacy (SCQ) during the first and fourth (final) week of inpatient treatment. Analyses confirmed our predictions that alcohol effect expectancies and self-efficacy were inversely correlated at the beginning of treatment, and that both alcohol expectancies and self-efficacy changed significantly during the four-week treatment program. Larger decreases in alcohol effect expectancies were evident for individuals who entered treatment with less confidence in their ability to resist drinking compared to those with more confidence in potential drinking situations. Results suggest that both expectancies and self-efficacy are useful factors to target in alcohol treatment.