Neurodegenerative diseases affect multiple domains of functioning, including cognition, emotion, and motor behavior. Sexual functioning is a domain that may also be affected but has received less attention within the field of research. Extant literature on sexual functioning among patients with neurodegenerative diseases tends to focus on clinical and caregiver reports of patient sexual behavior. To understand the response to sexual stimuli in patients with neurodegenerative diseases using non-invasive laboratory-based measures, two studies were conducted.

The first study examined reactivity of three diagnostic groups (18 behavioral variant frontotemporal dementia, 9 Alzheimer’s disease, and 23 healthy controls). Participants were shown an erotic film clip and their responses: physiological, facial behavior, and self-reported affective response were recorded. A group difference emerged in physiological reactivity to the erotic film. More specifically, patients with behavioral variant frontotemporal dementia showed diminished physiological arousal in comparison with healthy controls. I found no statistically significant group differences in facial behavior and self-reported affective responses. With respect to facial behavior, nearly 90% of participants did not show the target facial behavior of happiness while watching the erotic film. With respect to self-reported affective response, all groups reported feeling sexually aroused to a small extent. Results suggest that the physiological measure, which captured more automatic responses to sexual stimuli, was better able to detect diagnostic group differences than facial behavior or self-reported affective response.

The second study examined whether the responses (physiological, facial behavior, and self-reported affective response) of patients with neurodegenerative diseases to sexual stimuli were associated with spousal caregiver depression and marital satisfaction. In addition, I assessed whether these associations were mediated by caregiver reports of patient sexual behavior using a multiple mediation model. Sixty-two patients with neurodegenerative diseases were shown the same erotic film clip as in study 1, and their respective spousal caregivers completed measures of depression, marital satisfaction, and patient sexual behavior. I found an association between patient facial behavior and caregiver marital satisfaction, in which higher displays of happiness on patients’ faces while watching the erotic film was associated with lower caregiver marital satisfaction. A marginal association was found between patient self-reported affective response and caregiver marital satisfaction, in which greater endorsement of feelings of sexual arousal while watching the erotic film was associated with lower caregiver marital satisfaction. No associations were found between patient physiological response and caregiver marital satisfaction or between any of the laboratory-based measures and caregiver depression. Although mediation did not occur in any of the analyses, one of the two mediators revealed that the less sexually responsive the patients were toward their spousal caregivers, the higher the caregiver depression and the lower the caregiver marital satisfaction.

The studies show that laboratory-based measures of response to sexual stimuli and caregiver reports of patient sexual behavior can reveal important information about the influence of neurodegenerative diseases on marital relationships.

Bipolar disorder is a serious mental illness that goes untreated more often among blacks than whites in the U.S. In the current study, I identified and tested a proposed mechanism underlying differential treatment in bipolar disorder, namely how treatment providers’ racial biases contribute to the inadequate care of black patients with bipolar disorder. Findings from research in general and mental healthcare show that providers’ clinical decisions may be related to racial biases based on stereotypes that providers hold. Moreover, general healthcare research has demonstrated the presence of implicit racial biases (defined as unconscious preferences for one race over another) among providers that are linked to the differential treatment of blacks and whites. Unfortunately, much less work has been done to show the presence and effects of implicit racial biases among mental healthcare providers. The hypothesized model in the current study proposes that implicit racial biases held by mental healthcare providers bias diagnostic and prognostic assessments as well as treatment recommendations in bipolar disorder and result in the observed treatment disparities between black and white patients. The Implicit Association Test was used to measure general racial biases in a sample of 82 mental healthcare providers. Clinical decision-making was simulated using clinical vignettes about theoretical black and white patients with psychotic and non-psychotic bipolar disorder. Three-way ANOVAs were used to test for racial disparities in decision-making, and structural equation modeling was used to determine whether providers’ implicit racial biases were associated with decision-making outcomes. Results showed that providers held moderate pro-white/anti-black racial biases and neutral explicit attitudes, also known as an “aversive racism” profile. Racial disparity was observed, but confounded by a mismatch in the severity of symptoms of the hypothetical patients. Composite scores for the vignettes were used to overcome this issue in the SEM analyses. These results revealed that there was no link between racial bias and decision-making. Suggestions for future research are given to improve modeling of the relationship between racial bias and patient care. Despite limitations, findings provide some of the first evidence establishing the presence or implicit racial biases in mental healthcare.

Recent theoretical and empirical contributions to the emotion regulation and close relationships literatures have begun to elucidate the dynamic complexities and functional consequences of interpersonal emotion regulation (IER) processes. The present study sought to evaluate a naturalistic method for capturing IER processes in the daily lives of committed romantic couples by using ambulatory acoustic recording in tandem with ecological momentary self-report to measure enacted behavior and subjective experience. A coding manual was developed for this purpose. Then, a community sample of cohabiting romantic couples was recruited (final N = 59 couples, 118 participants) to consider the feasibility, reliability, and validity of this method. Couples completed a thorough baseline assessment, followed by eight days of ecological momentary assessment and ambulatory acoustic recording with the Electronically Activated Recorder. A team of undergraduate and post-baccalaureate coders was trained to identify and code the content of acoustically observable IER-relevant interactions that occurred within the couples. Participants’ self-reported evaluations of wearing the audio recorder, total number of recordings produced, the characteristics of the IER-relevant interactions that coders identified, inter-rater reliability among the coders, the correlational structure of the coder ratings, and correspondences between coder ratings and participant self-report were analyzed. Consistent with past research, participants generally reported that wearing the audio recorder was only modestly obtrusive for themselves and others. In total, participants produced nearly 2200 hours of audio. Using a periodic sampling strategy, coders identified 836 unique IER-relevant interactions. Many of these interactions appeared to have been “invisible” to the participants in that they reported not having engaged in IER during those epochs in ecological momentary self-report surveys. Inter-rater reliability ranged from tolerable to excellent for the coder ratings, albeit some codes were rarely endorsed in this sample. There were systematic correspondences between coder ratings and participant self-report, although the magnitude of these correspondences was generally quite modest. Overall, data from this study suggest that this approach to recording and coding spontaneously occurring IER interactions is feasible, reliable, and valid.

Obsessive Compulsive Disorder (OCD) is characterized by intrusive and unwanted thoughts followed by specific patterns of behavior or mental acts that function to ‘neutralize’ those thoughts. These behaviors and mental acts, referred to as compulsions, share qualities with habits, responses triggered by a cue and independent of outcome values. In recent years, a number of studies have linked OCD to habit learning and failures in goal-directed control. It has been suggested that OCD, and disorders of compulsivity in general, are characterized by a bias toward learning habits and/or over-relying on habitual control at the expense of goal-directed control over behavior. The aim of the present study was to address two remaining gaps in our understanding of the relationship between OCD and failures in goal-directed control: first, to distinguish habit-related response styles from non-habit-related deficits in goal-directed control by modifying a commonly used slips-of-action test, and second, to examine more specific relationships between task performance and core motivational dimensions of OCD proposed to drive compulsive behavior. To address these goals, a sample of U.S.-based adult participants with symptoms of OCD were recruited from a mixture of undergraduate and community sources. One hundred fourteen participants completed an instrumental learning task with a subsequent slips-of-action test, and 82 of these also completed clinical self-report measures and a diagnostic clinical interview. The results support an alternative possibility to the habit hypothesis: that OCD is more strongly associated with failures in execution of goal-directed action than habit-related insensitivity to outcome devaluation. Further, results show that a commonly used task-based measure of habit-driven failures in goal-directed control in fact reflects multiple learning-related processes unrelated to habitual control, and what can appear as an increase in habitual control as measured by insensitivity to outcome devaluation on a slips-of-action test is strongly influenced by failures of learning implicit and explicit representations of causal relationships between stimuli, actions, and outcomes. These results implicate a need to investigate the intermediate cognitive processes between initial instrumental learning and execution of goal-directed control as they relate to OCD and related disorders.

Emotion-related impulsivity, the trait-based tendency to respond impulsively to heightened emotions, is a transdiagnostic phenomenon associated with diverse forms of psychopathology and problematic behavior. Theory and research on the process of emotion-related impulsivity have identified deficits in cognitive control. Emotion-related impulsivity leads to problems during heightened emotions, which suggests that increased arousal may be core to problematic behavior. Arousal is also known to contribute to decays in some facets of cognitive control, especially working memory. A key need is to understand how arousal-induced decays in working memory relate to emotion-related impulsivity and whether arousal-induced decays in working memory mediate the relation between emotion-related impulsivity and internalizing symptoms.

Participants (N = 100) were recruited as part of a larger two-site study including people who experience a full range of internalizing and externalizing symptoms. Participants completed measures of internalizing symptoms, impulsivity, and potential confounds and then completed a novel N-back task including a within-task stressor to induce high arousal. Skin conductance and pupil diameter were collected at baseline and throughout the task to index arousal. Preliminary cleaning and analyses were conducted to exclude unusable data to yield a final sample (N=82).

Impulsivity was positively related to internalizing symptoms with significant large effects. Contrary to hypotheses, neither higher emotion-related impulsivity nor higher internalizing symptoms were related to poorer working memory performance, and neither interacted with arousal in relation to working memory performance. Arousal did not induce decays in working memory, and arousal-induced decay in working memory was not a putative mediator for the relationship between emotion-related impulsivity and internalizing symptoms.

Findings inform the emotional and neurocognitive processes involved in emotion-related impulsivity. Results did not support the role of arousal-induced decays in working memory in impulsivity or internalizing symptoms, however, future research is warranted to evaluate this model with other methods given the present findings contradict large and growing literatures on the role of arousal and cognition. Further pursuit of this model could identify the process underlying emotion-related impulsivity which may point to potential targets for intervention.