Were we erring? The impact of worry and arousal on error-related negativity in a non-clinical sample

The monitoring of one's own actions allows humans to adjust to a changing and complex world. Previous neuroscientific research found overactive action monitoring and increased sensitivity to errors to be associated with anxiety and it is assumed to contribute to the development and maintenance of anxiety symptoms. A largely shared decomposition of anxiety differentiates two dimensions: anxious apprehension (i.e., worry) and anxious arousal (i.e., physiological hyperarousal). Alterations in neural correlates of error monitoring have been more closely linked to anxious apprehension compared to anxious arousal. This study examined the relationship between anxiety dimensions and electrophysiological correlates of action monitoring (i.e., error-related negativity, ERN, and correct-response negativity, CRN). A total of 135 non-clinical participants performed a flanker task while their electroencephalogram was recorded. We recruited participants with converging and diverging anxiety dimension profiles (i.e., above or below median in anxious apprehension and anxious arousal or above median in one and below in the other dimension). This grouping strategy facilitates disentangling possible interactions and allows the investigation of the isolated effect of each anxiety dimension. Regression analyses did not reveal a significant main or interaction effect of anxiety dimensions on ERN or CRN, irrespective of gender. In addition, Bayesian statistical analyzes yielded evidence for the absence of an association between both anxiety dimensions and ERN and CRN. Altogether, our results suggest that the association of anxiety dimensions, particularly anxious apprehension, and action monitoring might be smaller in non-clinical samples as previous studies indicate.     

Turkish adaptation of the Short Schema Mode Inventory

The purpose of the current study is to present the psychometric properties of the Short Schema Mode Inventory in the Turkish culture. The study sample comprised 1,287 participants, including both clinical and nonclinical participants. The age of the participants ranged between 18 and 48 years. The construct validity of the scale was tested using confirmatory factor analysis. The internal (Cronbach's alpha) and test–retest reliability coefficients were used to examine the reliability of the scale. Discriminant validity was investigated by comparing the nonclinical and clinical participants. Concurrent validity was tested via the Splitting Scale. The results of the study showed that the tested model had good data‐model fit statistics. Additionally, the reliability analyses revealed that the scales had good internal and test–retest reliability coefficients. A significant association was found between the subscales of the Schema Mode Inventory. Furthermore, the scores of the clinical participants were significantly higher compared with the scores of the nonclinical participants for the maladaptive schema modes. Nonetheless, the participants in the nonclinical group had significantly higher levels of the healthy schema modes than individuals in the clinical group. The results of this study demonstrated that the Schema Mode Inventory was a reliable and valid instrument to measure schema modes in the Turkish population.     

Emergent Life Events During Youth Evidence-Based Treatment: Impact on Future Provider Adherence and Clinical Progress

Emergent life events (ELEs)—unexpected stressors disclosed in psychotherapy that have a significant negative impact on the client—commonly occur in community populations of youth and are associated with decreased provider adherence to evidence-based treatment (EBT) in session. The present study extends previous research by examining longer term associations of ELEs with (a) provider adherence to planned EBT practices in subsequent sessions and (b) clinical progress. Data were drawn from the modular EBT condition (MATCH) of the Child STEPs California trial conducted with primarily Latino youth, ages 5–15, who were 54% male (Chorpita et al., 2017). Study 1 utilized data from 57 MATCH participants who reported at least one ELE during treatment. Provider adherence was measured by identifying whether planned practices were covered in either the session in which the ELE was reported or the following session using the MATCH Consultation Record. In Study 2, clinical progress for 78 MATCH participants was assessed using weekly youth- and caregiver-ratings of symptomatology (Brief Problem Checklist) and functioning (Top Problems Assessment). Study 1 revealed that ELEs were associated with reduced adherence to planned practices for at least two sessions. Study 2 demonstrated that each disruptive ELE (i.e., an ELE for which no EBT content was covered) was associated with a 14%–20% slower rate of clinical improvement, with greater declines for functioning and externalizing symptoms. Findings suggest that ELEs can be a major barrier to the effectiveness of an EBT and require further research in order to be addressed effectively.     

An empirical investigation of Albert Ellis's binary model of distress

In the current literature, distress is typically described according to a unitary model: High levels of distress are conceptualized as a high level of negative affect while low levels of distress are typically conceptualized as a low level of negative affect. On the other hand, Albert Ellis (1994) and some of his rational-emotive and cognitive-behavioral professional colleagues have more recently described distress as a binary construct composed of two different components: functional negative feelings (e.g., sad) and dysfunctional negative feelings (e.g., worthless). In two studies using 55 U.S. breast-cancer patients and 45 Romanian breast-cancer patients, respectively, we compared hypotheses derived from unitary and binary models of distress. The results revealed that in a stressful situation (i.e., upcoming breast surgery) high levels of irrational beliefs were associated with a high level of both functional and dysfunctional negative feelings while low levels of irrational beliefs were associated with a low level of dysfunctional negative feelings and a high level of functional negative feelings. Thus, that support for the binary model of distress found in both U.S. and Romanian samples suggests both the robustness and the generalizability of the results. Theoretical and practical implications are discussed.     

Inductive creation of an annotation schema for manually indexing clinical conditions from emergency department reports

Evaluating automated indexing applications requires comparing automatically indexed terms against manual reference standard annotations. However, there are no standard guidelines for determining which words from a textual document to include in manual annotations, and the vague task can result in substantial variation among manual indexers. We applied grounded theory to emergency department reports to create an annotation schema representing syntactic and semantic variables that could be annotated when indexing clinical conditions. We describe the annotation schema, which includes variables representing medical concepts (e.g., symptom, demographics), linguistic form (e.g., noun, adjective), and modifier types (e.g., anatomic location, severity). We measured the schema's quality and found: (1) the schema was comprehensive enough to be applied to 20 unseen reports without changes to the schema; (2) agreement between author annotators applying the schema was high, with an F measure of 93%; and (3) the authors made complementary errors when applying the schema, demonstrating that the schema incorporates both linguistic and medical expertise.     

Parental report of health-related quality of life in children with sickle cell disease

Health-related quality of life (HRQOL) of youths with sickle cell disease (SCD) has not been described, despite the psychosocial and physical consequences associated with the disease. We compared the HRQOL of 58 children with SCD to a demographically similar sample of 120 healthy children and examined predictors of HRQOL. Child HRQOL was assessed using the Child Health Questionnaire--Parent Report Form. Review of medical charts of children with SCD provided data on disease-related complications. Results demonstrated that caregivers of children with SCD reported that their children had more limited physical, psychological, and social well-being than healthy children. Older child age, female gender, and more disease-related complications predicted limitations in the physical health of children with SCD. The findings indicated that SCD significantly affects the HRQOL of youths. Certain subgroups of patients (e.g., children with more disease complications) may benefit from interventions specifically designed to improve their physical functioning.     

Client variables and the behavioral treatment of recurrent tension headache: A metaanalytic review

Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, the treatment outcome has varied with the client samples (e.g., age, gender, referral source) that have been used but not with the treatment procedures (e.g., type of behavioral intervention, length of treatment, whether or not efforts were made to facilitate transfer of training) or the research designs (e.g., internal validity, explicitness of diagnostic criteria) that have been used. Mean client age proved the best predictor of treatment outcome, accounting for 30% of the outcome variance following behavior therapy. Significantly poorer outcomes have also been reported in recent studies than were reported in early studies. These findings suggest that (1) outcomes obtained with behavioral interventions have been less dependent upon the treatment variables that have been the primary focus of research attention than upon characteristics of client samples and (2) behavioral interventions may be less effective in reducing headache activity than has previously been assumed.Preparation of this article was supported in part by National Institute of Mental Health Grant MH37464 to Kenneth A. Holroyd.     

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization

Background

Current “gold standard” treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals.

Method

Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style.

Results

Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother.

Conclusion

Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

     

An Easy Guide for Caring Parents (Book)

Evaluated behavioral difficulties in three groups of preschoolers (ages 2 lo 4 years): low risk, social risk (e,g., poverty, one-parent families), and dual risk (both biological and social risk conditions). Parents of 238 toddlers completed the Child Bei~avior ChecklistJ2-3 (CBCU2-3) and the Eyberg Child Behavior Inventory (ECBI). Demographic, prenatal, and perinatal information was obtained to determine group status. Results indicated that toddlers in social- and dual-risk groups obtained significantly higher parent ratings on the Internalizing behaviors scale and the Anxious/Depressed, Withdrawn, and Destructive behavior subscales of the CBCU2-3 when compared to toddlers in the low-risk group. No significant differences were obtained between social- and dual-risk groups or between specific biological risk categories (e.g., prematurity vs. developmental disorder). All ECBI results were nonsignificant. These findings suggest that social risk conditions place a preschooler at greater risk for behavioral difficulties, whether these poor social conditions occur with full-term, healthy infants or with children at biological risk (e.g., prematurity). It is recommended that social risk factors as well as biological risk factors be considered so that early intervention programs may target problematic behavior in their treatment approaches with preschoolers.     

Effects of preinterview suggestion on counselor memory,clinical impression,and confidence in judgments

This study examined the effects of schematic preinterview suggestion on counselorS' (a) recognition memory of the information presented by the client; (b) clinical impression rating of the client; and (c) confidence in rating clinical impression. Fifty-two Master's-level counselor-trainees were assigned randomly to two conditions of preinterview suggestion about the status of the client (i.e., depression and no depression). After subjects had received appropriate preinterview information (i.e., depression or no-depression content) and had viewed a videotaped counseling interview, information was gathered from them. The results indicated that the preinterview suggestion (a) did not affect counselor-traineeS' clinical impression rating of the client; (b) did not affect confidence of rating; and (c) yielded a weak, but significant, confirmatory memory. Implications for the interview setting are discussed.     

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.     

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.     

Win,lose, or draw: Examining salience,reward memory,and depression with the reward positivity

The reward positivity (RewP) is a putative biomarker of depression. Careful control of stimulus properties and manipulation of both stimulus valence and salience could facilitate interpretation of the RewP. RewP interpretation could further be improved by investigating functional outcomes of a blunted RewP in depression, such as reduced memory for rewarding outcomes. This study sought to advance RewP interpretation first by advancing task design through use of neutral (i.e., draw) control trials and counterbalanced feedback stimuli. Second, we examined the RewP’s association with memory and the impact of depression. Undergraduates completed self-report measures of depression and anhedonia prior to a modified doors task in which words were displayed in colored fonts that indicated win, loss, or draw feedback. Memory of the feedback associated with each word (i.e., source memory) was tested. Results showed that RewP response to wins was more positive than to losses, which was more positive than to draws. The RewP was not associated with depression or anhedonia. The low depression group showed a source memory advantage for win words, but the high depression group did not. Source memory showed small relations to the RewP, but these did not survive Bonferroni correction. Results suggest the RewP is sensitive to salience and highlight challenges in detecting an association between the RewP and depression in modified doors tasks. Findings indicate that depression is related to dysfunctional source memory for reward but not loss and that future research should probe the possible associations between the RewP and memory in depression.     

Predicting inept discipline: The role of parental depressive symptoms, anger, and attributions

Relations among parents' psychological difficulties (i.e., depressive symptoms, overt anger), dysfunctional attributions for child misbehavior, and inept discipline were investigated in a representative community sample of 451 mothers and 449 fathers. Depressive symptoms and anger were hypothesized to relate to discipline via their link with parents' attributions. Path analyses revealed that depressive symptoms predicted parent-centered causal attributions (i.e., stable, global, and dispositional), which, in turn, related to laxness. Depressive symptoms also predicted child-centered responsibility attributions (i.e., controllable, intentional, and negative), which, in turn, related to overreactivity. Anger predicted overreactivity directly. The patterns of relations were similar for fathers and mothers. The importance of addressing parents' psychological difficulties and dysfunctional attributions in interventions for families with disruptive children is discussed.     

Body‐related cognitive distortions (thought–shape fusion body) associated with thin‐ideal exposure in female students—An ecological momentary assessment study

Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body‐related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self‐ideal discrepancy and result in body‐related cognitive distortions such as thought–shape fusion body (TSF‐B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF‐B in a naturalistic setting. It was further analysed whether TSF‐B is associated with self‐ideal discrepancy, dysfunctional body‐related behaviour, and disordered eating behaviour. Moreover, person‐related predictors of TSF‐B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF‐B. TSF‐B was associated with higher self‐ideal discrepancy and dysfunctional body‐related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF‐B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre‐existing BD) on TSF‐B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.     

Longitudinal association between self-compassion and intuitive eating: Testing emotion regulation and body image flexibility as mediating variables

Objectives

Growing evidence suggests that intuitive eating is associated with numerous positive mental health and well-being constructs. Understanding factors that predict intuitive eating is necessary for identifying practical targets to enhance this style of eating, yet research identifying such predictors is scarce. Self-compassion is one variable that could enhance intuitive eating because it involves the practice of healthy emotion regulation skills that may disrupt the tendency to turn to food to cope during distressing situations. The present study tested for a longitudinal association between self-compassion and intuitive eating. We also tested whether this association was mediated by indices of emotion regulation (i.e., global emotion regulation skill scores and body image flexibility).

Method

Adult women (n = 3039) were invited to completed study measures at baseline (T1), 4-month follow-up (T2), and 8-month follow-up (T3). Path analyses were computed to test hypothesized indirect effects.

Results

A direct path from T1 self-compassion to T3 intuitive eating emerged, such that higher self-compassion levels predicted increased intuitive eating over time. However, this association was not mediated by T2 emotion regulation skills nor body image flexibility.

Conclusion

Findings suggest that self-compassion may facilitate an intuitive eating style, which does not appear to be explained by certain emotion regulation skills.     

Effects of stimulus emotionality and sentence generation on memory for words in adults with unilateral brain damage

Does sentence generation and/or stimulus emotionality enhance verbal memory in patients with neurological impairment? This question was addressed by testing 40 patients with unilateral stroke (20 with left-brain and 20 with right-brain damage) and 20 healthy control participants for recall and recognition of 48 target words. During encoding, emotional and nonemotional words were either presented in sentences (read condition) or used to form sentences (generate condition). Both word emotionality and generative processing improved memory performance in all groups. The authors suggest that a similar influence (i.e., cognitive activation) underlies both of these memory-enhancing effects, although the putative origins of the 2 effects are quite different. Neuropsychological underpinnings and clinical implications of these phenomena are discussed.     

Mirror apraxia affects the peripersonal mirror space. A combined lesion and cerebral activation study

Mirror apraxia is a condition in which patients with lesions of the posterior parietal cortex have deficits in reaching to objects presented through a mirror. The aim of the present study was to investigate possible mechanisms underlying this disorder. First, we addressed the question of whether mirror apraxia is exhibited to the same extent in peripersonal and in body space. Four patients with lesions of the posterior parietal lobe on either side and with marked mirror apraxia were required to reach for objects that were presented to them through a mirror and located either in body space (i.e. on the body surface) or in peripersonal space (i.e. in the reaching distance). Whereas reaching for objects located in body space was flawless in all patients, the performance deteriorated when the same objects were transferred to the peripersonal space. Although the objects were located only a few centimetres above the body surface, the patients reached towards the virtual object in the mirror. Based on these results we suggest that mirror apraxia may originate from a dissociation between the representations of body schema and peripersonal space and that objects located on the body surface become integrated into the body schema. In the second part of the study, using positron emission tomography study (PET), we studied the cerebral activation pattern during reaching to objects presented through a mirror in the peripersonal space in healthy subjects. The results show that increased neural activity in the anterior part of the intraparietal sulcus and in the dorsal premotor cortex was bound to the transformation of the target position from the mirror space to the real space. In contrast, the activity related to object localization in the mirror occurred at the parieto-occipital junction. Both mirror and arm transformation involved the medial posterior part of the superior parietal lobule, putatively area V6a. The results demonstrate that acting through a mirror is processed in a number of cortical areas of the dorsal stream.     

Age-related reduction in the differential pathways involved in internal and external movement generation

Age-related differences in regional brain activation during two different movement generation modes were examined. Old and young volunteers were scanned while performing cyclical hand-foot flexion-extension movements in the presence and the absence of augmented visual feedback, referring to external and internal movements generation, respectively. Performing the coordination task under both conditions resulted in the activation of two distinct neural networks in the young adults, i.e., the hMT/V5+, and parietal and premotor cortices were typically involved during the visually guided mode, whereas the supplementary motor area (SMA), cingulate motor area (CMA), frontal operculum (FO) and secondary somatosensory area (S2) were typically involved during internally guided movements. Remarkably, much less differentiation between both feedback dependent networks was observed in the seniors, i.e., they exhibited high activity in the SMA, CMA, FO and S2 during both modes, suggesting that the typical network differentiation was largely diminished. This is hypothesized to reflect a general increase in processing resources within areas contributing to motor control and associated sensory processing, supporting motor performance in the elderly.     

Change in Psychotherapy: A Plea for No More "Nonspecific" and False Dichotomies

What factors are responsible for change in psychotherapy? We welcome those who question the primacy frequently given to relationship variables in explaining client improvement, as well as the delineation of cognitive‐behavioral oriented treatments found to be effective for several disorders. However, we are also concerned about the terminology used (i.e., “nonspecific variables”), as well as with the dichotomy of variables (techniques vs. relationship) that was emphasized. Although such ways of defining and categorizing process variables are predominant in the field, we argue that they may fail to do justice to the complexity of the process of change.