The effectiveness of personal construct psychotherapy in clinical practice: A systematic review and meta-analysis

Abstract

This study updates a systematic review of the effectiveness of personal construct psychotherapy and refines a previous meta-analysis by focusing on studies conducted in clinical settings. Twenty-seven studies satisfied the criteria for the systematic review, including 20 in clinical settings. Meta-analysis of the latter provided strong evidence of an advantage of personal construct psychotherapy over a no-treatment control; this benefit was maintained at follow-up. Meta-analysis of studies with an active treatment control group provided no evidence of the superiority or inferiority of personal construct psychotherapy. The available research justifies the practice of personal construct psychotherapy with clients in clinical practice, but conclusions must be tempered by the small number of studies and their methodological shortcomings.     

Organization of multisynaptic circuits within and between the medial and the central extended amygdala

The central and medial extended amygdala comprises the central (CEA) and medial nuclei of the amygdala (MEA), respectively, together with anatomically connected regions of the bed nucleus of the stria terminalis (BST). To reveal direct and multisynaptic connections within the central and medial extended amygdala, monosynaptic and transneuronal viral tracing experiments were performed in adult male rats. In the first set of experiments, a cocktail of anterograde and retrograde tracers was iontophoretically delivered into the medial CEA (CEAm), anterodorsal MEA (MEAad), or posterodorsal MEA (MEApd), revealing direct, topographically organized projections between distinct amygdalar and BST subnuclei. In the second set of experiments, the retrograde transneuronal tracer pseudorabies virus (PRV) was microinjected into the CEAm or MEAad. After 48 hours of survival, there were no significant differences between monosynaptic and PRV cases in the subnuclear distribution or proportions of retrogradely labeled BST neurons. However, after 60 hours of survival, CEAm‐injected cases displayed an increased proportion of labeled neurons within the anteromedial group of BST subnuclei (amgBST) and within the posterior BST, which do not directly innervate the CEA. MEApd‐injected 60‐hour cases displayed a significantly increased proportion of retrograde labeling in the amgBST compared with monosynaptic and 48‐hour cases, whereas MEAad‐injected cases displayed no proportional changes over time. Thus, multisynaptic circuits within the medial extended amygdala overlap the direct connections making up this anatomical unit, whereas the multisynaptic boundaries of the central extended amygdala extend into BST subnuclei previously identified as part of the medial extended amygdala. J. Comp. Neurol. 521:3406‐3431, 2013. © 2013 Wiley Periodicals, Inc.     

Informativeness of the spoken narratives of younger and older adolescents with specific language impairment and their counterparts with normal language

A large body of literature describing the narrative skills of young children with and without language impairments exists. However, there has been only limited study of the informativeness of narratives of adolescents with normally developing language (NL) and those of adolescents with specific language impairment (SLI), even though narratives play an important role in adolescents' complex social and academic lives and there is emerging evidence that narrative abilities in young children portend their later language proficiency. This study examined the informativeness of oral narratives produced by four groups of adolescents: younger adolescents with NL (mean age = 13years:2 months), older adolescents with NL (15:10), younger adolescents with SLI (13:2) and older adolescents with SLI (15:9). The results indicated that the narratives produced by the SLI adolescents consisted of fewer informative and more irrelevant/inaccurate responses than the narratives of their peers with NL. The SLI adolescents also tended to give more vague responses in their narratives than their NL counterparts, as well tending not to provide any responses to the pictures representing the story. Taken together, these results painted a picture of SLI adolescents producing less satisfying, complete, and cohesive narratives, findings consistent with those of the research on children with SLI. Language status more than age appeared to be the factor that affected the likelihood of the adolescents providing or not providing informative responses. These results suggested that the performance of adolescents with SLI may not catch up to the level of performance of their NL counterparts during adolescence.     

Assessing awareness in early-stage Alzheimer's disease: Development and piloting of the Memory Awareness Rating Scale

There are indications that awareness may have an important impact on functioning and response to rehabilitative interventions in early-stage Alzheimer's disease (AD), yet studies have so far produced few clear findings, and a comprehensive explanatory model is needed together with a reliable assessment method. A theory-driven approach to assessing awareness in early-stage Alzheimer's disease was used to develop the Memory Awareness Rating Scale (MARS), a measure that addresses key methodological limitations of the assessment methods adopted in existing studies. The MARS was piloted with 12 couples where one partner had a diagnosis of AD. This demonstrated that the MARS has satisfactory psychometric properties, and suggested some refinements to the scale that may improve its usefulness. Results obtained with the MARS allow further consideration of theoretical and methodological issues that arise in attempting to understand and assess awareness. The development of this rigorous method of assessing awareness of memory difficulties in early-stage AD provides a basis for further investigation of the relationship between awareness of memory difficulties and outcome of neuropsychological rehabilitation in early-stage AD.     

Divergent Patterns of Social Cognition Performance in Autism and 22q11.2 Deletion Syndrome (22q11DS)

Individuals with developmental disorders frequently report a range of social cognition deficits including difficulties identifying facial displays of emotion. This study examined the specificity of face emotion processing deficits in adolescents with either autism or 22q11DS compared to typically developing (TD) controls. Two tasks (face emotion recognition and weather scene recognition) were used to explore group differences in visual scanpath strategy and concurrent recognition accuracy. For faces, the autism and 22q11DS groups demonstrated lower emotion recognition accuracy and fewer fixations compared to the TD group. Individuals with autism demonstrated fewer fixations to some weather scene stimuli compared to 22q11DS and TD groups, yet achieved a level of recognition accuracy comparable to the TD group. These findings provide evidence for a divergent pattern of social cognition dysfunction in autism and 22q11DS.     

Goal-oriented cognitive rehabilitation for an individual with Mild Cognitive Impairment: Behavioural and neuroimaging outcomes

An individual, goal-oriented cognitive rehabilitation intervention was conducted with AB, a 77-year-old woman with MCI. Outcomes were evaluated using a client-centred measure of goal achievement and an experimental associative learning task testing a skill practised in the intervention. Pre- and post-intervention fMRI scans were compared to examine changes in brain activation. Following intervention, AB showed improved performance on rehabilitation goals and on the associative learning task. There were significant decreases in brain activation in sensory areas and significant increases in memory-related areas. Both client-centred measures and fMRI may assist in detecting clinically-meaningful changes resulting from cognitive rehabilitation interventions.     

Temporal analysis of acute myocardial infarction in Ontario, Canada

BACKGROUND: Acute myocardial infarction (AMI) is a substantial cause of morbidity and mortality in Canada. Evidence suggests that the incidence and mortality of AMI increase in the winter. Determining the strength and nature of seasonality patterns in relation to age and sex may be helpful in health care planning. OBJECTIVES: To examine the seasonal patterns of AMI hospital admissions by age and sex, to assess the strength of the seasonal patterns and to examine the overall trends in admissions. METHODS: A retrospective population-based study was conducted to assess temporal patterns in 14 years of hospital admissions for AMI (from April 1, 1988, to March 31, 2002) in Ontario. Seasonality was assessed using the autoregression coefficient (R2Autoreg), and Fisher's Kappa and Bartlett's Kolmogorov-Smirnov tests. RESULTS: There were 271,321 people in the cohort, of whom 63% (n = 171,546) were male and 37% (n = 99,775) were female. There was an increase in AMI admissions since 1988 that reached a plateau in 1992, which was attributable mostly to the increased rate in the oldest age groups (70 years and older), where admission rates more than doubled. An association between seasonality and AMI admissions was found in most age and sex groups, with men consistently exhibiting a stronger seasonality pattern. The greatest difference in the cohort, 2.5 per 100,000 per month (134 admissions), occurred between December and September (13.64 per 100,000 in September versus 16.14 per 100,000 in December). CONCLUSIONS: AMI admissions show seasonality patterns, which are more pronounced in men. Although statistically significant, the seasonal differences are small in terms of absolute numbers, and are likely irrelevant in health care planning.