Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Cognitive functioning and cortisol profiles in first episode major depression

Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty‐one patients meeting the DSM‐IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after Dexamethasone and cognitive measures. The results indicate impairment on HPA‐axis functioning in first episode MDD patients, with less suppression functioning compared to healthy controls, but no relationship between cortisol profile and cognitive functioning in EF or Memory.     

Perceptual biases and metacognition and their association with anomalous self experiences in first episode psychosis

Anomalous self-experiences have been described as a prerequisite for anomalous perceptual experiences. Later, these anomalous perceptual experiences may then be metacognitively appraised as distressing, maintaining these experiences and later leading to anomalous (delusional) beliefs. This model of anomalous events may potentially be driven by perceptual biases and metacognitive deficits. This cross-sectional study explored the association between perceptual biases, metacognition and anomalous self- and perceptual experiences and delusional beliefs in First Episode Psychosis (FEP) and a matched healthy control sample. Fifty-eight individuals with FEP and seventy-two healthy controls were included in the main analysis. Increased auditory perceptual biases were significantly associated with increased state and trait anomalous self-experiences, in particular alienation from surroundings and emotional numbing. No significant associations were found between metacognitive efficiency and anomalous experiences. These findings may be consistent with the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly with the hyperreflexivity concept.     

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.     

Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind randomised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted.     

Premorbid personality indicators of schizophrenia-related psychosis in a hypothetically psychosis-prone college sample

Bolinskey, P. K. & Gottesman, I. I. (2010). Premorbid personality indicators of schizophrenia-related psychosis in a hypothetically psychosis-prone college sample. Scandinavian Journal of Psychology, 51, 68–74.
Research into psychosis proneness has established the Chapman Psychosis Proneness Scales (CPPS), certain personality disorders, certain response patterns on the MMPI-2, and social withdrawal as being valid indicators of liability. The current study extends our understanding of premorbid indicators of schizophrenia-related psychosis (SRP) by examining whether individuals identified as hypothetically psychosis prone (HPP) by virtue of their CPPS scores also show differences on other premorbid indicators of SRP. Results indicate that HPP individuals evidence more deviancy in the schizophrenic direction. By providing additional construct validity for the CPPS and other endophenotypic indicators of premorbid processes, strategies for understanding the development of SRP are enhanced.     

The role of cognitive variables in psychological functioning after the death of a first degree relative

The present study sought to explore the relationship between negative cognitions and emotional problems after bereavement, with a group of 329 adults who had suffered the loss of a first degree relative. The following cognitions were assessed: global negative beliefs, cognitions about self-blame, negative cognitions about other people's responses after the loss, and negative cognitions about one's own grief reactions. Results showed that each of these cognitive variables was significantly related to the severity of symptoms of traumatic grief, depression and anxiety, even when background and loss-related variables that were initially found to influence symptom severity, were statistically controlled. When the shared variance between the cognitive variables was controlled, it was found that global negative beliefs about life, the world, and the future, and threatening interpretations of grief reactions each explained a unique proportion of variance in traumatic grief symptom severity. Global negative beliefs about life, the self and the future, and threatening interpretations of grief explained most variance in depression, while negative beliefs about the self and threatening interpretations of grief explained most variance in anxiety. Overall, the findings are in support of cognitive theories of grief, and suggest that effective treatment of problematic grief will need to address negative cognitions.     

Premorbid behavioral and psychosocial adjustment of children with traumatic brain injury

The premorbid adjustment of 85 six- to sixteen-year-old children with traumatic brain injury was assessed by means of standardized rating forms that were completed by the children's parents and teachers. Parents and teachers were in moderate agreement when rating children's premorbid functioning. Less than 11% of the children appeared to have premorbid disturbances. Premorbid adjustment did not appear to be clearly related to injury severity or to type of injury. It is concluded that premorbid behavioral and psychosocial factors are not strongly related to the incidence of traumatic brain injury in a sample of children with predominantly relatively severe injuries.The author gratefully acknowledges the assistance of Amy Herrema, Kevin Hogeterp, and Mary Jeanne Lynch in the data collection process.     

Younger drivers executive functioning and the relationship with experiencing signs of sleepiness

Young drivers are more likely to continue driving when experiencing signs of sleepiness and are over-represented in sleep-related crashes. Adolescence and early adulthood are characterised by comparatively poor executive functioning, and while previous research has demonstrated a link between poor executive functions and several risky driving behaviours, the relationship with sleepy driving is not well understood. Accordingly, the first aim of the current study was to examine the association between executive functions and experiencing the signs of driver sleepiness in a sample of young adult drivers. Additionally, young drivers who have less experience with driving while sleepy, may attribute less importance to the signs of sleepiness as an indicator of underlying sleepiness level. To test this assumption (aim two), the impact of experiencing signs of sleepiness on perceptions of the importance of those signs was examined. Participants included 118 young adults aged between 17 and 25 years, who completed an online survey measuring experiences with the signs of sleepiness while driving, executive functions, and demographic characteristics. This sample of young adults reported having considerable experience with several signs of sleepiness (i.e., yawning, mind wandering, and difficulty keeping eyes while driving). A linear regression analysis found that the demographic variables of age and hours driven per week, as well as the executive function constructs of organization, strategic planning, and impulse control were associated with experiencing signs or sleepiness. Moreover, having experienced more signs of sleepiness was associated with an increased likelihood in rating those signs as important indicators of sleepiness. The current findings suggest both that several high-level cognitive processes as well as levels of experience with driving when experiencing signs of sleepiness contribute to young peoples’ sleepy driving.     

Dimensions of premorbid functioning in schizophrenia: a review of neuromotor, cognitive, social, and behavioral domains

After a brief discussion of methods for studying the premorbid period in schizophrenia, the authors review relevant experimental literature to assess the validity of current theories. A critical review is provided that includes representative empirical investigations on premorbid functioning in schizophrenia in the domains of neuromotor, intellectual, academic, cognitive, social, emotional, and behavioral functioning. Limitations of past research, such as lack of specificity to schizophrenia populations, high incidences of false positives, questionable definitions of the premorbid period, inconsistent measures of premorbid functioning, and problems with the current method of DSM classification are discussed. Alternative approaches to studying early functioning in schizophrenia are highlighted.     

Purpose in life and cognitive functioning in adulthood

With an increasingly aging population, more work is needed to identify factors which may promote the maintenance of normal cognitive functioning. The current study tested the concurrent association between sense of purpose in life and the cognitive variables of episodic memory, executive functioning, and composite cognitive functioning in adults (N = 3489, M_age = 56.3 years, SD = 12.27, Range = 32–84 years) from the Midlife in the United States study (MIDUS). Correlational analyses suggested that purpose in life was associated with higher scores for memory, executive functioning, and overall cognition. Bootstrapping tests of moderation found no evidence for a moderating effect of age on purpose and the cognitive variables. Future studies should attempt to explain the mechanisms behind this relationship and explore the potential for interventions to promote healthy cognitive and purposeful aging.     

Differential cerebral involvement in the cognitive functioning of bilinguals

The cognitive processing strategies of two groups of French-English bilinguals were studied by means of an auditory Stroop test designed to evaluate cerebral hemispheric involvement. An “early bilingual” group were bilingual before the age of 5, and a “late bilingual” group were bilingual after the age of 10. Stimuli were words uttered in pitches that were related to word meanings either congruently (as in the word “high” uttered in a high pitch) or incongruently (the word “haute” uttered in a low pitch). In one condition, subjects were to differentiate low from high pitches, disregarding meaning, while in a second condition, they were to disregard pitch and respond to word meanings. Measures of field independence were also taken. Results of data analyses suggest that male early bilinguals—the most field independent subgroup—process meaning efficiently in both cerebral hemispheres, but process pitch better in the right hemisphere. However, male late bilinguals and female bilinguals, both early and late, process meaning more rapidly in the right cerebral hemisphere and pitch equally rapidly in both hemispheres. The findings are interpreted as reflecting hemisphere-based strategy and sex differences in information-processing by the two bilingual groups.     

The role of cognitive stimulation on the relations between age and cognitive functioning

To make a convincing argument that cognitive stimulation moderates age trends in cognition there must be (a) a negative relation between age and level of cognitive stimulation, (b) a positive relation between level of cognitive stimulation and level of cognitive functioning, and (c) evidence of an interaction between age and cognitive stimulation in the prediction of cognitive functioning. These conditions were investigated in a study in which 204 adults between 20 and 91 years of age completed an activity inventory and performed a variety of cognitive tasks. Only the 1st condition received empirical support, and, thus, the results of this study provide little evidence for the hypothesis that cognitive stimulation preserves or enhances cognitive functioning that would otherwise decline.     

Changes in behavioral problems and prosocial functioning in child treatment

Decreasing emotional and behavioral problems and increasing prosocial functioning are two ares of interest in child treatment. The present study examined the extent to which changes in deviant behavior were associated with changes in prosocial functioning. Three separate samples of children (N = 393, ages 6–13) referred to inpatient or outpatient services were evaluated by parents and teachers on three separate assessment occasions spanning 1–2 years. The major findings indicated that behavioral problems and prosocial functioning and changes in behavioral problems and prosocial functioning over time showed low to moderate negative correlations for parent and teacher evaluations. These relations were consistent across separate time periods, samples of children, and parent and teacher ratings. The magnitude of the correlations between behavioral problems and prosocial functioning indicated that these domains are related but represent relatively independent spheres of child functioning. The importance of assessing both domains of functioning in evaluating children and treatment outcome is discussed.     

Bridging the schism between behavioral and cognitive analyses

A major schism in modern scientific psychology has occurred between behavior analysts and cognitive psychologists. The two groups speak in different languages, but the languages can be translated so that they are mutually understandable; when either language is translated into the other, similarities emerge from seeming differences. We draw an analogy between the basic units of behavior analysis (the operant and the establishing operation) and cognitive psychology (the production). We argue that both units describe behavior as a function of motivative and discriminative antecedents. In addition, the two perspectives account in analogous ways for ongoing changes in motivation and for control by verbal statements. Adherents of the two perspectives have experimentally analyzed some of the same problems and fashioned similar solutions for applied problems. We conclude that many of the commonly cited differences between the two perspectives are the result of misunderstanding, and that the real differences need not preclude communication and collaboration. The schism can be bridged.