Four process studies in the behavioral treatment of chronic headache

Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.     

Identifying predictors of treatment response

This article provides a rationale for considering predictors of growth in a treatment group as inadequate to identifying predictors of treatment response. When we interpret predictors of growth in a treatment group as synonymous with predictors of treatment response, we implicitly attribute all of the treated children's growth to the treatment, an untenable assumption under most conditions. We also contend that the use of standard scores in predictors of growth studies does not allow us to differentiate growth from treatment, from growth from other factors. We present two research methodologies that are appropriate methods of identifying predictors of treatment response: (a) single-subject experimental logic utilized to identify the specific participants in which treatment responses (not just growth) were found, combined with follow-up group comparison logic to identify the characteristics on which responders and nonresponders differ, and (b) statistical interactions among child/family/context characteristics and randomly assigned group membership. Principles for selecting potential predictors of treatment response are provided.     

Outcome predictors in the behavioral treatment of stuttering

The MMPI and subscales of the Stuttering Severity scale were utilized to predict motivation and success in the behavioral treatment of 32 stutterers. Subjects spent a mean of 10 individual sessions in criterion-oriented learning of fluent speech based on speech-muscle relaxation aided by EMG visual biofeedback. Judged motivation and judged success were strongly related to each other and significantly related to MMPI K and Es scores and negatively to F and Sc. Actual success was negatively related to Sc and Pd, completely unrelated to Es, and (if anything) negatively related to K. Results are consistent with previous studies, and show that global judgements of progress were only minimally related to a measure of actual progress.     

Psychophysiological evidence of response conflict and strategic control of responses in affective priming

This experiment investigated the role of conflict in the response and evaluative categorization systems in the affective congruency effect using event-related brain potentials (ERPs). Participants completed a primed evaluative decision task in which the proportion of congruent to incongruent trials was manipulated. The size of the affective congruency effect increased along with the proportion of congruent trials. ERP data identified the locus of this effect in the response system: the lateralized readiness potential (LRP) showed that preferential response activation occurred in motor cortex following prime onset, and the fronto-central N2 (conflict monitoring) component indicated that conflict occurred when the response activated by the prime differed from the target response, irrespective of the affective congruency of the prime and target. The extent of this conflict covaried with strategic processing of primes, as participants directed less attention to primes that were likely to elicit conflict. These data support a response conflict account of affective congruency effects in the evaluative decision task and indicate that strategic control of attention is important in determining the extent to which conflict occurs.     

Behold the wrath: Psychophysiological responses to facial stimuli

The complex musculature of the human face has been shaped by natural selection to produce gestures that communicate information about intentions and emotional states between senders and receivers. According to the preparedness hypothesis, different facial gestures are differentially prepared by evolution to become associated with different outcomes. As attested by psychophysiological responses in Pavlovian conditioning experiments, expressions of anger and fear more easily become signals for aversive stimuli than do expression of happiness. Consistent with the evolutionary perspective, the superior conditioning to angry faces is stronger for male than for female faces, for adult than for child faces, and for faces directed toward the receiver rather than directed away. Furthermore, it appears to be primarily located in the right cerebral hemisphere. The enhanced autonomic activity to angry faces signaling electric shock is not mediated by conscious cognitive activity, but is evident also when recognition of the facial stimulus is blocked by backward masking procedures. Similarly, conditioned responses can be established to masked angry, but not to masked happy faces. Electromyographic measurement of facial muscle activity reveals a tendency for emotional facial expression to rapidly and automatically elicit its mirror image in the face of the receiver, typically accompanied by the appropriate emotional experience. The research reviewed in this paper supports the proposition that humans have been evolutionarily tuned to respond automatically to facial stimuli, and it is suggested that such early automatic reactions shape the subsequent conscious emotional processing of the stimulus.The responsibility for this paper is shared equally between the authors. The research reviewed in the paper has been supported by separate grants to both authors from the Swedish Council for Research in the Humanities and Social Sciences, The Swedish Council for the Coordination and Planning of Research, and the Bank of Sweden Tercentennial Fund.     

Psychophysiological, behavioral, and cognitive indices of the emotional response: a factor-analytic study

Previous research on the components of the emotional response employing factor analytic studies has yielded a two-factor structure (Lang, Greenwald, Bradley, & Hamm, 1993; Cuthbert, Schupp, Bradley, Birbaumer, & Lang, 2000). However, the startle blink reflex, a widely employed measure of the emotional response, has not been considered to date. We decided to include two parameters of the startle reflex (magnitude and latency) in order to explore further how this response fits into the two-factor model of emotion. We recorded the acoustic startle blink response, skin conductance response, heart rate, free viewing time, and picture valence and arousal ratings of 45 subjects while viewing 54 pictures from the International Affective Picture System (IAPS; 18 unpleasant, 18 neutral, and 18 pleasant). Factorizations of all measures gave a two-factor solution (valence and arousal) that accounted for 70% of the variance. Although some measurements, including heart rate change, did not behave as predicted, our results reinforce the two-dimension model of the emotion, and show that startle fits into the model.     

Psychophysiological responses to appraisal dimensions in a computer game

A computer game was used to study psychophysiological reactions to emotion‐relevant events. Two dimensions proposed by Scherer (1984a, 1984b) in his appraisal theory, the intrinsic pleasantness and goal conduciveness of game events, were studied in a factorial design. The relative level at which a player performed at the moment of an event was also taken into account. A total of 33 participants played the game while cardiac activity, skin conductance, skin temperature, and muscle activity as well as emotion self‐reports were assessed. The self‐reports indicate that game events altered levels of pride, joy, anger, and surprise. Goal conduciveness had little effect on muscle activity but was associated with significant autonomic effects, including changes to interbeat interval, pulse transit time, skin conductance, and finger temperature. The manipulation of intrinsic pleasantness had little impact on physiological responses. The results show the utility of attempting to manipulate emotion‐constituent appraisals and measure their peripheral physiological signatures.     

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.     

Psychophysiological responses to cooperation: The role of outcome and gender

Instances of sustained cooperative behaviour in humans can be considered as an adaptive strategy that enhances the probability of reaching a goal. This study investigates psychophysiological responses to cooperation in healthy subjects, while considering outcome and gender as potential moderators of these responses. Salivary cortisol levels (Csal), heart rate (HR), skin conductance level (SCL), nonspecific skin conductance responses (NSRs), and mood states were measured at different points before, during and after a Lego house‐building task in undergraduate men (n = 22) and women (n = 20). Once the task was finished, the experimenter informed the participants about the outcome obtained (positive or negative). Cooperation produces an increase in HR, SCL, and NSR responses. When the outcome is positive it produces a gradual diminution in Csal levels, but when the outcome is negative there is a significant increase in Csal levels after the task followed by a progressive decrease. Men with positive outcomes showed a lower area under curve (AUC) in Csal than women with a negative outcome. Men had more NSR responses in all periods other than the rest period. Several mood states are differently affected by the combined effect of outcome and gender. Our laboratory results can be generalized to other situations in which negotiation, mediation, and cooperative strategies are relevant for taking decisions and/or solving problems.     

Anxiety sensitivity and history of panic as predictors of response to hyperventilation

In this study, we examined the effects of anxiety sensitivity on the response to hyperventilation in college students with and without a history of spontaneous panic attacks. Reiss et al.'s (Behav. Res. Ther. 24, 1-8, 1986) Anxiety Sensitivity Index and Norton et al.'s (Behav. Ther. 17, 239-252, 1986) Panic Attack Questionnaire were used to select Ss. Following five min of voluntary hyperventilation, high anxiety sensitivity Ss reported more anxiety and more hyperventilation sensations than did low anxiety sensitivity Ss. A history of panic was only associated with enhanced responding to hyperventilation in Ss with high anxiety sensitivity; low anxiety sensitivity Ss who had experience with panic were no more responsive than low anxiety sensitivity Ss who had never had a panic attack. These findings suggest that high anxiety sensitivity may be a crucial determinant of panic attacks provoked by biological challenges (e.g. hyperventilation, sodium lactate infusion).     

Parents' behavioral norms as predictors of adolescent sexual activity and contraceptive use

The influence of parental factors on adolescent sexual behavior and contraceptive use has been examined previously, and findings have been contradictory. Previous studies, which found little relationship between parental norms and adolescent sexual activity, have been limited by their failure to recognize developmental differences in the relative weight of parent and peer influences between younger and older teens and by use of selected samples, resulting in a restriction of range. The current study differs in that it utilizes a clustered sample household survey of 329 males and females, aged 14 to 17, and 470 of their parents. Using multiple regression analysis, it was found that parents' reported behavioral norms account for 5% of the variance in whether adolescents have had intercourse, and for 33% of the variance in use of contraception at last intercourse. The study suggests that while parents' normative beliefs have limited effect in the decision to become sexually active, they have considerable impact on later contraceptive use.     

Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa

Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight suppression in a large sample of patients with AN (N = 185), and to evaluate whether weight suppression at admission for intensive behavioral treatment predicts weight gain and clinical outcomes at discharge. Weight suppression varied from 0 kg to 78 kg (M [SD] = 17.1 [10.8] kg) in AN patients. Higher levels of weight suppression predicted greater total weight gain, a faster rate of weight gain, and bulimic symptoms during intensive treatment even after controlling for body mass index on admission, length and type of intensive treatment received, restricting versus binge-eating/purging AN subtype, and other predictors of study outcomes. These findings converge with previous research documenting the clinical significance of weight suppression in the treatment of eating disorders. Future work is needed to replicate the current findings, and examine whether weight suppression predicts the course of AN following discharge from intensive treatment.     

Cardiovascular and neurohumoral responses to behavioral challenge as a function of race and sex

Cardiovascular and hormonal responses to a structured interview, an electronic video game, a cold pressor test, and exercise on a bicycle ergometer were assessed in eighty-three 25- to 44-year-old normotensive Black and White men and women. Blacks showed significantly greater diastolic blood pressure (DBP) responses than Whites during the cold pressor test, which were not accounted for by an increase in plasma catecholamines. Exercise produced reliably greater systolic blood pressure (SBP) increases in Black women than in Black men or White women. Men showed significantly greater SBP and DBP changes than women during the video game. These findings suggest that the pattern of physiological reactivity elicited by challenge is related to the race and sex of the subjects.     

Psychophysiological outcome of cognitive, behavioral and psychophysiologically-based treatments of agoraphobia

Psychophysiological process and outcome phenomena were analyzed to examine differential temporal patterns within and across cognitive, behavioral and physiologically-based treatments of agoraphobia. Eighty-eight severe and chronic agoraphobics with panic attacks (DSM-III) were randomly assigned to one of three treatments: Paradoxical Intention, Graduated Exposure or Progressive Deep Muscle Relaxation Training. Protocol therapists, whose treatment integrity was objectively monitored, conducted 12 two-hour weekly sessions. All subjects received programmed practice instructions concurrent with their primary treatment. Analyses revealed numerous significant reductions on in vivo psychophysiological measures for the relaxation condition, a few improvements for the exposure treatment and no effects for the paradoxical intention modality. The mediating role of pretreatment physiological reactivity in treatment outcome and follow-up status was examined and revealed no significant associations. Synchrony-desynchrony patterns were found to vary widely according to both treatment phase and the time interval between assessments. No between-group differences were observed on the proportion of synchronizers. However, synchronizers exhibited superior outcome and follow-up compared to desynchronizers on all domains except the physiological measures. Conceptual, methodological and clinical implications of these findings are discussed with recommendations for future research.     

Information-processing predictors of emotional response to stress

Information-processing biases of attention toward and interpretation of threat were measured in 29 undergraduates during a period of low academic stress. During a later period of high academic stress, participants were interviewed about their emotional response: anxious and depressive symptoms, and positive and negative affect. Anxiety symptoms at follow-up were predicted by attention to masked threat stimuli, while negative affect at follow-up was predicted by interpretation of ambiguous items as threatening. Results suggest that although attentional processes appears to play a role in the development of anxiety symptoms, the experience of negative affect during stress may be regulated by more interpretive processes.