Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Objective

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method

Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.

Results

Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions

Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.     

Age-related impairments of new memories reflect failures of learning,not retention

Learning impairments and the instability of memory are defining characteristics of cognitive aging. However, it is unclear if deficits in the expression of new memories reflect an accelerated decay of the target memory or a consequence of inefficient learning. Here, aged mice (19–21-mo old) exhibited acquisition deficits (relative to 3–5-mo old mice) on three learning tasks, although these deficits were overcome with additional training. When tested after a 30-d retention interval, the performance of aged animals was impaired if initial learning had been incomplete. However, if trained to equivalent levels of competence, aged animals exhibited no retention deficits relative to their young counterparts. These results suggest that age-related “memory” impairments can be overcome through a more effective learning regimen.Aging is associated with broad deficits in the acquisition of new knowledge (Matzel et al. 2008; see, for review, Gallagher and Rapp 1997; Rosenzweig and Barnes 2003), as well as impairments in the retrieval of both old and newly acquired information. While it is clear that old memories (i.e., ones obtained prior to age-related cognitive declines) do in fact become less stable with age (Gallagher 1997), it is less clear whether newly attained memories are inherently less stable in aged animals, or whether age-related memory deficits reflect a secondary consequence of inefficient learning.The majority of published data regarding cognitive aging describes impairments of animals'' learning abilities (Gage and Dunnett 1984; Markowska et al. 1994; Meliska et al. 1997; Nalbantoglu et al. 1997; Vogel et al. 2002; Matzel et al. 2008), although a smaller percentage of these studies also report animals'' performances after long retention intervals. Of those studies that report retention deficits, in most of those studies the initial learning upon which the long-term memory was based was impaired relative to young animals (e.g., Barnes and McNaughton 1985; Kinney et al. 2001a,b; Gould and Feiro 2005). Interestingly, in those few studies in which initial learning was equated across young and old animals, including studies of spatial water maze performance and appetitive instrumental responding, no retention deficits were observed, even after retention intervals as long as 21 d (Soffie and Lejeune 1991; Martinez-Serrano et al. 1996; Port et al. 1996).Although suggestive, the above experiments were not systematically designed to assess the stability of memory in aged animals as a function of the level of initial learning. In the present study, young (3–5 mo) and old (19–21 mo) male Balb/C mice were trained in three learning tasks (a spatial water maze, an egocentric Lashley III maze, and a three-choice odor discrimination). When trained to pre-asymptotic levels, aged animals exhibited both learning and retention deficits (assessed 30 d after initial training). However, when aged animals were trained to levels of competence comparable to their young counterparts, both young and old animals exhibited statistically indistinguishable levels of retention.Sixty Balb/C mice arrived in our laboratory at 2.5 mo (n = 30) or 18.5 mo (n = 30) of age. Each age category was divided into two groups of 15, one of which would receive subasymptotic training on each of the three learning tasks, and one of which would receive extended training on those tasks. Two aged mice became ill during the course of testing and were excluded from all analyses. Young mice ranged from 19.8 to 29.1 g, and aged mice from 26.2 to 37.3 g. Maintenance, food deprivation, and training conditions were as previously described (Matzel et al. 2006, 2003). Behavioral testing of young and aged mice was concluded at ∼5 and 21 mo of age, respectively.All animals were tested in three independent learning tasks. Briefly, the spatial water maze encourages mice to integrate spatial information to efficiently escape from a pool of water. In odor discrimination, animals must use a target odor (from a group of three odors) to guide their search for food. In the Lashley III maze, animals learn an egocentric sequence of turns to obtain a food reinforcer. Training on each task required 2–10 d (depending on the task and the level of training), and animals received four days of rest between tasks. A retention test was administered 30 d after the last training trial of each task.A Lashley III maze was constructed from black Plexiglas. A 3-cm-diameter white disk was located in the center of the goal box, and a 45 mg Bio-Serv food pellet (dustless rodent grain) was placed at the center of the disk and served as the reinforcer. Food-deprived animals received a day of acclimation to the maze, followed by either one or two days of training (four trials/day). On the day prior to the acclimation, animals received three Bio-Serv pellets in their home cage (thus mitigating any neophobia to the food on subsequent exposures). On the acclimation day, each mouse was confined in each of the first three alleys of the maze for 4 min, and in the final alley (containing the goal box) for 6 min. On this acclimation day, three Bio-Serv pellets were placed in the goal box. On the subsequent training day(s), each animal was placed in the start box and allowed to freely navigate the maze, during which time the number of errors to reach the goal box were recorded. (An error was constituted by a turn in the wrong direction or a retracing of a previously completed path.) Upon consuming the food pellet, the animal was returned to its home cage for a 25-min intertrial interval (ITI). All animals completed four trials during the first training day. Half of those animals then received an additional four training trials on the following day. Twenty-nine days after the last training trial, all animals received three Bio-Serv pellets in their home cages, and on the subsequent day were again tested in the maze.For the water maze, a round pool (140 cm diameter, 56 cm deep) was filled to within 20 cm of the top with water that was clouded with a water soluble black paint. A hidden 14-cm-diameter black platform was located in a fixed position 1 cm below the surface of the water. The pool was enclosed by a ceiling high black curtain on which five different light patterns (which served as spatial cues) were fixed at various positions. These light cues provided the only illumination of the maze, which was 60 Lux at the water''s surface.On the day prior to training, each animal was confined for 360 sec to the platform by a clear Plexiglas cylinder that fits around the platform. For either one or two training days (six trials Day 1, five trials Day 2), the animals were started from one of three positions, such that no consecutive trials started from the same position. After locating the platform or swimming for 90 sec, the animals were left or placed on the platform for 10 sec, after which they were placed in a holding box (for 12 min) before the start of the next trial. After the sixth or 11th training trial, animals were returned to their home cages for 3 h, and were then administered a 30-sec “probe” test in which the escape platform was removed from the maze and the time spent searching in the target quadrant was recorded. One hour later each animal received an additional training trial (intended to re-establish the search strategy employed by the animal prior to the probe test). Animals were then returned to their home cages, where a 30-d retention interval began.In odor discrimination, mice navigate through a field using unique odors to guide them. The animals learn to choose the food cup that contains the target smell when given three choices. The food cup locations are rearranged on each trial, but the accessible food is always marked by the same target odor (in this case mint). The chamber consisted of a black Plexiglas 60-cm-square field with 30-cm-high walls, which was located in a dimly lit room with high ventilation. A food cup was located in three corners. The target cup had accessible food (30 mg of chocolate puffed rice), while the remaining cups contained food that could not be accessed. A cotton tipped swab (2-cm long) was loaded with 25 μL of lemon-, mint- (the target odor), or almond-flavored extract and extended vertically from the back corner of each cup.Each animal had one day of acclimation and one day of training (consisting of four training trials). (In this task, both young and old animals reached asymptotic levels of performance [near errorless] within four training trials.) On Day 1 (adaptation), each mouse was placed in the box for 20 min with no food cups present. On the subsequent training day, a food cup was placed in three corners of the field, but only the cup associated with the mint odor contained accessible food. Each animal received four trials in which they were placed in the corner of the training chamber that did not contain a food cup. A trial continued until the animal obtained the food from the target location, at which time the animal was returned to its home cage to begin a 20 min ITI. At the end of each trial the food cups were rearranged, but mint always remained as the target odor. For each trial, the number of errors (contact with or sniffing within 2 cm of an incorrect food cup) was recorded. After the fourth training trial, the animal was returned to its home cage for a 30-d retention interval. On the 29th retention day, all animals received three pieces of chocolate flavored rice in their home cages, and on the subsequent day were again tested as in original training.     

Blood flow velocity changes in anterior cerebral arteries during cognitive tasks performance

Objective

Transcranial Doppler sonography (TCD) enables monitoring of blood flow velocities (BFVs) in basal cerebral arteries during different cognitive tasks performance with great temporal resolution. So far, BFVs changes during mental activity were monitored primarily in middle cerebral arteries (MCAs) and little is known about these changes in anterior cerebral arteries (ACAs).

Aim

To determine the effect of different cognitive tasks performance on BFV changes and hemispheric dominance in ACAs and to assess the most suitable activation test for monitoring of BFV changes in ACAs.

Methods

Fourteen right-handed, healthy subjects aged 20–26 were included in the study. BFVs in both ACAs were recorded simultaneously during performance of cognitive tasks designed to activate frontal lobes: phonemic verbal fluency test (pVFT), Stroop tests and Trail Making Tests (TMTs).

Results

A statistically significant BFV increase was recorded in both ACAs during performance of all cognitive tasks. Statistically significant right ACA dominance was found during performance of pVFT and TMTB. The most significant BFV increase was obtained during performance of TMTB.

Conclusion

Our result addressed cognitive tests with great activation potential for monitoring of ACAs that might be used in distinguishing of healthy individuals and patients with neurovascular or neurodegenerative diseases.     

Increased sensitivity to proactive and retroactive interference in amnestic mild cognitive impairment: new insights

Background

Increased sensitivity to proactive (PI) and retroactive (RI) interference has been observed in amnestic mild cognitive impairment (aMCI). PI and RI are often explained as being the result of a response competition mechanism. However, patients with aMCI are supposed to suffer mostly from encoding deficits. We hypothesized that in aMCI interference may occur at encoding and not only at the retrieval stage.

Material and methods

We developed an original paradigm enabling PI and RI to be tested with and without response competitors. Eighteen young controls (YC), 16 elderly controls (EC) and 15 aMCI participated in the study.

Results

The YC and EC groups presented interference effects only in conditions that included a direct response competitor. In contrast, aMCI had interference effects in all conditions including the one without response competitor.

Conclusion

Increased sensitivity to interference in aMCI appears to occur at the encoding/consolidation stage and not only at the retrieval stage, as is the case in healthy subjects. This result is discussed in the context of the associative encoding deficits characterizing aMCI.     

Recollection training and transfer effects in Alzheimer's disease: effectiveness of the repetition-lag procedure

Objective

This study was designed to extend the use of a memory training technique, known as the repetition-lag procedure, to Alzheimer patients. The specificity of this procedure is to target the process of recollection for improvement.

Method

A group of 12 patients were trained individually for 6 h. The training procedure consisted of a series of yes/no recognition tasks in which some words were repeated throughout the test list across gradually increasing delays. Their performance was evaluated on pre-and-post tests and compared with a recognition practice group and a no contact control group.

Results

Initially, recollection training patients only performed accurately when the delay between repetitions consisted of one intervening word, but by the end of training their performance increased up to four-word intervals. Interestingly, these benefits generalized to other measures of memory, such as working memory, visual memory and source recognition.

Conclusions

Effectiveness of the repetition-lag procedure in Alzheimer’s disease is discussed.     

Right up there: hemispatial and hand asymmetries of altitudinal pseudoneglect

Background

Pseudoneglect is a normal left sided spatial bias observed with attempted bisections of horizontal lines and a normal upward bias observed with attempted bisections of vertical lines. Horizontal pseudoneglect has been attributed to right hemispheric dominance for the allocation of attention. The goal of this study was to test the hypothesis that the upward bias in vertical line bisection may also relate to right hemispheric dominance for the allocation of attention and/or action-intention.

Methods

Twenty right handed healthy adults were asked to bisect vertical lines presented in the midsagittal plane (center space) and in sagittal planes to the left and right of the midsagittal plane (left and right hemispace) when using a pen held in either the right or left hand.

Results

Vertical line bisections were biased upward in all three sagittal planes and higher in left than right hemispace. However, bisections made with the left hand were lower than those made with the right hand.

Discussion

Whereas these results suggest a left hemispace-right hemispheric visuospatial attentional upward bias and a relative left hemispheric-right hand upward action-intentional bias, further studies are needed to document this intentional versus attentional bias and to understand the brain mechanisms that produce these biases.     

Myelin breakdown mediates age-related slowing in cognitive processing speed in healthy elderly men

Background

To assess the hypothesis that in a sample of very healthy elderly men selected to minimize risk for Alzheimer’s disease (AD) and cerebrovascular disease, myelin breakdown in late-myelinating regions mediates age-related slowing in cognitive processing speed (CPS).

Materials and methods

The prefrontal lobe white matter and the genu of the corpus callosum myelinate later in brain development (late-myelinating white matter; LMWM) and are more vulnerable to breakdown due to the effects of normal aging. An in vivo MRI biomarker of myelin integrity (transverse relaxation rates; R₂) of LMWM was obtained for 38 very healthy elderly adult men (mean age = 66.3 years; SD = 6.0; range = 55–76). To evaluate regional specificity, we also assessed a contrasting early-myelinating region (splenium of the corpus callosum; SWM), which primarily contains axons involved in visual processing. CPS was assessed using the Trail Making Test.

Results

LMWM R₂ and CPS measures were significantly correlated (r = .515, p = .0009), but no significant association between R₂ and CPS was detected in the splenium (p = .409). LMWM R₂, but not SWM R₂, was a significant mediator of the relationship between age and CPS (p = .037).

Conclusions

In this very healthy elderly sample, age-related slowing in CPS is mediated by myelin breakdown in highly vulnerable late-myelinating regions but not in the splenium.     

Response speed, contingent negative variation and P300 in Alzheimer’s disease and MCI

Background

Decreased speed of information processing is a hallmark of Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Recent studies suggest that response speed (RS) measures are very sensitive indicators of changes in longitudinal follow-up studies. Insight into the psycho-physiological underpinnings of slowed RS can be provided by measuring the associated event-related potentials (ERP).

Aims

The current study aims to investigate the relation between RS and its psycho-physiological correlates in AD and MCI.

Methods

Fifteen psychoactive drug-naïve AD patients, 20 MCI patients and twenty age-matched, healthy control subjects participated. Response speed was measured during a simple (SRT) and choice reaction time task (CRT). An oddball and contingent negative variation (CNV) paradigm were used to elicit ERP. To evaluate test-retest reliability (TRR), subjects underwent a similar assessment one week after the first.

Results

The SRT and CRT distinguished the patient groups significantly. The P300 amplitude and latency also distinguished the groups and showed a significant correlation with response speed. The CNV amplitude did not reveal a significant difference between groups and also showed a low TRR.The TRR of the SRT, CRT and P300 amplitude and latency in general was moderate to high.The current study suggests that response speed measures on a behavioural and psycho-physiological level deserve attention as a possible marker in the diagnosis and follow-up of AD.     

Are parenting interventions effective in improving the relationship between mothers and their preterm infants?

Aim

To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants.

Method

Randomized or quasi-randomized controlled trials (RCT) of parenting interventions for mothers of preterm infants where mother–infant relationship quality outcomes were reported. Databases searched: The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science.

Results

Seventeen studies met the inclusion criteria, 14 with strong methodological quality. Eight parenting interventions were found to improve the quality of the mother–preterm infant relationship.

Conclusions

Heterogeneity of the interventions calls for an integrated new parenting program focusing on cue-based, responsive care from the mother to her preterm infant to improve the quality of the relationship for these mother–preterm infant dyads.     

Long-term memory loss in senescent rats: neuropsychological analysis of interference and context effects

Four experiments are reported in which normal, senescent (25-27 months) and young adult (6 months) rats were tested for recall of a passive avoidance response 1 hr or several weeks after conditioning. There were no age differences at the 1-hr test, but a decrement was observed in old rats tested under standard conditions after long delays. The age-related impairment was exaggerated when additional approach training was administered in an identical apparatus between avoidance conditioning and testing. When the approach training was administered in an apparatus that contrasted markedly from the original, no age differences were observed. It was concluded that increased susceptibility to interference and contextual factors contributed to rapid forgetting in old rats, a pattern very similar to that observed previously in young adult rats with selective lesions to the hippocampus.     

Cognitive behaviour therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study

Background

Mental health problems such as depression and anxiety are common in Multiple Sclerosis (MS) and are often under treated.

Aims

This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous randomised controlled trials (RCTs) of cognitive behaviour therapy (CBT) in this population.

Methods

49 patients were deemed appropriate for CBT and 29 accepted treatment. Assessments were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale. Results in the form of a standardized effect of treatment were compared with five previous RCTs.

Results

The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety. The uncontrolled effect size was large but inferior to those found in published RCTs.

Conclusions

Cognitive behaviour therapy is effective for people with MS in routine clinical practice. Possible limits on effectiveness include more liberal patient selection, lack of specificity in rating scales and heterogeneity of target problems. Given the high rates of distress in this population, routine psychological interventions within neurology services are justifiable. Future research should aim to maximise CBT in such settings.     

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

Comparison of tongue muscle characteristics of preterm and full term infants during nutritive and nonnutritive sucking

Background

Independent oral feeding requires coordination of suck, swallow and breathe and the lingual musculature plays a significant role in this coordinative action. However, clinical benchmarks of lingual function fundamental to successful feeding have not been explored.

Aims

The present study tests our model for quantifying infant lingual force and size and compares the muscle measures of interest in two cohorts: healthy full-term infants (FT) (N = 5) and healthy preterm infants (PT) (N = 6).

Method

Using an instrumented pacifier and bottle nipple, we determined the resultant compressive forces applied to the nipple by the tongue during nutritive (NS) and nonnutritive sucking (NNS). Muscle size was estimated from measures of posterior tongue thickness using ultrasonography.

Results

After controlling for weight and post menstrual age, statistically significant differences were found between FT and PT infants beginning to feed for NNS frequency and NS tongue force. Clinically significant differences were detected for NNS tongue force and posterior tongue thickness. Additionally, PT infants demonstrated a significant difference in mean tongue force between NS and NNS and FT infants did not. FT infants demonstrated a significant difference in mean frequency between NS and NNS and PT infants did not. Linear regression indicated that mean posterior tongue thickness alone predicted 55% of the variance in NS force.

Conclusions

Results demonstrate the feasibility of our approach and suggest that infant tongue muscle characteristics necessary for successful feeding differ between healthy full term infants and preterm infants who are beginning oral feeding.     

Self-help for binge eating disorder in primary care: A randomized controlled trial with ethnically and racially diverse obese patients

Objective

The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center.

Method

48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment.

Results

Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition.

Conclusions

Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.     

Aberrant neural mediation of verbal fluency in autism spectrum disorders

Objective

Contrasts of verbal fluency and automatic speech provide an opportunity to evaluate the neural underpinnings of generativity and flexibility in autism spectrum disorders (ASD).

Method

We used functional magnetic resonance imaging (fMRI) to contrast brain activity in high functioning ASD (n = 17, mean verbal IQ = 117) and neurotypical (NT; n = 20, mean verbal IQ = 112) adolescent and young adult males (12–23 years). Participants responded to three word generation conditions: automatic speech (reciting months), category fluency, and letter fluency.

Results

Our paradigm closely mirrored behavioral fluency tasks by requiring overt, free recall word generation while controlling for differences in verbal output between the groups and systematically increasing the task demand. The ASD group showed reduced neural response compared to the NT participants during fluency tasks in multiple regions of left anterior and posterior cortices, and sub-cortical structures. Six of these regions fell in cortico-striatal circuits previously linked to repetitive behaviors (Langen, Durston, Kas, van Engeland, & Staal, 2011), and activity in two of them (putamen and thalamus) was negatively correlated with autism repetitive behavior symptoms in the ASD group. In addition, response in left inferior frontal gyrus was differentially modulated in the ASD, relative to the NT, group as a function of task demand.

Conclusions

These data indicate a specific, atypical brain response in ASD to demanding generativity tasks that may have relevance to repetitive behavior symptoms in ASD as well as to difficulties generating original verbal responses.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

Emotional reactivity and regulation in preschool-age children who stutter

Purpose.

This study experimentally investigated behavioral correlates of emotional reactivity and emotion regulation and their relation to speech (dis)fluency in preschool-age children who do (CWS) and do not (CWNS) stutter during emotion-eliciting conditions.

Method.

Participants (18 CWS, 14 boys; 18 CWNS, 14 boys) completed two experimental tasks (1) a neutral (“apples and leaves in a transparent box,” ALTB) and (2) a frustrating (“attractive toy in a transparent box,” ATTB) task, both of which were followed by a narrative task. Dependent measures were emotional reactivity (positive affect, negative affect), emotion regulation (self-speech, distraction) exhibited during the ALTB and the ATTB tasks, percentage of stuttered disfluencies (SDs) and percentage of non-stuttered disfluencies (NSDs) produced during the narratives.

Results.

Results indicated that preschool-age CWS exhibited significantly more negative emotion and more self-speech than preschool-age CWNS. For CWS only, emotion regulation behaviors (i.e., distraction, self-speech) during the experimental tasks were predictive of stuttered disfluencies during the subsequent narrative tasks. Furthermore, for CWS there was no relation between emotional processes and non-stuttered disfluencies, but CWNS's negative affect was significantly related to nonstuttered disfluencies.

Conclusions.

In general, present findings support the notion that emotional processes are associated with childhood stuttering. Specifically, findings are consistent with the notion that preschool-age CWS are more emotionally reactive than CWNS and that their self-speech regulatory attempts may be less than effective in modulating their emotions.Educational objectives. The reader will be able to: (a) communicate the relevance of studying the role of emotion in developmental stuttering close to the onset of stuttering and (b) describe the main findings of the present study in relation to previous studies that have used different methodologies to investigate the role of emotion in developmental stuttering of young children who stutter.     

Hemispheric connectivity and the visual–spatial divergent-thinking component of creativity

Background/hypothesis

Divergent thinking is an important measurable component of creativity. This study tested the postulate that divergent thinking depends on large distributed inter- and intra-hemispheric networks. Although preliminary evidence supports increased brain connectivity during divergent thinking, the neural correlates of this characteristic have not been entirely specified. It was predicted that visuospatial divergent thinking would correlate with right hemisphere white matter volume (WMV) and with the size of the corpus callosum (CC).

Methods

Volumetric magnetic resonance imaging (MRI) analyses and the Torrance Tests of Creative Thinking (TTCT) were completed among 21 normal right-handed adult males.

Results

TTCT scores correlated negatively with the size of the CC and were not correlated with right or, incidentally, left WMV.

Conclusions

Although these results were not predicted, perhaps, as suggested by Bogen and Bogen (1988), decreased callosal connectivity enhances hemispheric specialization, which benefits the incubation of ideas that are critical for the divergent-thinking component of creativity, and it is the momentary inhibition of this hemispheric independence that accounts for the illumination that is part of the innovative stage of creativity. Alternatively, decreased CC size may reflect more selective developmental pruning, thereby facilitating efficient functional connectivity.