Cognitive manipulation of GSR extinction: Analogues for conditioning therapies

Cognitive determinants of GSR activity during extinction trials were examined following conditioning. Conditioned GSRs extinguished rapidly when subjects were informed the UCS would not again be administered, compared to subjects not given this information. Of greater interest was the finding that (false) high feedback concerning subjects’ responsivity to the Cs+ during extinction served to maintain GSR activity at a higher level than subjects receiving (false) low feedback. The relationship was observed within both information conditions. Implications are drawn for both aversive conditioning therapy and systematic desensitization.     

Boundary Management for Cognitive Behavioral Therapies

In recent years, the scholarship regarding professional boundaries has increased significantly in a variety of areas. Despite many advances in this line of research, less attention has been devoted to the question of boundary maintenance and its relationship to theoretical orientation. In this article we examine these issues for cognitive-behavioral therapies. After a brief historical review of the evolution of the concept of boundaries, we select three procedures integral to cognitive-behavioral practice and discuss how they may create boundary problems for practitioners. We conclude with recommendations for practice.     

Cognitive conditioning: Imagined stimulus contiguity and the third interval conditional GSR

The effect of repeatedly imagining paired or unpaired CSs and USs on the frequency of post-CS responses during real extinction was studied. Four groups of 10 Ss first received a model tone and shock. For two of the groups the stimuli were paired (delayed conditioning paradigm). For the others the stimuli were arranged in a long trace paradigm. The Ss then received a series of commands requiring them to imagine receiving paired CSs and USs, or to imagine the events singly. Then 10 real tone extinction trials were given. The groups which received delayed conditioning model stimuli were more responsive than trace groups, and groups which had imagined paired stimuli were more responsive than their unpaired controls. Cognitively oriented explanations of these findings were discussed.     

First- and Second-Order Change: Implications for Rationalist and Constructivist Cognitive Therapies

Inquiry into the nature and process of change is fundamental to the domains of counseling and psychotherapy. Particularly relevant to counselors is an understanding of the distinction between first- and second-order change. This article clarifies the distinction and suggests a relationship between these two types of change and Mahoney's (1988) recent metatheoretical contrast between rationalist and constructivist approaches to counseling. Specifically, it is proposed that rationalist approaches are guided by first-order assumptions about change whereas constructivist approaches are based on second-order principles and processes. Within this context, a number of implications for the counseling practitioner are discussed.     

GSR amplitude instead of GSR magnitude: Caveat emptor!

Size of GSR made by 300 Ss to 20 repetitions of a visual stimulus is presented as mean magnitude and mean amplitude, illustrating that the amplitude method (averaging only those responses which are greater than zero) is susceptible to distortion resulting from a systematic elimination of Ss who initially make small responses. From trial to trial, the amplitude function comes more and more to be due to the behavior of Ss who initially make large responses. Even though the latter Ss’ responses actually reduce across trials, the amplitude function rises. Magnitude (including zeroes) docs not suffer from this distortion. It is suggested that the definition of a zero response is the source of the problem.     

Cognitive Restructuring-Assistance in the Clinical Extinction of Fear and Avoidance

Abstract

Two case studies are presented in which the attempted extinction of negative reinforcement-maintained behavior was unsuccessful because clients were unable to completely stop avoiding the target situations. Clinical treatment was based on the hypothesis that a self-control deficit caused the problem behavior to be maintained because of partial negative reinforcement. In the first case, a male college student experienced considerable anxiety while urinating in public restrooms. He frequently avoided or escaped restrooms with people in them, thus causing a number of secondary problems. The second case was a college female who engaged in an obsessive-compulsive chain in which a catastro-phizing thought set the occasion for engaging in compulsive behavior. The compulsive behavior was taking up a large amount of her time. After unsuccessfully using therapeutic instructions designed to preclude avoidance, systematic cognitive restructuring was used as a way to increase the likelihood clients would follow instructions and discontinue avoidance behavior by decreasing the mediational control of negative and irrational verbal behaviors. Both cases showed that compliance with the extinction instructions was enhanced by combining cognitive restructuring with the treatment program.     

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets–cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes–restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Effects of Emotional Valence and Arousal Manipulation on Eyeblink Classical Conditioning and Autonomic Measures

Using a classical eyeblink conditioning paradigm, we have previously shown that the rate of acquisition of a conditioned response may be manipulated by engaging subjects in background tasks of varying complexity concurrent to conditioning. To further examine the influence of the background environment on conditioning, a picture set designed to elicit emotional responses, the International Affective Picture System (IAPS), was presented to subjects during classical eyeblink conditioning. The results suggest that eyeblink conditioning does appear to be sensitive to contextual manipulations of arousal. Pictures rated as very arousing were found to engage subjects enough to enhance learning, although not to the point that autonomic functions were significantly altered between picture groups. We suggest that group differences in learning may be a result of either novelty of, or vigilance to, interesting pictures rather than as a direct result of physiological arousal.     

A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes

This paper critically examines the historical conceptualization of cognitive behavioral psychotherapy approaches (CBT) as a direct clinical counterpart of the cognitive revolution. The main “second wave” cognitive psychotherapies, either standard cognitive therapy (CT) or constructivist, in spite of their differences, share a common conceptualization of psychopathological factors as superordinate structural cognitive content belonging to the self: self-beliefs, self-schemata, personality organizations and so on. On the other hand, rational emotive behavior therapy (REBT) is an exception given that in REBT self-knowledge is not the core psychopathological tenet, being rather a derivate mechanism. Moreover, in non clinical cognitive science cognition is conceived as a regulatory function that operates retroactively and not in a hierarchically super- ordered fashion centered on the self. A historical review suggests that in both CT and constructivist model the structuralistic model of self-centered cognition may have emerged for both cultural and scientific reasons: self-centered cognitive models may be more readily understandable to clinicians as they allow for a straightforward identification of operationalizable self-beliefs. The emergence of new “third wave” process-centered CBT approaches may represent a comeback to functionalism, where cognition is considered again a regulatory function and not a structure. In addition, REBT’s interest in dysfunctional evaluations not focused on the self presaged this clinical and scientific turning point toward functionalism.     

Economic Impact of Third-Wave Cognitive Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials

The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration’s tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.