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.     

Trauma exposure is associated with increased context-dependent adjustments of cognitive control in patients with posttraumatic stress disorder and healthy controls

Recent evidence has suggested that posttraumatic stress disorder (PTSD) is associated with alterations in prefrontal-cortex-dependent cognitive processes (e.g., working memory, cognitive control). However, it remains unclear whether these cognitive dysfunctions are related to PTSD symptomatology or trauma exposure. Furthermore, regarding cognitive control, research has only focused on the integrity of selected control functions, but not their dynamic regulation in response to changing environmental demands. Therefore, the present study investigated dynamic variations in interference control, in addition to overall interference susceptibility and working memory (WM) performance in matched groups of 24 PTSD patients and 26 traumatized and 30 nontraumatized healthy controls. The Simon task was used to measure overall interference susceptibility and the flexible adjustment of cognitive control, on the basis of the occurrence of response conflicts (conflict adaptation effect). WM performance was assessed with the forward and backward digit span tasks. Since we have previously shown that trauma exposure per se is associated with reduced hair cortisol concentrations (HCC), we further explored whether PTSD/trauma-related cognitive alterations are related to HCC in proximal 3-cm hair segments. The results revealed that PTSD patients and traumatized controls showed significantly more pronounced conflict adaptation effects than nontraumatized controls. Moreover, the conflict adaptation effect was positively related to the number of lifetime traumatic events and the frequency of traumatization. The groups did not differ in overall interference susceptibility or WM performance. Exploratory analyses revealed no association between HCC and the observed cognitive differences. These results suggest that context-driven control adjustments constitute a sensitive correlate of trauma exposure, irrespective of PTSD.     

Active Listening Delays Attentional Disengagement and Saccadic Eye Movements

Successful goal-directed visual behavior depends on efficient disengagement of attention. Attention must be withdrawn from its current focus before being redeployed to a new object or internal process. Previous research has demonstrated that occupying cognitive processes with a secondary cellular phone conversation impairs attentional functioning and driving behavior. For example, attentional processing is significantly impacted by concurrent cell phone use, resulting in decreased explicit memory for on-road information. Here, we examined the impact of a critical component of cell-phone use—active listening—on the effectiveness of attentional disengagement. In the gap task—a saccadic manipulation of attentional disengagement—we measured saccade latencies while participants performed a secondary active listening task. Saccadic latencies significantly increased under an active listening load only when attention needed to be disengaged, indicating that active listening delays a disengagement operation. Simple dual-task interference did not account for the observed results. Rather, active cognitive engagement is required for measurable disengagement slowing to be observed. These results have implications for investigations of attention, gaze behavior, and distracted driving. Secondary tasks such as active listening or cell-phone conversations can have wide-ranging impacts on cognitive functioning, potentially impairing relatively elementary operations of attentional function, including disengagement.     

Neurocognitive mechanisms behind emotional attention: Inverse effects of anodal tDCS over the left and right DLPFC on gaze disengagement from emotional faces

Background

Attention to relevant emotional information in the environment is an important process related to vulnerability and resilience for mood and anxiety disorders. In the present study, the effects of left and right dorsolateral prefrontal cortex (i.e., DLPFC) stimulation on attentional mechanisms of emotional processing were tested and contrasted.

Methods

A sample of 54 healthy participants received 20 min of active and sham anodal transcranial direct current stimulation (i.e., tDCS) either of the left (n = 27) or of the right DLPFC (n = 27) on two separate days. The anode electrode was placed over the left or the right DLPFC, the cathode over the corresponding contra lateral supraorbital area. After each neurostimulation session, participants completed an eye-tracking task assessing direct processes of attentional engagement towards and attentional disengagement away from emotional faces (happy, disgusted, and sad expressions).

Results

Compared to sham, active tDCS over the left DLPFC led to faster gaze disengagement, whereas active tDCS over the right DLPFC led to slower gaze disengagement from emotional faces. Between-group comparisons showed that such inverse change patterns were significantly different and generalized for all types of emotion.

Conclusions

Our findings support a lateralized role of left and right DLPFC activity in enhancing/worsening the top-down regulation of emotional attention processing. These results support the rationale of new therapies for affective disorders aimed to increase the activation of the left over the right DLPFC in combination with attentional control training, and identify specific target attention mechanisms to be trained.

     

Effects of mineralocorticoid receptor blockade on empathy in patients with major depressive disorder

Background

The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex and is involved in social cognition. We recently found that pharmacological stimulation of the MR enhances emotional empathy but does not affect cognitive empathy. In the current study, we examined whether blockade of the MR impairs empathy in patients with major depressive disorder (MDD) and healthy individuals.

Methods

In a placebo-controlled study, we randomized 28 patients with MDD without psychotropic medication and 43 healthy individuals to either placebo or 300 mg spironolactone, a MR antagonist. Subsequently, all participants underwent two tests of social cognition, the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC), measuring cognitive and emotional facets of empathy.

Results

In the MET, we found no significant main effect of treatment or main effect of group for cognitive empathy but a highly significant treatment by group interaction (p < 0.01). Patients had higher cognitive empathy scores compared to controls in the placebo condition but not after spironolactone. Furthermore, in the spironolactone condition reduced cognitive empathy was seen in MDD patients but not in controls. Emotional empathy was not affected by MR blockade. In the MASC, no effect of spironolactone could be revealed.

Conclusion

Depressed patients appear to exhibit greater cognitive empathy compared to healthy individuals. Blockade of MR reduced cognitive empathy in MDD patients to the level of healthy individuals. Future studies should further clarify the impact of MR functioning on different domains of social cognition in psychiatric patients.

     

Social anxiety and attentional biases: A top-down contribution?

Selective attention toward threatening facial expressions has been found to precipitate and maintain symptoms of social anxiety. However, the automaticity of this bias is under debate. In the present study, we aimed to test whether top-down (controlled) engagement and disengagement of attention toward threatening faces is associated with social anxiety. This was examined by testing the impact of a secondary working memory (WM) load on attentional biases. In a variation of the dot-probe task, participants’ attention was initially cued to the left or right of fixation before an upright face paired with an inverted face was presented (displaying a disgust or neutral expression), and participants responded to a subsequently presented probe. The task was performed under no-load, low-load (one-digit memory task), and high-load (six-digit memory task) conditions. Social anxiety was not found to be associated with delayed disengagement from threat. However, surprisingly, high social anxiety was associated with an engagement bias away from threat, whereas low social anxiety was associated with a bias toward threat. These results were unaffected by the WM load manipulation. This indicates that engagement with threatening facial expressions has minimal contributions from top-down mechanisms, since it is likely that orienting to facial expressions occurs relatively automatically.     

急性应激对威胁刺激注意定向和注意解除的影响:认知神经机制研究

急性应激和注意偏向是焦虑障碍和创伤后应激障碍发生和症状保持的两个重要因素。急性应激导致交感神经系统激活以及儿茶酚胺和糖皮质激素分泌增加,因而影响对威胁刺激的注意偏向。但是急性应激如何影响注意偏向中的注意定向和注意解除尚不清楚。本项目采用点探测任务、威胁线索空间提示任务,结合恐惧条件反射、眼动和事件相关电位技术,研究急性应激对注意定向和注意解除影响的认知神经机制。研究结果可为治疗焦虑和创伤后应激障碍提供支持,为公共卫生管理政策的制定提供建议。     

<Emphasis Type="Italic">DSM-5</Emphasis> Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8 % girls) with age ranging from 13 to 17 years (M = 14.3, SD = 0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.     

Stress Reactivity as a Pathway from Attentional Control Deficits in Everyday Life to Depressive Symptoms in Adolescent Girls

The goal of this research was to expand theoretical models of adolescent depression to determine whether individual differences in cognitive processing—specifically attentional control deficits—help to explain increased risk for depression during adolescence. We also examined whether this pathway was stronger in girls than in boys. A longitudinal design was used to examine whether poor attentional control in everyday life (i.e., difficulties shifting between ideas, tasks, and activities) contributes to depression over time by fostering higher levels of stress reactivity. Youth (298 boys, 338 girls) completed questionnaires assessing stress reactivity (6th and 7th grades) and depressive symptoms (6th, 7th and, 8th grades); teachers completed the shifting subscale of the Behavior Rating Scale of Executive Function (Gioia et al. 2000a) to assess attentional control (6th and 7th grades). Structural equation modeling analyses provided support for the predicted pathway in girls but not boys, yielding a significant indirect effect from 6th grade shifting deficits to 8th grade depressive symptoms via 7th grade stress reactivity. These results suggest that attentional control deficits in early adolescence heighten girls’ sensitivity to stress and consequent depressive symptoms, providing a critical direction for efforts to decrease adolescent girls’ risk for depression.     

More than meets the eye: The attentional blink in multisensory environments. Commentary on Kranczioch and Thorne

Temporal fluctuations of attention can influence performance of cognitive tasks substantially. A common paradigm to investigate temporal fluctuations of attention is the attentional blink paradigm. Kranczioch and Thorne (2013) report new evidence for the impact of auditory stimuli on the visual attentional blink in the current issue of Advances in Cognitive Psychology.     

Alertness and cognitive control: Is there a spatial attention constraint?

Congruency effects in arrow flanker tasks are often larger when subjects are more alert, suggesting an unusual connection between alertness and cognitive control. Theoretical accounts of the alerting–congruency interaction differ with respect to whether and how spatial attention is involved. In the present study, the author conducted eight experiments to determine whether there is a spatial attention constraint linking alertness to cognitive control. Alertness was manipulated in color-word Stroop tasks involving stimuli that were spatially integrated (Experiments 1–3) or separated (Experiments 4 and 5), as well as in Stroop-like tasks involving spatially separated stimuli for which the irrelevant stimulus features were spatial words (Experiments 6 and 7) or arrows (Experiment 8). All experiments yielded effects of alerting and congruency, but none produced the alerting–congruency interaction typically found with arrow flanker tasks. The results suggest that there is a spatial attention constraint on the relationship between alertness and cognitive control, part of which might involve having a task goal associated with spatial information processing.     

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.     

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.     

Summary statistics in the attentional blink

We used the attentional blink (AB) paradigm to investigate the processing stage at which extraction of summary statistics from visual stimuli (“ensemble coding”) occurs. Experiment 1 examined whether ensemble coding requires attentional engagement with the items in the ensemble. Participants performed two sequential tasks on each trial: gender discrimination of a single face (T1) and estimating the average emotional expression of an ensemble of four faces (or of a single face, as a control condition) as T2. Ensemble coding was affected by the AB when the tasks were separated by a short temporal lag. In Experiment 2, the order of the tasks was reversed to test whether ensemble coding requires more working-memory resources, and therefore induces a larger AB, than estimating the expression of a single face. Each condition produced a similar magnitude AB in the subsequent gender-discrimination T2 task. Experiment 3 additionally investigated whether the previous results were due to participants adopting a subsampling strategy during the ensemble-coding task. Contrary to this explanation, we found different patterns of performance in the ensemble-coding condition and a condition in which participants were instructed to focus on only a single face within an ensemble. Taken together, these findings suggest that ensemble coding emerges automatically as a result of the deployment of attentional resources across the ensemble of stimuli, prior to information being consolidated in working memory.     

Influence of emotional task relevancy on the temporal dynamic of attentional bias in people with high-trait anxiety

ABSTRACT

It is unknown whether high-trait anxiety (HTA) individuals show facilitated attention or impaired attentional disengagement. In the present study, we have manipulated emotion and task relevance to explore the temporal dynamic of attentional bias in an HTA group via emotional attentional blink (EAB) and emotion-induced blindness (EIB). The results showed that the attentional blink effect was greater in the negative compared to neutral condition. When emotional stimulation was task-irrelevant at lag6, this enhanced effect was only present for the HTA group, indicating impaired attentional disengagement. However, when emotional stimulation was task-relevant at lag4, the enhanced attentional blink was absent for HTA but still present for LTA until lag8, suggesting facilitated attention for HTA. Thus, task relevancy of emotional distractor appears to influence attention biases in HTA individuals. In addition, individual characteristics modulate the magnitude and time window of the attentional blink in the context of EIB and EAB tasks.     

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.     

Multiple attentional control settings at distinct locations without the confounding of repetition priming

An attentional control setting (ACS), which is based on the task goal, induces involuntary attentional capture by a stimulus possessing a target-defining feature. It is unclear whether ACSs are maintained for multiple targets defined as conjunctions of a color and location. In the present study we examined the possibility of local ACSs for dual targets defined as combinations of color and location, using different paradigms: visual search in Experiment 1, and spatial cueing in Experiment 2. In Experiment 1, a distractor captured attention only when its features matched the ACSs. Likewise, in Experiment 2, a significant attentional capture effect was found only with a matching cue, whose color and location were in line with the conjunction of the target definition. Importantly, the identical pattern of attentional capture was also obtained for a neutral-color target, which was unlikely to be primed by any color of the cue. Thus, these findings imply that the attentional bias depending on the match between the cue and target did not result from cue–target repetition priming. The present study highlights that top-down attentional control can be set flexibly to accomplish a complex task goal efficiently.     

Negative Affectivity, Effortful Control, and Attention to Threat-Relevant Stimuli

There is increasing recognition of temperamental influences on risk for psychopathology. Whereas the link between the broad temperament construct of negative affectivity (NA) and problems associated with anxiety and depression is now well-established, the mechanisms through which this link operate are not well understood. One possibility involves interactions between reactive and effortful components of temperament, as well as cognitive factors, like attentional biases to threat stimuli. This study tested a predicted relation between high levels of NA, low levels of effortful control (EC), and an attentional bias toward threat in children. A sample of 104 4th through 12th graders, selected from a larger screening sample because they reported high or low levels of trait NA and EC, completed a dot probe detection task. Results indicated that EC moderated the relation between NA and attentional bias; only children with low levels of EC and high levels of NA showed an attentional bias to threat stimuli. This pattern was not moderated by grade level or age.

Reduced Value-Driven Attentional Capture Among Children with ADHD Compared to Typically Developing Controls

The current study examined whether children with ADHD were more distracted by a stimulus previously associated with reward, but currently goal-irrelevant, than their typically-developing peers. In addition, we also probed the associated cognitive and motivational mechanisms by examining correlations with other behavioral tasks. Participants included 8–12 year-old children with ADHD (n = 30) and typically developing controls (n = 26). Children were instructed to visually search for color-defined targets and received monetary rewards for accurate responses. In a subsequent search task in which color was explicitly irrelevant, we manipulated whether a distractor item appeared in a previously reward-associated color. We examined whether children responded more slowly on trials with the previously-rewarded distractor present compared to trials without this distractor, a phenomenon referred to as value-driven attentional capture (VDAC), and whether children with and without ADHD differed in the extent to which they displayed VDAC. Correlations among working memory performance, immediate reward preference (delay discounting) and attentional capture were also examined. Children with ADHD were significantly less affected by the presence of the previously rewarded distractor than were control participants. Within the ADHD group, greater value-driven attentional capture was associated with poorer working memory. Although both ADHD and control participants were initially distracted by previously reward-associated stimuli, the magnitude of distraction was larger and persisted longer among control participants.     

Rejecting salient distractors: Generalization from experience

Distraction impairs performance of many important, everyday tasks. Attentional control limits distraction by preferentially selecting important items for limited-capacity cognitive operations. Research in attentional control has typically investigated the degree to which selection of items is stimulus-driven versus goal-driven. Recent work finds that when observers initially learn a task, the selection is based on stimulus-driven factors, but through experience, goal-driven factors have an increasing influence. The modulation of selection by goals has been studied within the paradigm of learned distractor rejection, in which experience over a sequence of trials enables individuals eventually to ignore a perceptually salient distractor. The experiments presented examine whether observers can generalize learned distractor rejection to novel distractors. Observers searched for a target and ignored a salient color-singleton distractor that appeared in half of the trials. In Experiment 1, observers who learned distractor rejection in a variable environment rejected a novel distractor more effectively than observers who learned distractor rejection in a less variable, homogeneous environment, demonstrating that variable, heterogeneous stimulus environments encourage generalizable learned distractor rejection. Experiments 2 and 3 investigated the time course of learned distractor rejection across the experiment and found that after experiencing four color-singleton distractors in different blocks, observers could effectively reject subsequent novel color-singleton distractors. These results suggest that the optimization of attentional control to the task environment can be interpreted as a form of learning, demonstrating experience’s critical role in attentional control.