Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.     

Cultural Considerations for Treating PTSD in Latinx Sexual Assault Survivors With Prolonged Exposure

There is growing interest in the implementation of culturally responsive mental health care that balances treatment fidelity and cultural fit (Castro et al., 2004). Prolonged exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD) and has been successfully implemented in low-income and ethnoracial minority samples (Feske, 2008) and with Latinx individuals specifically (Vera et al., 2011). However, cultural and systemic factors may contribute to Latinx individuals experiencing higher conditional risk for PTSD (Alcántara et al., 2013), disparities in mental health care utilization (Alves-Bradford et al., 2020), and challenges with PTSD treatment delivery (Valentine et al., 2017). Culturally responsive implementation of PE with Latinx clients involves making culturally informed but person-specific assessments of clients, with adaptations as needed. We propose several culturally responsive strategies for therapists to consider when conducting PE with Latinx sexual assault survivors, such as building trust and rapport early on, conducting culturally informed assessment, investing in psychoeducation, optimizing imaginal exposure and in vivo exposure, and problem-solving barriers to homework engagement. Therapists are encouraged to approach this work with cultural humility (Fisher-Borne et al., 2015; Tervalon & Murray-Garcia, 1998) through open listening, critical self-reflection, and consideration for the way in which Latinx identity intersects with other important identity characteristics that can impact treatment relevance and engagement.     

复合字母刺激心理旋转加工中的整体优先效应

采用复合字母材料结合正镜像判断任务,首次揭示了心理旋转加工中的整体优先效应。实验一延长复合字母材料的呈现时间,检验心理旋转实验常用的正/镜像判断任务中的视知觉整体优先效应;实验二将实验一的复合字母材料旋转一定角度,考察心理旋转加工中的整体优先效应。结果发现：（1）延长复合字母呈现时间后的字母正镜像判断任务中,被试判断大字母和判断小字母的时间没有显著差异,并且大小字母是否一致对大字母判断和小字母判断的影响无显著差异;（2）在排除了视知觉的整体优先效应存在的情况下,发现心理旋转加工中存在明显的整体优先效应,大字母（整体）旋转条件下的反应时显著短于小字母（局部）旋转条件下的反应时;（3）旋转角度一致性对大字母旋转和小字母旋转条件下的反应时均无显著影响,表明心理旋转的整体优先效应模式可能有别于视知觉加工的整体优先效应模式     

Athlete doping confrontation efficacy and confrontation likelihood

Evidence supports the role of coach doping confrontation efficacy (DCE; Sullivan et al., 2015) as a deterrent against athletes’ doping cognitions (Boardley et al., 2019; Sullivan & Razavi, 2017), but the role of the athlete has largely been ignored. Current anti-doping campaigns encourage athletes to report doping misconduct (i.e., whistleblowing), but some athletes would prefer to confront the athlete directly (Erickson et al., 2017). Thus, it is important to consider what may contribute to athletes’ likelihood to confront a doping teammate or opponent. The purpose of this study was to determine whether DCE could predict an athlete’s likelihood to confront a doping teammate or opponent. Additionally, doping moral disengagement (MD) was included as a possible moderator of this relationship. Surveys were completed by 155 college athletes (n_male = 145) to measure their perceived DCE, doping MD, likelihood to confront a teammate, and likelihood to confront an opponent. Separate linear regression analyses were run for the two targets of confrontation. In the teammate model, both DCE and doping MD were significant predictors of confrontation likelihood. DCE was the only significant predictor in the opponent model. Neither model presented with a significant interaction, suggesting no moderation effect. Results suggest perceived DCE is associated with a greater likelihood to confront a doping athlete, regardless of whether they are a teammate or opponent; however, moral disengagement plays a greater role if the athlete is a teammate. These findings imply that confrontation may be the first line of defense against doping before whistleblowing action is taken. Research should continue to explore antecedents and consequences of athlete doping confrontation, providing greater insight into the whistleblowing process.     

Mental rotation: cross-task training and generalization

It is well established that performance on standard mental rotation tasks improves with training (Peters et al., 1995), but thus far there is little consensus regarding the degree of transfer to other tasks which also involve mental rotation. In Experiment 1, we assessed the effect of mental rotation training on participants' Mental Rotation Test (MRT) scores. Twenty-eight participants were randomly assigned to one of three groups: a "One-Day Training," "Spaced Training," or "No Training" group. Participants who received training achieved higher scores on the MRT, an advantage that was still evident after 1 week. Distribution of training did not affect performance. Experiment 2 assessed generalization of mental rotation training to a more complex mental rotation task, laparoscopic surgery. Laparoscopic surgical skills were assessed using Fundamentals of Laparoscopic Surgery (FLS) tasks. Thirty-four participants were randomly assigned to a "Full Mental Rotation Training, MRT and FLS," "MRT and FLS," or "FLS-only" group. MRT results from Experiment 1 were replicated and mental rotation training was found to elicit higher scores on the MRT. Further, mental rotation training was found to generalize to certain laparoscopic surgical tasks. Participants who obtained mental rotation training performed significantly better on mental-rotation dependent surgical tasks than participants who did not receive training. Therefore, surgical training programs can use simple computer or paper-based mental rotation training instead of more expensive materials to enhance certain aspects of surgical performance of trainees.     

Individual differences in neonatal “imitation” fail to predict early social cognitive behaviour

The influential hypothesis that humans imitate from birth – and that this capacity is foundational to social cognition – is currently being challenged from several angles. Most prominently, the largest and most comprehensive longitudinal study of neonatal imitation to date failed to find evidence that neonates copied any of nine actions at any of four time points (Oostenbroek et al., [2016] Current Biology, 26, 1334–1338). The authors of an alternative and statistically liberal post‐hoc analysis of these same data (Meltzoff et al., [2017] Developmental Science, 21, e12609), however, concluded that the infants actually did imitate one of the nine actions: tongue protrusion. In line with the original intentions of this longitudinal study, we here report on whether individual differences in neonatal “imitation” predict later‐developing social cognitive behaviours. We measured a variety of social cognitive behaviours in a subset of the original sample of infants (N = 71) during the first 18 months: object‐directed imitation, joint attention, synchronous imitation and mirror self‐recognition. Results show that, even using the liberal operationalization, individual scores for neonatal “imitation” of tongue protrusion failed to predict any of the later‐developing social cognitive behaviours. The average Spearman correlation was close to zero, mean r_s = 0.027, 95% CI [?0.020, 0.075], with all Bonferroni adjusted p values > .999. These results run counter to Meltzoff et al.'s rebuttal, and to the existence of a “like me” mechanism in neonates that is foundational to human social cognition.     

Single-letter coloring and spatial cuing do not eliminate or reduce a semantic contribution to the Stroop effect

The automaticity of semantic activation in the Stroop task is still the subject of considerable debate (Augustinova & Ferrand, 2007; Manwell, Roberts, & Besner, 2004). The present experiments were designed to assess whether coloring and cuing a single letter (vs. all letters) in the Stroop task reliably eliminates semantically based Stroop interference or whether the elimination observed by Manwell et al. was due to insufficient statistical power. Experiment 1 was an exact replication of the experiment conducted by Manwell and colleagues and involved a large population. Experiment 2 replicated and extended Experiment 1 by controlling for initial fixation. In line with previous findings obtained by Augustinova and Ferrand, both experiments indicated that coloring and cuing a single letter failed to eliminate or even reduce the semantically based Stroop effect. Thus, these results add to the growing body of evidence suggesting that semantic activation in the Stroop task is automatic.     

Repetition benefit in mental rotation is independent of stimulus repetition

In this study, we investigated whether there is a repetition benefit in mental rotation that is independent of stimulus repetition (i.e., due to increased efficiency in postencoding processing). Three experiments were conducted, in which different conditions of stimulus repetition (different letters on consecutive trials in Experiment 1, letters of different orientations on consecutive trials in Experiment 2, and priming of rotation direction in Experiment 3) were used, and the extent of repetition of rotation direction between two consecutive trials was manipulated. The results of all three experiments showed clear evidence of a repetition benefit without repeating the stimulus, suggesting that this effect is independent of stimulus repetition and lending support to the notion of increased efficiency in mental rotation as a result of repeated rotation direction per se.     

A meta-analysis of mental rotation in the first years of life

Mental rotation, the cognitive process of moving an object in mind to predict how it looks in a new orientation, is coupled to intelligence, learning, and educational achievement. On average, adolescent and adult males solve mental rotation tasks slightly better (i.e., faster and/or more accurate) than females. When such behavioral differences emerge during development, however, remains poorly understood. Here we analyzed effect sizes derived from 62 experiments conducted in 1705 infants aged 3–16 months. We found that male infants recognized rotated objects slightly more reliably than female infants. This difference survives correction for small degrees of publication bias. These findings indicate that gender differences in mental rotation are small and not robustly detectable in the first months of postnatal life.

Research Highlights

• We analyzed effect sizes of 62 mental rotation experiments including 1705 infants.
• Looking time reveals that 3–16-months-old infants are able to perform mental rotation.
• Mental rotation is slightly more reliable in male infants compared to female infants.
• Gender difference in mental rotation is robust to small degrees of publication bias.

     

Biases in research evaluation: Inflated assessment, oversight, or error-type weighting?

Reviewers of research are more lenient when evaluating studies on important topics [Wilson, T. D., Depaulo, B. M., Mook, D. G., & Klaaren, K. J. (1993). Scientists’ evaluations of research: the biasing effects of the importance of the topic. Psychological Science, 4(5), 323-325]. Three experiments (N = 145, 36, and 91 psychologists) investigated different explanations of leniency, including inflation of assessments (applying a heuristic associating importance with quality), oversight (failing to detect flaws), and error-weighting (prioritizing Type II error avoidance). In Experiment 1, psychologists evaluated the publishability and rigor of studies in a 2 (topic importance) × 2 (accuracy motivation) × 2 (research domain) design. Experiment 2 featured an exact replication of Wilson et al. and suggested that report length moderated the effects of importance on perceived rigor, but not on publishability. In Experiment 3, a manipulation of error-weighting replaced the manipulation of domain (Experiment 1). Results favored error-weighting, rather than inflation or oversight. Perceived seriousness of Type II error (in Experiments 1 and 3) and the error-weighting manipulation (in Experiment 3) predicted study evaluations.     

Comprehension of the Referential Intent of Looking and Pointing Between 12 and 15 Months

Butler, Caron, & Brooks (2000) tested the gaze following of 14-and 18-month-olds under 3 conditions: (1) when the adult's view of the targets was blocked by barriers, (2) when the barriers contained open windows, and (3) no barriers. Contrary to a nonmentalist "ecological" model (adult turns serve as cues to the location of interesting events), frequency of gaze following by 14-month-olds was not equivalent across the 3 conditions. Contrary to a mentalist model (infant wants to see what the adult is seeing), gaze following was not substantially less in the barrier than in the window and no-barrier conditions (as was the case for 18-month-olds). To examine whether the barriers posed vector projection problems for essentially nonmentalist, or line-of-sight problems for essentially mentalist younger infants, 3 experiments were conducted. In Experiment 1, a 12-month group was tested in the same 3 conditions to determine if, being younger, they might yield a more clearcut nonmentalist pattern. Contrarily, they behaved like Butler et al.'s 14-month-olds. In Experiment 2, a 14-month group was tested in the barrier and window conditions, but now combining pointing with turning. Infants behaved as predicted by the mentalist model: strong responding in the window condition and minimal in the barrier (where many strained to look inside the partitions). In Experiment 3, an attempt was made to differentiate between mentalist and "geometric" (vector projection) interpretations of the results of Experiment 2 by testing another 14-month group with the adult's eyes closed while pointing. Gaze following now dropped precipitously in the window condition as did looking inside the solid barriers, indicating (1) that infants in Experiment 2 had not simply been guided to target by an extended arm, but construed it as part of a referential act that was as much visual as gestural, and (2) that by 14 months, infants may have acquired a mentalistic concept of seeing.     

Exploring block construction and mental imagery: Evidence of atypical orientation discrimination in Williams syndrome

The visuospatial perceptual abilities of individuals with Williams syndrome (WS) were investigated in two experiments. Experiment 1 measured the ability of participants to discriminate between oblique and between nonoblique orientations. Individuals with WS showed a smaller effect of obliqueness in response time, when compared to controls matched for nonverbal mental age. Experiment 2 investigated the possibility that this deviant pattern of orientation discrimination accounts for the poor ability to perform mental rotation in WS (Farran, Jarrold, & Gathercole, 2001). A size transformation task was employed, which shares the image transformation requirements of mental rotation, but not the orientation discrimination demands. Individuals with WS performed at the same level as controls. The results suggest a deviance at the perceptual level in WS, in processing orientation, which fractionates from the ability to mentally transform images.     

Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research

Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.     

The relationship between peer servant leadership,social identity,and team cohesion in intercollegiate athletics

Servant leadership is characterized by a leader’s emphasis on serving their followers first. Within the sport context, servant leadership has been studied primarily in coaches and has been associated with positive athlete outcomes, such as increased athlete satisfaction, motivation, and performance. However, the impact of servant leadership from an athlete perspective (e.g., formal team captains) has been underexplored. As such, the purpose of the present study was to examine the relationships between peer servant leadership, cohesion, and social identity within intercollegiate athletes. Two hundred and eighty-eight Division I and Division III NCAA intercollegiate athletes participated in the present study (female n = 165; male n = 123; M_age = 19.41, SD_age = 1.09) and completed the Revised Servant Leadership Profile for Sport (RSLP-S; Hammermeister et al., 2008), Group Environment Questionnaire (GEQ; Carron et al., 1985; Eys et al., 2007), and Social Identity Questionnaire for Sport (SIQS; Bruner & Benson, 2018). Structural equation modeling was used to assess the relationships between peer servant leadership, cohesion, and social identity. Results revealed that peer servant leadership positively predicted cohesion, and this relationship was fully mediated by social identity. The current study supports the effectiveness of peer servant leadership in sport contexts and provides theoretical support for the social identity approach to leadership.     

Spatial and temporal separation fails to counteract the effects of low prevalence in visual search

Recent research has shown that, in visual search, participants can miss 30–40% of targets when they only appear rarely (i.e., on 1–2% of trials). Low target prevalence alters the behaviour of the searcher. It can lead participants to quit their search prematurely (Wolfe, Horowitz, & Kenner, 2005), to shift their decision criteria (Wolfe et al., 2007), and/or to make motor or response errors (Fleck & Mitroff, 2007). In this paper we examine whether the low prevalence (LP) effect can be ameliorated if we split the search set in two, spreading the task out over space and/or time. Observers searched for the letter “T” among “L”s. In Experiment 1, the left or right half of the display was presented to the participants before the second half. In Experiment 2, items were spatially intermixed but half of the items were presented first, followed by the second half. Experiment 3 followed the methods of Experiment 2 but allowed observers to correct perceived errors. All three experiments produced robust LP effects with higher errors at 2% prevalence than at 50% prevalence. Dividing up the display had no beneficial effect on errors. The opportunity to correct errors reduced but did not eliminate the LP effect. Low prevalence continues to elevate errors even when observers are forced to slow down and permitted to correct errors.     

“We” are familiar but “It” is not: Ingroup pronouns trigger feelings of familiarity

The notion that language can shape social perception has a long history in psychology. The current work adds to this literature by investigating the relationship between ingroup-designating pronouns and perceptions of familiarity. In two experiments, participants were exposed to nonsense syllables that were primed with ingroup (e.g., we) and control (e.g., it) pronouns before perceptions of the syllables’ familiarity (Experiments 1 and 2) and positivity (Experiment 2) were assessed. Because previous work has shown that ingroup pronouns are perceived positively (Perdue, Dovidio, Gurtman, & Tyler, 1990), and that positivity can trigger familiarity (e.g., [Garcia-Marques et al., 2004] and [Monin, 2003]), we predicted that syllables primed with ingroup-designating pronouns would be perceived as more familiar and positive than would syllables primed with control pronouns. These predictions were confirmed. Additionally, Experiment 2 provided suggestive evidence that the effect of ingroup pronouns on perceived familiarity is mediated by positivity. Implications of these results for the literatures on how language shapes intergroup biases and on how positivity triggers feelings of familiarity are discussed.     

中文阅读中的预视效应与词切分*

通过眼动随动显示技术操作注视点右侧文字的掩蔽范围和掩蔽单元,考察中文阅读的预视效应和词切分现象。研究包括两项实验。实验一以词为单元掩蔽注视点右侧的文字,发现词 n 右侧文本掩蔽(条件1)、词n+1右侧文本掩蔽(条件2)和词n+1掩蔽(条件3)均显著影响总阅读时间。其中,条件2剥夺了词n+1以右文字的预视加工,同时提供了词n+1的右侧边界线索,结果导致总阅读时间增加,并减少基于单词的平均凝视时间和再注视概率。实验二采用与实验一相同的处理方式,以不提供词边界的双字为单元掩蔽注视点右侧文字,结果发现掩蔽条件对阅读的影响程度甚于实验一,条件2基于词的平均凝视时间显著高于控制条件。综合两个实验的结果可见,中文读者能够切分出注视点右侧的第一个词汇,并以词为单元识别词n和词n+1处的汉字,在注视词n的时间内可加工到词n+2处的文字。     

Eating Disorders,Impaired Mentalization,and Attachment: Implications for Child and Adolescent Family Treatment

ABSTRACT

This article reviews the attachment and neuroscience model of Mentalization Based Treatment (MBT) (Allen, Fonagy, & Bateman, 2008) and its application for understanding and treating eating disorders (Skarderud & Fonagy, 2012). Mentalization, or mentalizing, refers to the capacity to apprehend one’s own and others’ behavior in terms of underlying mental states (needs, emotions, desires, beliefs, goals, reasons, and thoughts). Evidence from prospective studies suggests that insecure attachment and poor mentalizing difficulties may be risk factors for the development of eating pathology (Jewell et al., 2015; Rothschild-Yakar, Levy-Shiff, Fridman-Balaban, Gur, & Stein, 2010; Rothschild-Yakar & Stein, 2013). Preliminary research on the use of MBT for treating eating disorders, with nonsuicidal self-injury co-morbidity, suggests some promise for this model (Robinson et al., 2015). The theoretical rationale and key interventions of the MBT eating disorder model (MBT-ED) used in a multicenter research and treatment project are discussed (Skarderud & Fonagy, 2012; Robinson et al., 2015). Modifications of MBT-ED’s structure and techniques are proposed for family treatment of adolescent and child patients with eating disorders. Case example illustrates the impact of problems in the family system with mentalizing capacities on family cohesion, the therapeutic process, and the family’s ability to help the child recover.     

Mental rotation is not easily cognitively penetrable

When participants take part in mental imagery experiments, are they using their “tacit knowledge” of perception to mimic what they believe should occur in the corresponding perceptual task? Two experiments were conducted to examine whether such an account can be applied to mental imagery in general. These experiments both examined tasks that required participants to “mentally rotate” stimuli. In Experiment 1, instructions led participants to believe that they could reorient shapes in one step or avoid reorienting the shapes altogether. Regardless of instruction type, response times increased linearly with increasing rotation angles. In Experiment 2, participants first observed novel objects rotating at different speeds, and then performed a mental rotation task with those objects. The speed of perceptually demonstrated rotation did not affect the speed of mental rotation. We argue that tacit knowledge cannot explain mental imagery results in general, and that in particular the mental rotation effect reflects the nature of the underlying internal representation and processes that transform it, rather than participants’ pre-existing knowledge.