(Mis)perception of sleep in insomnia: a puzzle and a resolution

Insomnia is prevalent, causing severe distress and impairment. This review focuses on illuminating the puzzling finding that many insomnia patients misperceive their sleep. They overestimate their sleep onset latency (SOL) and underestimate their total sleep time (TST), relative to objective measures. This tendency is ubiquitous (although not universal). Resolving this puzzle has clinical, theoretical, and public health importance. There are implications for assessment, definition, and treatment. Moreover, solving the puzzle creates an opportunity for real-world applications of theories from clinical, perceptual, and social psychology as well as neuroscience. Herein we evaluate 13 possible resolutions to the puzzle. Specifically, we consider the possible contribution, to misperception, of (1) features inherent to the context of sleep (e.g., darkness); (2) the definition of sleep onset, which may lack sensitivity for insomnia patients; (3) insomnia being an exaggerated sleep complaint; (4) psychological distress causing magnification; (5) a deficit in time estimation ability; (6) sleep being misperceived as wake; (7) worry and selective attention toward sleep-related threats; (8) a memory bias influenced by current symptoms and emotions, a confirmation bias/belief bias, or a recall bias linked to the intensity/recency of symptoms; (9) heightened physiological arousal; (10) elevated cortical arousal; (11) the presence of brief awakenings; (12) a fault in neuronal circuitry; and (13) there being 2 insomnia subtypes (one with and one without misperception). The best supported resolutions were misperception of sleep as wake, worry, and brief awakenings. A deficit in time estimation ability was not supported. We conclude by proposing several integrative solutions.     

Activity engagement is related to level, but not change in cognitive ability across adulthood

It is unclear whether the longitudinal relation between activity participation and cognitive ability is due to preserved differentiation (active individuals have higher initial levels of cognitive ability), or differential preservation (active individuals show less negative change across time). This distinction has never been evaluated after dividing time-varying activity into its two sources of variation: between-person and within-person variability. Further, few studies have investigated how the association between activity participation and cognitive ability may differ from early to older adulthood. Using the PATH Through Life Project, we evaluated whether between- and within-person variation in activity participation was associated with cognitive ability and change within cohorts aged 20-24 years, 40-44 years, and 60-64 years at baseline (n = 7,152) assessed on three occasions over an 8-year interval. Multilevel models indicated that between-person differences in activity significantly predicted baseline cognitive ability for all age cohorts and for each assessed cognitive domain (perceptual speed, short-term memory, working memory, episodic memory, and vocabulary), even after accounting for sex, education, occupational status, and physical and mental health. In each case, greater average participation was associated with higher baseline cognitive ability. However, the size of the relationship involving average activity participation and baseline cognitive ability did not differ across adulthood. Between-person activity and within-person variation in activity level were both not significantly associated with change in cognitive test performance. Results suggest that activity participation is indeed related to cognitive ability across adulthood, but only in relation to the starting value of cognitive ability, and not change over time.     

Suppression-induced forgetting on a free-association test

The repeated suppression of thoughts in response to cues for their expression leads to forgetting on a subsequent test of cued recall (Anderson & Green, 2001). We extended this effect by using homograph cues and presenting them for free association following suppression practice. Cue-target pairs were first learned under integrating imagery instructions; then in the think/no-think phase students practised suppressing thoughts connected to some homograph cues, with or without the assistance of thought substitutes that changed their meaning. Below-baseline forgetting on the subsequent free-association test was found in the production of suppressed targets. Following aided suppression this effect was also obtained in the production of other responses denoting the target-related meaning of the homograph cues. Discussion emphasises the ecological value of the test; rarely do people deliberately attempt recall of unwanted thoughts.     

Cognitive biases and obsessive-compulsive symptoms in children: examining the role of maternal cognitive bias and child age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7-11) and adolescents (12-17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought-action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity-specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity-specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias-such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.     

Direction of threat attention bias predicts treatment outcome in anxious children receiving cognitive-behavioural therapy

BackgroundA bias to selectively direct attention to threat stimuli is a cognitive characteristic of anxiety disorders. Recent studies indicate that individual differences in pre-treatment threat attention bias predict treatment outcomes from cognitive-behavioural therapy (CBT) in anxious individuals. However, there have been inconsistent findings regarding whether attention bias towards threat predicts better or poorer treatment outcome.MethodThis longitudinal study examined treatment outcomes in 35 clinically-anxious children following a 10-week, group-based CBT program, as a function of whether children showed a pre-treatment attention bias towards or away from threat stimuli. The effect of CBT on attention bias was also assessed.ResultsBoth groups showed significant improvement after receiving CBT. However, anxious children with a pre-treatment attention bias towards threat showed greater reductions not only in anxiety symptom severity, but also in the likelihood of meeting diagnostic criteria for anxiety disorders at post-treatment assessment, in comparison with anxious children who showed a pre-treatment attention bias away from threat. Children who had a pre-treatment bias away from threat showed a reduction in this bias over the course of CBT.ConclusionsFindings suggest that pre-existing differences in the direction of attention towards versus away from threat could have important implications for the treatment of anxious children.     

Incremental Benefits of a Daily Report Card Intervention Over Time for Youth With Disruptive Behavior

This study examined the percentage of children who respond positively to a daily report card (DRC) intervention and the extent to which students achieve incremental benefits with each month of intervention in a general education classroom. Participants were 66 children (87% male) with attention-deficit hyperactivity disorder or disruptive behavior problems who were enrolled in a school-based intervention program in rural, low-income school districts in a Midwest state. The DRC was implemented by each child's teacher, who received consultation from a graduate student clinician, school district counselor, or school district social worker. A latent class analysis using growth-mixture modeling identified two classes of response patterns (i.e., significant improvement and significant decline). Results indicated that 72% of the sample had all of their target behaviors classified as improved, 8% had all of their targets classified as declining, and 20% had one target behavior in each class. To examine the monthly incremental benefit of the DRC, individual effect sizes were calculated. Results for the overall sample indicated that most children experience a benefit of large magnitude (.78) within the first month, with continued incremental benefits through Month 4. The differential pattern of effect sizes for the group of improvers and the group of decliners offer data to determine when and if the DRC should be discontinued and an alternative strategy attempted. Evidence-based guidelines for practical implementation of the DRC are discussed.     

The 2 × 2 Model of Goal Orientation and Burnout: The Role of Approach–Avoidance Dimensions in Predicting Burnout

Burnout is typically viewed as resulting from situational factors (e.g., workload). However, as burnout is partly a reaction to frustrated goal striving, dispositional goal orientation may also be important. We used Hobfoll's ( 1989 ) conservation of resources model to develop hypotheses for relationships between goal orientation and 3 dimensions of burnout. Self‐report questionnaire measures of the 2 × 2 model of goal orientation (Elliot & McGregor, 2001 ) and burnout were administered to undergraduate students. Structural equation modeling revealed that all 4 dimensions of goal orientation were related to burnout. Avoidance‐related dimensions were positively associated and approach‐related dimensions were negatively associated with burnout. The findings suggest the importance of considering the role of motivational dispositions in development, prediction, and prevention of burnout.     

Increasing accurate preference assessment implementation through pyramidal training

Preference assessments directly evaluate items that may serve as reinforcers, and their implementation is an important skill for individuals who work with children. This study examined the effectiveness of pyramidal training on teachers' implementation of preference assessments. During Experiment 1, 3 special education teachers taught 6 trainees to conduct paired-choice, multiple-stimulus without replacement, and free-operant preference assessments. All trainees acquired skills necessary to implement preference assessments with 90% or greater accuracy during the training sessions and demonstrated generalization of skills to their classrooms or clinic. During Experiment 2, 5 teachers who served as trainees in Experiment 1 trained 18 preschool teachers. All preschool teachers met the mastery criterion following training. Training teachers to implement preference assessments may increase teachers' acceptance and use of behavior-analytic procedures in school settings.     

Racism leads to pushups: How racial discrimination threatens subordinate men's masculinity

Two studies explored the gendered nature of racial discrimination for Black men, focusing on the relationship between race, discrimination, and masculinity threat. Specifically, we hypothesized that racial discrimination may also represent a threat to Black, but not White, men's masculinity. Both studies examined the target's perspective (i.e. Black and White men's perspectives) on the experience of racism and threat. Black men who experienced discrimination reported greater endorsement of male gender norms and were more vigilant to masculinity threat cues than were those who did not experience discrimination. Additionally, Black men engaged in masculine-typed behaviors–for our purposes, completing more pushups–in proportion to their experience of masculinity threat. Conversely, White men disengaged from the pushup task after experiencing discrimination. Study 2 suggests that White men's disengagement is mediated by affirming their social status. Our data suggest the importance of considering the gendered consequences of racial discrimination toward subordinate-group men.