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.     

Development and Preliminary Evaluation of a Cognitive-Behavioral Intervention for Perinatal Grief

Perinatal loss, typically defined as fetal death beyond 20 weeks gestation through infant death 1-month postpartum, is a potentially traumatizing experience for parents occurring in approximately 1% of births in the United States. Although many women recover, 15% to 25% have enduring grief-related symptomatology and functional impairment. Perinatal grief is a unique bereavement experience, but clinical resources for detecting and treating severe perinatal grief are rare and interventions are largely without empirical support. We developed and pilot tested a cognitive-behavioral intervention targeting the psychological and behavioral sequelae of perinatal bereavement. To initially evaluate the feasibility and efficacy of the intervention, 5 women who suffered a perinatal loss were randomized to a 2-week, 4-week, or 6-week baseline period in a multiple-baseline single-case experimental design. In most cases, after the respective baseline periods, there was a steady decline in reported grief symptoms. These gains were largely maintained at a 6-week follow-up assessment. This study provides initial evidence in support of future research and clinical efforts tailoring cognitive behavioral interventions to meet the specific needs of women who experience perinatal loss.     

Development of a Unified Protocol for the Treatment of Emotional Disorders in Youth

This study evaluated the efficacy of the Mind Reading interactive computer software to remediate emotion recognition deficits in children with autism spectrum disorders (ASD). Six unmedicated children with ASD and 11 unmedicated non-clinical control subjects participated in the study. The clinical sample used the software for five sessions. The control sample was evaluated only on pre- and post-test performance to assess practice effects. Results showed that participants with ASD scored significantly higher on the posttest than on the pretest. As level of emotion difficulty increased, mean scores on the pretest decreased, indicating that difficulty level had a valid effect. The Mind Reading computer software appears to significantly improve the emotion recognition abilities in children with ASD.     

Transitivity for height versus speed: To what extent do the under-7s really have a transitive capacity?

Transitive inference underpins many human reasoning competencies. The dominant task (the “extensive training paradigm”) employs many items and large amounts of training, instilling an ordered series in the reasoner's mind. But findings from an alternative “three-term paradigm” suggest transitivity is not present until 7 + years. Interestingly, a second alternative paradigm (the “spatial task”), using simultaneously displayed height relationships to form premise pairs, can uphold the 4-year estimate. However, this paradigm risks cueing children and hence is problematic. We investigated whether a height-task variant might correspond to a more ecologically valid three-term task. A total of 222 4–6-year-olds either completed a modified height task, including an increased familiarisation phase, or a computer-animated task about cartoon characters running a race in pairs. Findings confirmed that both tasks were functionally identical. Crucially, 4-year-olds were at chance on both, whereas 6-year-olds performed competently. These findings contrast with estimates from all three paradigms considered. A theoretical evaluation of our tasks and procedures against previous ones, leads us to two conclusions. First, our estimate slightly amends the 7-year estimate offered by the three-term paradigm, with the difference explained in terms of its greater relevance to child experiences. Second, our estimate can coexist alongside the 4-year estimate from the extensive training paradigm. This is because, applying a recently developed “dual-process” conception of reasoning, anticipates that extensive training benefits a species-general associative system, while the spatial paradigm and three-term paradigm can potentially index a genuinely deductive system, which has always been the target of transitive research.     

Investigating Hypervigilance for Social Threat of Lonely Children

The hypothesis that lonely children show hypervigilance for social threat was examined in a series of three studies that employed different methods including advanced eye-tracking technology. Hypervigilance for social threat was operationalized as hostility to ambiguously motivated social exclusion in a variation of the hostile attribution paradigm (Study 1), scores on the Children’s Rejection-Sensitivity Questionnaire (Study 2), and visual attention to socially rejecting stimuli (Study 3). The participants were 185 children (11 years-7 months to 12 years-6 months), 248 children (9 years-4 months to 11 years-8 months) and 140 children (8 years-10 months to 12 years-10 months) in the three studies, respectively. Regression analyses showed that, with depressive symptoms covaried, there were quadratic relations between loneliness and these different measures of hypervigilance to social threat. As hypothesized, only children in the upper range of loneliness demonstrated elevated hostility to ambiguously motivated social exclusion, higher scores on the rejection sensitivity questionnaire, and disengagement difficulties when viewing socially rejecting stimuli. We found that very lonely children are hypersensitive to social threat.     

Perceived motion is influenced by random dynamic information

Distortions of the local spatial-frequency power spectrum caused by motion blur may be used by the visual system to improve motion analysis (e.g., Barlow and Olshausen, 2004 Journal of Vision 4415-426). We tested this hypothesis by measuring the error of perceived motion direction of moving patterns in the presence of random noncoherent motion manipulated to create different spatial power spectra. The results showed that error increased when the background power spectrum was similar to the motion power spectrum; however, when the background power spectrum had an anisotropy consistent with motion blur, the error was reduced. Shifting the power spectrum away from the motion power spectrum reduced the error.     

Understanding the Relationship Between State Forgiveness and Psychological Wellbeing: A Qualitative Study

Over the last 20 years, increasing attention has been given to associations between dispositional forgiveness and specific mental health problems. However, few studies have assessed whether forgiving real-life interpersonal hurts may be related to diverse psychological health outcomes. The present study addresses this gap by investigating, in depth, relationships between perceptions about state forgiveness and a variety of mental wellbeing outcomes as well as exploring perceptions about the factors that may modify such effects. Developing an understanding of a forgiveness wellbeing relationship is of relevance to healthcare workers, researchers and policy makers with an interest in improving public health. In-depth semi-structured interviews were conducted, and data were analysed using grounded theory methods. From England and Ireland, eleven adults who were affiliated with religious/spiritual and secular/atheist groups were recruited using purposive and convenience sampling methods. Key themes that appeared to be related to the effects of unforgiveness were: increases in negative affect; reduction in cognitive abilities and barriers to psychological and social growth. For the majority of participants, state forgiveness had strong ties to participants perceived sense of mental wellbeing, including reductions in negative affect, feeling positive emotions, positive relations with others, spiritual growth, a sense of meaning and purpose in life as well as a greater sense of empowerment. The data also revealed a number of factors that may positively or negatively influence a forgiveness–wellbeing link such as: viewing an offender as spiritually similar or different, responsibility/karma, blaming, wanting restitution/apology as well as practices such as meditation and prayer. The findings suggest that forgiving a range of real-life interpersonal offences may be an important determinant of psychological wellbeing, particularly among religious/spiritual populations. Further research is, however, needed.     

Minority report: Social identity,cognitions of rejection and intergroup anxiety predicting prejudice from one racially marginalized group towards another

The present study investigated the attitudes of one disadvantaged minority group in Australia, Asian Australians (N = 87), towards another more severely disadvantaged minority group, Aboriginal Australians. Asian Australian attitudes were compared to European Australian attitudes (N = 273). Cognitions of outgroup rejection, identification and intergroup anxiety were assessed in relation modern racism, desire for intergroup avoidance and support for a national apology. Both Asian and European participants who perceived Aboriginal Australians as rejecting were more likely to express intergroup anxiety. Anxiety mediated the relationship between cognitions of rejection and the dependent variables. Whilst there was a direct positive relationship between European Australian identification and prejudice, for Asian Australian participants, identification moderated the relationship between cognitions of rejection and the dependent variables. Highly identified Asian Australian participants were particularly sensitive to cognitions of rejection, which increased modern racism and avoidance and lowered political support. The pattern was reversed for low identifiers, who were more likely to endorse a national apology to Aboriginal Australians when they perceived Aboriginal Australians as rejecting. The role of perceived rejection in predicting prejudice and avoidance, and the moderating role of Asian Australian identification, are both discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

The Interaction of Motivation and Therapist Adherence Predicts Outcome in Cognitive Behavioral Therapy for Panic Disorder: Preliminary Findings

This report is a post-hoc, exploratory examination of the relationships among patient motivation, therapist protocol adherence, and panic disorder outcome in patients treated with cognitive behavioral therapy within the context of a randomized clinical trial for the treatment of panic disorder (Barlow, Gorman, Shear, & Woods, 2000). Results suggested that motivation and adherence interacted to predict change in panic severity. Among patients rated as less motivated, greater therapist protocol adherence was associated with poorer outcome. Among patients rated as more motivated, adherence was not significantly associated with outcome. Further process research is needed to confirm these preliminary results and to understand the interactions of patient and therapist factors and how they are related to outcome in standardized protocols such as cognitive behavioral therapy for panic disorder.     

Essential theory, processes, and procedures for successful group psychotherapy: Group cohesion as exemplar

With few exceptions or at the very least cautions (cf. Burlingame, MacKenzie & Strauss, 2003) group psychotherapy has proven to be an effective and efficient treatment for a number of psychological disorders (Burlingame, Kapetanovic, & Ross, 2005). This article will briefly describe a theory that underlies successful group therapies. In addition, certain group processes—those elements that occur during the group itself that appear to be necessary conditions for improved patient outcomes—will also be addressed, although unfortunately, the sufficient conditions tying moment-to-moment process to actual outcome (improved patient functioning by the end of therapy, and at 6-month follow-up, for instance) are not quite as easily delineated. A closer study of the group therapeutic factor cohesion will be utilized as an example of these practice and research dilemmas. Finally, suggestions for future directions, which might more clearly uncover important connections between process and outcome, are addressed.