Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy

Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.     

Staying alive: evolution, culture, and women's intrasexual aggression

Females' tendency to place a high value on protecting their own lives enhanced their reproductive success in the environment of evolutionary adaptation because infant survival depended more upon maternal than on paternal care and defence. The evolved mechanism by which the costs of aggression (and other forms of risk taking) are weighted more heavily for females may be a lower threshold for fear in situations which pose a direct threat of bodily injury. Females' concern with personal survival also has implications for sex differences in dominance hierarchies because the risks associated with hierarchy formation in nonbonded exogamous females are not offset by increased reproductive success. Hence among females, disputes do not carry implications for status with them as they do among males, but are chiefly connected with the acquisition and defence of scarce resources. Consequently, female competition is more likely to take the form of indirect aggression or low-level direct combat than among males. Under patriarchy, men have held the power to propagate images and attributions which are favourable to the continuance of their control. Women's aggression has been viewed as a gender-incongruent aberration or dismissed as evidence of irrationality. These cultural interpretations have "enhanced" evolutionarily based sex differences by a process of imposition which stigmatises the expression of aggression by females and causes women to offer exculpatory (rather than justificatory) accounts of their own aggression.     

Incentive downshifts evoke search repertoires in rats.

Negative incentive contrast effects (NCEs) have typically been attributed to frustration or the decremental generalization of learned associations. The purpose of these experiments was to clarify the relation of NCEs to the repertoires of functional search behaviors evoked by incentive downshifts. Rats shifted from 32% to 4% sucrose-solution decreased consummatory responses but increased nose-down locomotion, orientation, location entries, and sampling of alternatives relative to unshifted controls. These changes in behavior were terminated or failed to occur under incentive upshifts. Furthermore, reward downshifts did not produce avoidance of the location of the shifted incentive. Increased search occurred whether or not alternative reward locations were available. Together the evidence suggests that NCEs are related to evoked search modes supporting a repertoire of functional behaviors related to finding food.     

Attentional blink for color

Colored letters were presented by means of rapid serial visual presentation (RSVP). Two letters (T1 and T2) were targets that required a speeded (T1) or delayed (T2) response. T1 was shown on half of the trials. Two tasks were performed in the experimental conditions. Task 1 required a discrimination between 2 letters (when T1 was shown) or an indication that T1 was absent. In Experiment 1, Task 2 was to detect the presence of a unique color in the RSVP stream (e.g., green in a stream of alternating red and gray). In Experiment 2, Task 2 was to report the color of the first colored letter to appear in the RSVP stream. The lag between T1 and T2 in the RSVP stream was manipulated. Accuracy of color reports in Task 2 was poor at shorter lags and improved as the lag was lengthened in both experiments, demonstrating an attentional blink for chromatic information. Theoretical implications of the results are discussed.     

Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls

Fifty-six heroin addicts and 60 age-matched controls were offered choices between monetary rewards ($11-$80) available immediately and larger rewards ($25-$85) available after delays ranging from 1 week to 6 months. Participants had a 1-in-6 chance of winning a reward that they chose on one randomly selected trial. Delay-discounting rates were estimated from the pattern of participants' choices. The discounting model of impulsiveness (Ainslie, 1975) implies that delay-discounting rates are positively correlated with impulsiveness. On average, heroin addicts' discount rates were twice those of controls (p = .004), and discount rates were positively correlated with impulsivity as measured by self-report questionnaires (p < .05). The results lend external validity to the delay-discounting rate as a measure of impulsiveness, a characteristic associated with substance abuse.     

What is the nature of increased Stroop interference in schizophrenia?

In comparison to controls, patients with schizophrenia classically display (1) an overall slowing in response times (RTs) and (2) a disproportionate slowing in RTs in the conflict condition of the Stroop color/word interference task. These two effects appear repeatedly in the card version of the Stroop task but were not replicated in a number of studies using a computer item-by-item version of the task. The present study was aimed at understanding the exact nature of the increased interference classically found in the performance of patients with schizophrenia in the card version of the Stroop task. We used a computer trial-by-trial version in which we investigated the effects of two major methodological differences between the two versions: (1) blocked (card version) versus mixed (computer version) presentation of the neutral, congruent and conflict conditions and (2) presence (card version) versus absence (computer version) of distractors in the spatial surrounding of the target. We found an overall slowing in performance and a disproportionate slowing in the conflict condition for patients with schizophrenia but only when the target was surrounded by distractors (in Experiments 2 and 3). The data are discussed in terms of a deficit in selective attention and inhibitory processes in schizophrenia.     

Early developments in the ability to understand the relation between stimulus and reward

Delayed nonmatching to sample (DNMS) is used to test the recognition memory function dependent on the medial temporal lobe. Children cannot succeed on this task until about 21 months. Because robust recognition is present well before then, the late emergence of another ability must account for the late success on DNMS. Evidence is presented here that the critical late-maturing competence is the ability to grasp the relation between stimulus and reward--that is, to understand that the stimulus is a symbol or marker for the reward. Infants of 9 and 12 months were tested on 3 conditions of DNMS. A sample object was presented. After a delay, the sample and a novel object appeared; choice of the novel object was rewarded. In the standard task, the reward was in a well beneath the stimulus. In the verbal-reward condition the reward was not a separate object but was praise and applause. In the Velcro condition, the reward, although a separate and separable object, was attached to the base of the stimulus. Most infants at both ages succeeded in the verbal-reward and Velcro conditions but not in the standard condition.     

The relations between temperament and empathy in 2-year-olds.

The role of infant and toddler temperament in the prediction of empathy in 2-year-old children was examined. Assessments of temperament included reactivity and affect observed at 4 months of age, as well as inhibition at Age 2. Empathy was measured in 2-year-old children's responses to simulations of distress performed by their mothers and by an unfamiliar person. Children showed relatively more concern for the mother's distress, but they were also responsive to unfamiliar victims. Infants who were unreactive and showed little affect also showed less empathy toward the unfamiliar adult almost 2 years later. Inhibition toward an unfamiliar adult (but not toward the mother) at 2 years of age was negatively related to empathy. Inhibited temperament may thus have a major impact on young children's empathy in unfamiliar contexts. Findings also highlight the need to consider early underarousal as another dimension of temperament that may dampen expressions of empathic concern.     

MMPI-A in the inpatient assessment of adolescents with eating disorders.

The MMPI-A (Butcher et al., 1992), like the older MMPI (Hathaway & McKinley, 1983), distinguishes between anorexia and bulimia. In this study, 245 adolescent girls diagnosed with anorexia, bulimia, or eating disorder not otherwise specified completed the MMPI-A. Multivariate analyses revealed significant differences between anorexia and bulimia on the MMPI-A's validity, clinical, content, and supplementary scales, particularly suggesting multiple impulse control problems among bulimic patients. However, profiles were also more homogeneous across eating disorder groups than in studies using the older MMPI, with high points involving some combination of Scales 1, 2, 3, and 0 for two thirds of the patients in this study. Implications are considered for understanding the common and differential psychopathology of eating disorders.