Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.     

Reduction in Memory Specificity Following an Approach/Avoidance Scrambled Sentences Task Relates to Cognitive Avoidant Coping

Overgeneral autobiographical memory (OGM) refers to the tendency to retrieve less specific personal memories. According to the functional avoidance hypothesis, OGM might act as a cognitive strategy to avoid emotionally distressing details of negative memories. In the present study, we investigated the effect of an experimentally induced avoidant state on memory specificity. We primed an avoidant state in half of the participants and an approaching state in the other half by means of a Scrambled Sentences Task (SST). Memory specificity was measured before and after priming. Trait cognitive avoidant coping was assessed prior to the experiment. Analyses indicated that higher trait avoidance was significantly associated with lower memory specificity after the SST and stronger reductions in memory specificity from pre- to post-SST, irrespective of the priming condition. The latter suggests that the SST triggered high avoiders’ avoidance schema in both conditions, possibly because it was experienced as a stressor.

     

Reliability and validity of the Revised Children's Manifest Anxiety Scale in a French-Canadian sample

The aim of this study was to examine the reliability and validity of a French version of the Revised Children's Manifest Anxiety Scale (RCMAS). A sample of 2,666 school-age French-Canadian children completed the questionnaire. With regard to factor structure, the 5-factor model found in U.S. normative samples was confirmed. The internal consistency of the 5 scales and of the 2 global scales was good to excellent. Test-retest reliabilities after a 6-month period were also similar to those of the original version. Finally, the concurrent validity, assessed by a correlation with the State-Trait Anxiety Inventory for Children, was also found to be good. Results of the present study show that the French version of the RCMAS is a good instrument to assess anxiety in children.     

The regression trunk approach to discover treatment covariate interaction

The regression trunk approach (RTA) is an integration of regression trees and multiple linear regression analysis. In this paper RTA is used to discover treatment covariate interactions, in the regression of one continuous variable on a treatment variable withmultiple covariates. The performance of RTA is compared to the classical method of forward stepwise regression. The results of two simulation studies, in which the true interactions are modeled as threshold interactions, show that RTA detects the interactions in a higher number of cases (82.3% in the first simulation study, and 52.3% in the second) than stepwise regression (56.5% and 20.5%). In a real data example the final RTA model has a higher cross-validated variance-accounted-for (29.8%) than the stepwise regression model (12.5%). All of these results indicate that RTA is a promising alternative method for demonstrating differential effectiveness of treatments. Supported by The Netherlands Organization for Scientific Research (NWO), grant 030-56403 to Jacqueline Meulman for the Pioneer project “Subject-Oriented Multivariate Analysis,” and grant 451-02-058 to Elise Dusseldorp for the Veni project “Modeling interaction effects as small trees in regression and classification.” We thank Bram Bakker for making the data of his doctoral dissertation available, and David Hand, Jerome Friedman, Bart Jan van Os, Philip Spinhoven, and the anonymous reviewers for their helpful suggestions. Special thanks are due to Lawrence Hubert.     

Self-Induced Motion Sickness and Body Movement During Passive Restraint

From both direct-realist and motor-theoretic perspectives, the objects of speech perception are construed as articulatory events. We offer the alternative view that it is the auditory properties of phonetic events to which listeners are primarily sensitive. Evidence for this alternative view comes from a variety of sources, including studies of phonetic and phonological universals, comparisons of the perception of speech and nonspeech signals, cross-language perceptual experi- ments, and studies of phonetic categorization by nonhuman animals.