Empirically and clinically useful decision making in psychotherapy: differential predictions with treatment response models

In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research networks. This article presents a strategy to disaggregate patients into homogeneous subgroups to generate optimal expected treatment response profiles, which can be used to predict and track the progress of patients in different treatment modalities. The study was based on data from 618 diagnostically diverse patients treated with either a cognitive-behavioral treatment protocol (n = 262) or an integrative cognitive-behavioral and interpersonal treatment protocol (n = 356). The validity of expected treatment response models to predict treatment in those 2 protocols for individual patients was evaluated. The ways such a procedure might be used in outpatient centers to learn more about patients, predict treatment response, and improve clinical practice are discussed.     

Prioritization in visual search: visual marking is not dependent on a mnemonic search

Visual marking (VM) refers to our ability to completely exclude old items from search when new stimuli are presented in our visual field. We examined whether this ability reflects an attentional scan of the old items, possibly allowing observers to apply inhibition of return or maintain a memory representation of already seen locations. In four experiments, we compared performance in two search conditions. In the double-search (DS) condition, we required participants to pay attention to a first set of items by having them search for a target within the set. Subsequently, they had to search a second set while the old items remained in the field. In the VM condition, the participants expected the target only to be in the second (new) set. Selection of new items in the DS condition was relatively poor and was always worse than would be expected if only the new stimuli had been searched. In contrast, selection of the new items in the VM condition was good and was equal to what would be expected if there had been an exclusive search of the new stimuli. These results were not altered when differences in Set 1 difficulty, task switching, and response generation were controlled for. We conclude that the mechanism of VM is distinct from mnemonic and/or serial inhibition-of-return processes as involved in search, although we also discuss possible links to more global and flexible inhibition-of-return processes not necessarily related to search.     

Convergence of parent checklists and child psychiatric diagnoses

This study examined the correlation between the Childrens' Behavior Questionnaire by Rutter, Tizard, and Whitmore (1970) and clinical diagnoses in a total of 1,468 in-and outpatients. The following diagnoses were considered: conduct disorder, emotional disorder, mixed disorder of conduct and emotions, and the hyperkinetic syndrome. In general, correlations were low, but subscores indicating conduct or neurotic disorders had somewhat higher correlation with these respective disorders than the hyperactivity subscore. Sensitivity figures (i.e., percentage of true positives) were moderate to low, while specificity figures (i.e., percentage of true negatives) were high. It is concluded that convergence of parent checklists and child psychiatric diagnoses in unselected samples is only moderate.     

Intelligence and neural efficiency: The influence of task content and sex on the brain–IQ relationship

In studying physiological correlates of human intelligence, new brain imaging techniques like positron emission tomography (PET) and electroencephalography (EEG) mapping methods focus on the level and topographical distribution of cortical activation. Actually, there is strong empirical evidence that more intelligent individuals display a more focused cortical activation during cognitive performance resulting in lower total brain activation than in less intelligent individuals (i.e., neural efficiency hypothesis). Former studies have used only single, homogeneous tasks and most of the studies have been performed using males. Therefore, here the influence of different task content and of sex on the relationship between intelligence and cortical activation has been tested. In a sample of 26 males and 25 females, we administered verbal, numerical, and figural versions of a well-known elementary cognitive task, the so-called Posner task. Our results suggest a comparatively low cortical activation in brighter as compared to less intelligent individuals but this expected neural efficiency pattern interacted with sex and task content: In the verbal Posner task, the females were more likely to produce cortical activation patterns in line with the neural efficiency hypothesis, whereas in the figural task, primarily the males displayed the expected inverse relationship between IQ and cortical activation.     

Catastrophic associations predict level of change in anxiety sensitivity in response to cognitive-behavioural treatment for panic

The aim of the present study was to elucidate one of the factors that might be responsible for the maintenance of panic patients' harmful beliefs about anxiety. Specifically, it was hypothesized that harmful beliefs about anxiety, i.e. anxiety sensitivity, is maintained in panic patients by automatic activation of idiographic catastrophic cognitions. To test this prediction, panic patients participated in a one-session cognitive-behavioural treatment of 4-8h to reduce anxiety sensitivity. The strength of automatic catastrophic cognitions in response to idiographic anxiety symptoms, measured with a modified semantic priming task, as well as the strength of the consciously accessible catastrophic meaning of these symptoms were assessed before treatment. In accordance with the hypothesis, stronger automatic catastrophic cognitions predicted a smaller reduction of anxiety sensitivity independently of the strength of conscious catastrophic cognitions. Moreover, in a first exploration, the strength of catastrophic associations was also shown to have an incremental predictive value for change in anxiety sensitivity beyond that of a number of demographic, clinical, treatment and assessment variables. The theoretical and clinical implications are discussed.     

Differential time course of implicit and explicit cueing by colour and orientation in visual search

Using a cued conjunction search task, Anderson, Heinke, and Humphreys (2010) demonstrated larger effects from cueing target colour than from cueing target orientation. In this study, we separated the implicit (nonexpectation-dependent) and explicit (expectation-dependent) effects of orientation and colour visual cues. In Experiment 1, we replicated the original findings for short cue durations (100–200 ms), demonstrating that cues matching the physical property of the target on 80% of trials exert a rapid effect on search. These early cueing effects on reaction times were supported by evidence of guidance from cues on early eye movements. Experiment 2 introduced a feature to the cue that randomly matched the colour or orientation of the target. When cue orientation was predictive, there were strong implicit effects based on whether the colour of the cue and target matched. When cue colour was predictive, there were only weak effects from the cue's orientation. Implicit effects from cue colour remained when orientation-predictive cues were used and colour was unlikely to predict the target (Experiment 3). The data suggest that strong effects of colour cueing result from a combination of implicit and explicit processes, whereas effects from orientation cues are largely limited to the explicit guidance of visual search.     

Monkeys perform as well as apes and humans in a size discrimination task

Whether the cognitive competences of monkeys and apes are rather similar or whether the larger-brained apes outperform monkeys in cognitive experiments is a highly debated topic. Direct comparative analyses are therefore essential to examine similarities and differences among species. We here compared six primate species, including humans, chimpanzees, bonobos, gorillas (great apes), olive baboons, and long-tailed macaques (Old World monkeys) in a task on fine-grained size discrimination. Except for gorillas, subjects of all taxa (i.e. humans, apes, and monkeys) were able to discriminate three-dimensional cubes with a volume difference of only 10 % (i.e. cubes of 50 and 48 mm side length) and performed only slightly worse when the cubes were presented successively. The minimal size discriminated declined further with increasing time delay between presentations of the cubes, highlighting the difficulty to memorize exact size differences. The results suggest that differences in brain size, as a proxy for general cognitive abilities, did not account for variation in performance, but that differential socio-ecological pressures may better explain species differences. Our study highlights the fact that differences in cognitive abilities do not always map neatly onto phylogenetic relationships and that in a number of cognitive experiments monkeys do not fare significantly worse than apes, casting doubt on the assumption that larger brains per se confer an advantage in such kinds of tests.     

Epigenetic programming of the HPA axis: early life decides

Stress during early life can impact the developing brain and increase vulnerability to mood disorders later in life. Here, we argue that epigenetic mechanisms can mediate the gene-environment dialogue in early life and give rise to persistent epigenetic programming of adult physiology eventually resulting in disease. Early life stress in mice leads to epigenetic marking of the arginine vasopressin (AVP) gene underpinning sustained expression and increased hypothalamic-pituitary-adrenal axis activity. This epigenetic memory is laid down in the parvocellular neurons of the paraventricular nucleus and involves Ca(2+)/calmodulin kinase-mediated phosphorylation of the methyl-CpG binding domain protein MeCP2 leading to dissociation from its DNA-binding site and derepression of the AVP gene. The reduced occupancy of MeCP2 during this early stage of life facilitates the development of hypomethylation at the AVP enhancer, which sustains derepression throughout later life and thereby serves to hardwire early life experiences. The sequential order of these events may represent a critical time window for the preventive therapy of severe trauma.