First-Person Neuroscience: A new methodological approach for linking mental and neuronal states

Though the brain and its neuronal states have been investigated extensively, the neural correlates of mental states remain to be determined. Since mental states are experienced in first-person perspective and neuronal states are observed in third-person perspective, a special method must be developed for linking both states and their respective perspectives. We suggest that such method is provided by First-Person Neuroscience. What is First-Person Neuroscience? We define First-Person Neuroscience as investigation of neuronal states under guidance of and on orientation to mental states. An empirical example of such methodological approach is demonstrated by an fMRI study on emotions. It is shown that third- and first-person analysis of data yield different results. First-person analysis reveals neural activity in cortical midline structures during subjective emotional experience. Based on these and other results neural processing in cortical midline structures is hypothesized to be crucially involved in generating mental states. Such direct linkage between first- and third-person approaches to analysis of neural data allows insight into the "point of view from within the brain", that is what we call the First-Brain Perspective. In conclusion, First-Person Neuroscience and First-Brain Perspective provide valuable methodological tools for revealing the neuronal correlate of mental states.     

The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.     

Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records.105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital.One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence.Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care.     

Training to use voice onset time as a cue to talker identification induces a left-ear/right-hemisphere processing advantage

We examined the effect of perceptual training on a well-established hemispheric asymmetry in speech processing. Eighteen listeners were trained to use a within-category difference in voice onset time (VOT) to cue talker identity. Successful learners (n=8) showed faster response times for stimuli presented only to the left ear than for those presented only to the right. The development of a left-ear/right-hemisphere advantage for processing a prototypically phonetic cue supports a model of speech perception in which lateralization is driven by functional demands (talker identification vs. phonetic categorization) rather than by acoustic stimulus properties alone.     

Previewing the neighborhood: the role of orthographic neighbors as parafoveal previews in reading

In 2 experiments, a boundary technique was used with parafoveal previews that were identical to a target (e.g., sleet), a word orthographic neighbor (sweet), or an orthographically matched nonword (speet). In Experiment 1, low-frequency words in orthographic pairs were targets, and high-frequency words were previews. In Experiment 2, the roles were reversed. In Experiment 1, neighbor words provided as much preview benefit as identical words and greater benefit than nonwords, whereas in Experiment 2, neighbor words provided no greater preview benefit than nonwords. These results indicate that the frequency of a preview influences the extraction of letter information without setting up appreciable competition between previews and targets. This is consistent with a model of word recognition in which early stages largely depend on excitation of letter information, and competition between lexical candidates becomes important only in later stages.     

The effect of word frequency, word predictability, and font difficulty on the eye movements of young and older readers

Young adult and older readers' eye movements were recorded as they read sentences containing target words that varied in frequency or predictability. In addition, half of the sentences were printed in a font that was easy to read (Times New Roman) and the other half were printed in a font that was more difficult to read (Old English). Word frequency, word predictability, and font difficulty effects were apparent in the eye movement data of both groups of readers. In the fixation time data, the pattern of results was the same, but the older readers had larger frequency and predictability effects than the younger readers. The older readers skipped words more often than the younger readers (as indicated by their skipping rate on selected target words), but they made more regressions back to the target words and more regressions overall. The E-Z Reader model was used as a platform to evaluate the results, and simulations using the model suggest that lexical processing is slowed in older readers and that, possibly as a result of this, they adopt a more risky reading strategy.     

The ad coefficient as a descriptive measure of the within‐group agreement of ratings

The a_d coefficient was developed to measure the within‐group agreement of ratings. The underlying theory as well as the construction of the coefficient are explained. The a_d coefficient ranges from 0 to 1, regardless of the number of scale points, raters, or items. With some limitations the measure of the within‐group agreement of different groups and groups from different studies is directly comparable. For statistical significance testing, the binomial distribution is introduced as a model of the ratings' random distribution given the true score of a group construct. This method enables a decision about essential agreement and not only about a significant difference from 0 or a chosen critical value. The a_d coefficient identifies a single true score within a group. It is not provided for multiple true score settings. The comparison of the a_d coefficient with other agreement indices shows that the new coefficient is in line with their outcomes, but does not result in infinite or inappropriate values.