Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.     

Gender constructions from a project on sex offenders

Abstract

The four-year group therapy of 16 sex offenders in prison was videotaped, and 21 sessions were carefully transcribed and analysed by means of conversation analysis and analysis of metaphor and narration. These qualitative methods are apt for verbal data and can be combined with psychoanalytic thinking in a productive way. New forms of process analysis can be developed. The results presented here are selected to relate to the topic of how the imprisoned group therapy participants constructed “gender” by ways of speaking about themselves, women, and their victims, young girls. The results show that it would be a mistake to think of these ways of speaking as if they could be ignored in favour of “deeper” motives, lying “behind” the words. Our results show how unconscious constructions of gender are not beyond language, but in language. “Doing gender” is a conversational practice.     

Gutachtenleitfaden

The article presents an operationalized and manualized approach for the assessment of the capability of performance. This manual has been conceptualized and tested empirically by a multicentric and interdisciplinary workgroup. It is basically oriented to the “International Classification of Functioning” (ICF; WHO), which is well accepted for assessing the course of chronic diseases and the consequences for the individual. It is especially widely applied in the context of rehabilitation. The different diagnostic levels of the manual and their operationalization are outlined. Furthermore, the first results concerning reliability, content validity, applicability and practicability are described and questions on the areas of application of the instrument are discussed.     

Counter‐Interrogation Strategies when Anticipating Questions on Intentions

The present experimental study adds to the emerging line of psycholegal research focusing on true and false intentions. It is the first to examine mock suspects' (N = 120) counter‐interrogation strategies in investigative interviews in which they anticipate questions on their intentions. As planning is an inherent part of many intentions, mock suspects were, in addition to questions on their intentions, asked a set of questions that pertained to the planning phase in which they formed their intentions. Besides ratings of the anticipation and difficulty of the questions, participants were asked to provide their principal strategy for being perceived as truthful. Both truth tellers and liars perceived the questions on the planning phase as significantly more unanticipated than the questions on their intentions. Furthermore, liars perceived the questions on the planning phase as more difficult to answer than did truth tellers. Liars and truth tellers differed with respect to their principal strategy employed for being perceived as truthful. Liars' most commonly used strategy was to stick to the cover story, whereas truth tellers' most common strategy was to be honest. The results are discussed in relation to the unanticipated questions approach and psychological concepts such as the illusion of transparency. Copyright © 2012 John Wiley & Sons, Ltd.     

A behavioral task for the validation of a gaze-contingent simulated scotoma

Gaze-contingent displays provide a valuable method in visual research for controlling visual input and investigating its visual and cognitive processing. Although the body of research using gaze-contingent retinal stabilization techniques has grown considerably during the last decade, only few studies have been concerned with the reliability of the specific real-time simulations applied. Using a Landolt ring discrimination task, we present a behavioral validation of gaze-contingent central scotoma simulation in healthy observers. Importantly, behavioral testing is necessary to show whether the simulation impairs foveal processing of visual information. This test becomes even more crucial when researchers are faced with null results in a task performed with the scotoma, as compared with a control condition. It must be ruled out that the lack of behavioral effects results from a type II error caused by improper implementation before conclusions about foveal contributions to the given task may be drawn. In our experiment, the scotoma effectively prevented foveal processing of the visual stimuli, leading to significantly reduced response accuracies, as compared with unimpaired vision. Moreover, the final fixation at the time of the participants’ responses was placed close to the target position in the unimpaired condition, whereas the distance to the target was enhanced with the scotoma, indicating that the observers were not able to discriminate visual target stimuli from distractors, due to the scotoma. The present work presents a validated behavioral testing method for the efficiency of gaze-contingent scotoma simulations, including code for implementation. In addition, solutions for common methodological problems are discussed.     

What are you hiding? Initial validation of the reaction time-based searching concealed information test

The reaction time-based concealed information test (RT-CIT) has been used to judge the veracity of an examinees claim to be naïve by using RTs to test for recognition of relevant details. Here, we explore the validity of the RT-CIT to generate new knowledge about the incident—the searching CIT. In a mock terrorism study (n = 60) the RT-CIT not only allowed to link suspects to known crime details, but also allowed to reveal new crime details well above chance. A simulation study confirms the potential of the searching RT-CIT and identifies conditions under which it performs best. We used an archival dataset that met these conditions (high CIT effect, large number of item repetitions), and found better item classification performance than in the mock terrorism study. The searching RT-CIT could be a new, promising investigative tool to reveal new (e.g., crime) details to the investigative party.     

Speed limits: orientation and semantic context interactions constrain natural scene discrimination dynamics

The visual system rapidly extracts information about objects from the cluttered natural environment. In 5 experiments, the authors quantified the influence of orientation and semantics on the classification speed of objects in natural scenes, particularly with regard to object-context interactions. Natural scene photographs were presented in an object-discrimination task and pattern masked with various scene-to-mask stimulus-onset asynchronies (SOAs). Full psychometric functions and reaction times (RTs) were measured. The authors found that (a) rotating the full scenes increased threshold SOA at intermediate rotation angles but not for inversion; (b) rotating object or context degraded classification performance in a similar manner; (c) semantically congruent contexts had negligible facilitatory effects on object classification compared with meaningless baseline contexts with a matching contrast structure, but incongruent contexts severely degraded performance; (d) any object-context incongruence (orientation or semantic) increased RTs at longer SOAs, indicating dependent processing of object and context; and (e) facilitatory effects of context emerged only when the context shortly preceded the object. The authors conclude that the effects of natural scene context on object classification are primarily inhibitory and discuss possible reasons.     

Jugendliche Sexualstraftäter: Spezialfälle der Prognoseerstellung?

This study compared a sample of 273 juvenile (aged 14 to under 18), 178 adolescent (aged 18 to under 21) and 273 adult (older than 20 years) male sex offenders modus operandi (or MO, the way in which they committed their offenses), frequency of recidivism and predicted recidivism via the static-99. In terms of the frequencies of the MO aspects we found that juveniles and adolescents differed significantly from adult sexual offenders. However, concerning the frequency of sexual violent behaviors, adolescents committed more severe offenses in contrast to the two other groups. The comparison of recidivism rates indicated that adolescent sexual offenders were significantly less likely to commit a new sexual offense, but were considerably more likely to commit a non-sexual violent offense compared to adult sexual offenders. For juvenile offenders, only few static-99 variables were predictive of future recidivism in comparison to the other groups, suggesting that the static-99 may only have a restricted utility in juvenile offenders. Further, juvenile offenders risk levels were found to fall primarily within the medium risk group making individual differentiation of potential risk difficult. It is suggested that additional predictors, which help to differentiate young sexual offenders must be investigated.