Treatment of panic disorder with agoraphobia: randomized placebo-controlled trial of four psychosocial treatments combined with imipramine or placebo

Few randomized controlled trials have included panic disorder patients with moderate to severe agoraphobia. Therefore, this population was studied using pharmacotherapy as well as psychotherapy. At the time of the study, imipramine was widely used as a pharmacological treatment. Also, current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy. Therefore, the main objective of this study is to compare four psychosocial treatments-cognitive and graded in vivo exposure treatments, graded in vivo exposure, cognitive treatment, and supportive therapy-to evaluate the benefits of combining cognitive therapy with exposure in vivo. These treatments were combined with imipramine or placebo for a total of eight experimental conditions. Participants presented moderate to severe agoraphobia. The method involved a randomized, double-blind, placebo-controlled trial with 137 participants who completed a 14-session protocol involving the treatments just mentioned. Measures were taken at baseline and posttreatment and at 3-, 6-, and 12-month follow-up. All treatment conditions were statistically and clinically effective in reducing self-reported panic-agoraphobia symptoms over the 1-year follow-up. No statistical differences were observed between imipramine and placebo conditions. This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1-year follow-up period. These surprising results support the need to document the relations among the various components of an intervention. This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole.     

Clinical application of attachment theory in permanency planning for children in foster care: The importance of continuity of care

Permanency planning is a critical issue facing all children in foster care. Foster children frequently suffer from developmental delays and severe behavior problems, often leading to repeated displacements that in turn increase the risk for attachment disorders. To prevent the emergence of such disturbances, an Attachment Clinic was developed in Montreal to offer consultation to Youth Protection workers. A specific problem has frequently been identified in this Clinic: Should a child who has developed a significant attachment to his or her foster parents return to the biological parents or stay in the foster family? The choice between the two families is even more difficult when the parenting competencies of the biological parents seem to have progressed while the child has developed secure attachments in the foster family. Clinical cases will be presented to illustrate such dilemmas. Concepts rooted in attachment theory have been very useful to understand such problems, and have led us to believe that children's best interests lie in the preservation of their attachment ties and that repeated ruptures of such ties constitute a severe trauma. Resistances of the milieu to our position will be discussed as well as the Court's decisions in light of Canadian jurisprudence.     

Modulatory effects of happy mood on performance monitoring: Insights from error-related brain potentials

Goal-adaptive behavior requires the rapid detection of conflicts between actions and intentions or goals. Although many studies have focused in the past on the influence of negative affect on this cognitive control process (and more specifically, on error monitoring), little is known about the possible modulatory effects of positive affect on it. To address this question, we used a standard (positive) mood induction procedure (based on guided imagery) and asked participants to carry out a speeded go/no-go task while high-density electroencephalography was recorded concurrently. As a control condition, we used a group with neutral mood. Event-related potential results showed that the error-related negativity (ERN) component, reflecting early error detection within the dorsal anterior cingulate cortex, was not influenced by happy mood. In contrast, the subsequent error positivity (Pe) component, related to the appraisal of the motivational significance of errors, was reliably smaller in the happy than in the neutral mood group. Complementing source localization analyses showed that this effect was explained by decreased activation within the posterior cingulate and insular cortices. These results were obtained in the absence of group differences regarding behavioral performance and tonic arousal. These findings suggest that happy mood likely decreases and changes the motivational significance of worse-than-expected events (Pe), while leaving their earlier automatic detection (ERN) unaltered. We discuss these new results in terms of dynamic changes in the complex interplay of performance monitoring with motivation.     

Canadian Immigrants’ Access to a First Job in Their Intended Occupation

Using detailed information on employment trajectory provided by the Longitudinal Survey of Immigrants to Canada, this study examines the labor market outcomes of recent immigrants in terms of the duration until access to a first job in their intended occupation, as determined by a question in the first wave interview on labor market intentions. The matching between actual and intended occupations is obtained from the first two digits of the National Occupational Classification codes, which consider successively occupation type and skill level. Using a Cox proportional hazards model, the study investigates the roles of factors related to human and social capital in speeding up the matching process between actual and intended occupations. It is found that the initial year in Canada is critical for an immigrant to land a job in the intended field; after that period, the hazards of finding employment in the intended occupation flatten down. In general, those with intention to work in nonprofessional jobs, such as sales and services, trades, transport and equipment operators, primary industry, and processing and manufacturing occupations, enter the first job in the intended occupation more quickly. The results also show that education, English language ability, Canadian work experience, and friend networks facilitate access to the intended occupation.     

Is the learning of goal-directed displacement effector-independent?

The present experiment was designed to investigate whether the learning of goal-directed locomotion is effector independent. To answer this question a bilateral transfer of learning paradigm was used. We wanted to find out whether learning can be transferred from a trained effector system to an untrained one. Sixteen participants were asked to proceed through virtual hallways, while walking on a treadmill or handling of a joystick, in order to cross a pair of oscillating doors. Participants received 1050 training trials on the specific effector system before being transferred to the untrained one. Results indicated a clear transfer from handling to walking and only a moderate transfer from walking to handling. This asymmetrical transfer provides partial support in favor of the effector independent hypothesis. Both the theoretical implications of this work and the possible mediating effect of calibration are discussed.     

Spatial and temporal adaptations that accompany increasing catching performance during learning

The authors studied changes in performance and kinematics during the acquisition of a 1-handed catch. Participants were 8 women who took an intensive 2-week training program during which they evolved from poor catchers to subexpert catchers. An increased temporal consistency, shift in spatial location of ball-hand contact away from the body, and higher peak velocity of the transport of the hand toward the ball accompanied their improvement in catching performance. Moreover, novice catchers first adjusted spatial characteristics of the catch to the task constraints and fine-tuned temporal features only later during learning. A principal components analysis on a large set of kinematic variables indicated that a successful catch depends on (a) forward displacement of the hand and (b) the dynamics of the hand closure, thereby providing a kinematic underpinning for the traditional transport-manipulation dissociation in the grasping and catching literature.     

Intersection crossing considered as intercepting a moving traffic gap: Effects of task and environmental constraints

Safely crossing an intersection requires that drivers actively control their approach to the intersection with respect to characteristics of the flow of incoming traffic. To further our understanding of the perceptual-motor processes involved in this demanding manoeuvre, we designed a driving simulator experiment in which 13 participants actively negotiated intersections by passing through a gap in the train of incoming traffic. Task constraints were manipulated by varying the size of the traffic gap and the initial conditions with respect to the time of arrival of the traffic gap at the intersection. Environment constraints were manipulated by varying the intersection geometry through changes in the angle formed by the crossroads. The results revealed that the task constraints systematically gave rise to continuous and gradual adjustments in approach velocity, initiated well before arriving at the intersection. These functionally appropriate adjustments allowed the drivers to safely cross the intersection, generally just slightly ahead of the center of the traffic gap. Notwithstanding the fact that the geometry of the intersection did not affect the spatiotemporal constraints of the crossing task, approach behavior varied systematically over geometries, suggesting that drivers rely on the traffic gap's bearing angle. Overall, the pattern of results is indicative of a continuous coupling between perception and action, analogous to that observed in locomotor interception tasks.     

Rhesus monkeys (Macaca mulatta) and capuchin monkeys (Cebus apella) remember future responses in a computerized task

Planning is an important aspect of many daily activities for humans. Planning involves forming a strategy in anticipation of a future need. However, evidence that nonhuman animals can plan for future situations is limited, particularly in relation to the many other kinds of cognitive capacities that they appear to share with humans. One critical aspect of planning is the ability to remember future responses, or what is called prospective coding. Two monkey species (Macaca mulatta and Cebus apella) performed a series of computerized tasks that required encoding a future response at the outset of each trial. Monkeys of both species showed competence in all tests that were given, providing evidence that they anticipated future responses and that they appropriately engaged in those responses when the time was right for such responses. In addition, some tests demonstrated that monkeys even remembered future responses that were not as presently motivating as were other aspects of the task environment. These results indicated that monkeys could anticipate future responses and retain and implement those responses when appropriate.     

Repetition Errors in Habitual Prospective Memory: Elimination of Age Differences via Complex Actions or Appropriate Resource Allocation

ABSTRACT

A challenge in habitual prospective memory tasks (e.g., taking medication) is remembering whether or not one has already performed the action. Einstein, McDaniel, Smith, and Shaw (1998 Einstein, G. O., McDaniel, M. A., Smith, R. E. and Shaw, P. 1998. Habitual prospective memory and aging: Remembering intentions and forgetting actions. Psychological Science, 9: 284–288. [Crossref], [Web of Science ®] , [Google Scholar], Psychological Science, 9, 284) showed that older adults were more likely to incorrectly repeat an action on habitual prospective memory tasks. Extending this research, we (a) biased participants either toward repetition or omission errors, (b) investigated whether performing a more complicated motor action can reduce repetition errors for older adults, and (c) examined participants' resource allocation to the prospective memory task. Older adults committed more repetition errors than younger adults regardless of biasing instructions when ongoing task demands were challenging (Experiment 1). Performing the more complex motor action, however, reduced repetition errors for older adults. Further, when the ongoing task was less demanding, older adults' repetition errors declined to levels of younger adults (Experiment 2). Consistent with this finding, the resource allocation profiles suggested that older participants were monitoring their output (prospective memory execution) in each trial block.     

Problem Anger in Psychotherapy: An Emotion-Focused Perspective on Hate, Rage, and Rejecting Anger

This paper explores applies emotion-focused theory, for the first time, to the emotions of hate, rage, and destructive anger. The general case formulation proposed in this paper is that these emotions are always an elaboration of secondary anger. The body of the paper describes three clinical case formulations. First, problem anger is described in terms of an individual’s self-criticism. Second, we present a form of secondary anger, in which hostility and rage are reactive feelings to avoid more vulnerable (primary) experiences. An unfortunate example of this is has been described as a common underlying process in domestic violence. A alternate manifestation of secondary anger results from the deterioration of what may have initially been adaptive anger; thus, excessive arousal and the loss of meaning or focus that one’s anger embodied also leads to rage or destructive anger. Finally, the experience and expression of hate is described as a primary maladaptive and/or instrumental anger. This appears in-session particularly among those with certain personality disorders. The paper highlights implications for research and practice.