Therapist empathy,homework compliance,and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients’ subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist–client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients’ ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist’s caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.     

Writing errors and anosognosia in amyotrophic lateral sclerosis with dementia

Amyotrophic lateral sclerosis (ALS) with dementia (ALS-D) is known to exhibit characteristics of frontotemporal dementia. However, in clinical situations, it is often difficult to evaluate their cognitive functions because of impaired voluntary speech and physical disabilities. In order to identify characteristic and diagnostic cognitive symptoms of relatively advanced ALS-D patients, we retrospectively reviewed the clinical features of seven cases of clinically definitive ALS who had dementia, impaired voluntary speech, and physical disability. Their medical records showed that six out of seven patients made writing errors, and all of the patients demonstrated anosognosia. The writing errors consisted of paragraphia such as substitution, omission, or syntactic errors with individual differences in error types. Dissociation between kana and kanji were also observed. Anosognosia was evaluated by a self-rating scale with which the patients and the medical staff evaluated the patient's physical ability; the results indicated a large discrepancy between the evaluation by the patients and the medical staff. We emphasize that aphasic writing errors have been underestimated, particularly in ALS-D patients with impaired voluntary speech. We also reported that anosognosia was the most important and quantifiable symptom in ALS-D. The relationship between writing errors and anosognosia should be investigated further.     

A link between stress and depression: shifts in the balance between the kynurenine and serotonin pathways of tryptophan metabolism and the etiology and pathophysiology of depression

Alteration of tryptophan (TRP) metabolism elicited by proinflammatory cytokines has gained attention as a new concept to explain the etiological and pathophysiological mechanisms of major depression. The kynurenine (KYN) pathway, which is initiated by indoleamine 2,3-dioxygenase (IDO), is the main TRP metabolic pathway. It shares TRP with the serotonin (5-HT) pathway. Proinflammatory cytokines induce IDO under stress, promote the KYN pathway, deprive the 5-HT pathway of TRP, and reduce 5-HT synthesis. The resultant decrease in 5-HT production may relate to the monoamine hypothesis of major depression. Furthermore, metabolites of the KYN pathway have neurotoxic/neuroprotective activities; 3-hydroxykynurenine and quinolinic acid are neurotoxic, whereas kynurenic acid is neuroprotective. The hippocampal atrophy that appears in chronic depression may be associated with imbalances in neurotoxic/neuroprotective activities. Because proinflammatory cytokines also activate the hypothalamo-pituitary-adrenal (HPA) axis, these imbalances may inhibit the hippocampal negative feedback system. Thus, changes in the TRP metabolism may also relate to the HPA axis-hyperactivity hypothesis of major depression. In this article, we review the changes in TRP metabolism by proinflammatory cytokines under stress, which is assumed to be a risk factor for major depression, and the relationship between physiological risk factors for major depression and proinflammatory cytokines.     

Effect of pupil size on dynamic visual acuity

This study was conducted to assess the effect of pupil size on dynamic visual acuity (DVA). 60 young healthy men (M = 28.1 yr., SD = 3.9) with normal vision were divided into three age-matched groups by pupil size: dilated (n=20), unchanged (n=20), and constricted (n=20). DVA was measured binocularly with freehead viewing before and at 30 min. after each drop was instilled. Each of the three groups got a different amount. The sizes of the constricted, unchanged, and dilated pupils were 2.8 mm (SD = 0.5), 4.1 mm (SD = 0.3), and 7.8 mm (SD = 0.5), respectively. The pupil size x DVA interaction was significant (F(2,114)= 6.07). DVA in the constricted pupil decreased, but that in the dilated pupil increased (paired t test). DVA in the unchanged pupil did not change significantly (paired t test). Pupil size is possibly one of the factors which may affect DVA measurement.     

An ERP study on self-relevant object recognition

We performed an event-related potential study to investigate the self-relevance effect in object recognition. Three stimulus categories were prepared: SELF (participant's own objects), FAMILIAR (disposable and public objects, defined as objects with less-self-relevant familiarity), and UNFAMILIAR (others' objects). The participants' task was to watch the stimuli passively. Results showed that left-lateralized N250 activity differentiated SELF and FAMILIAR from UNFAMILIAR, but SELF and FAMILIAR were not differentiated. In the later time-course, SELF was dissociated from FAMILIAR, indicating the self-relevance effect in object recognition at this stage. This activity did not show consistent lateralization, in contrast to previous studies reporting right lateralization in self-relevant face and name recognition. We concluded that in object recognition, self-relevance was processed by higher-order cognitive functions later than 300ms after stimulus onset.     

Multiracial Identity,Color‐Blind Racial Ideology,and Discrimination: Professional Counseling Implications

Because of the expansive multiracial population growth in the United States, the authors explored multiracial identity integration (MII), color‐blind racial ideology (CBRI), and discrimination using regression analyses with 288 individuals. CBRI and discrimination significantly correlated and predicted MII, with 15.3% of the variance explained by discrimination and CBRI. Moderation analysis revealed that CBRI did not moderate the relationship between discrimination and MII. Continued research among multiracial individuals is recommended to better understand the CBRI and racial identity link.     

Psychometric Synthesis of the Five Factor Wellness Inventory

This quantitative synthesis combines results of 59 studies that published psychometrics of the Five Factor Wellness Inventory (5F-Wel; Myers & Sweeney, 2005a, 2005b). Although few studies reported complete statistics, and demographically targeted research studies are needed, this synthesis reflects that the 5F-Wel (also known as the FFWEL; Mind Garden, n.d.) is sound psychometrically for adults: Internal consistency, subsample means, and intrascale correlations are promising, as are correlations with related constructs. Consequently, the 5F-Wel demonstrates utility for clinical use when working with clients on wellness goals.     

Early development of subcortical regions involved in non-cued attention switching

This study examined the cognitive and neural development of attention switching using a simple forced-choice attention task and functional magnetic resonance imaging Fourteen children and adults made discriminations among stimuli based on either shape or color. Performance on these trials was compared to performance during blocked trials requiring all color or all shape discriminations. Magnetic resonance echo planar images were acquired during performance of the task. Both children and adults showed robust bilateral activity of the caudate nucleus when switching attention between color and shape discriminations that correlated negatively with mean response latency on these trials. However, neither switching costs nor caudate activity correlated with age, suggesting early development of the underlying neural circuitry involved in switching between salient stimulus sets. Overall, children and adults differed in performance and patterns of brain activity on the task, with adults responding more accurately and faster than children, and recruiting more prefrontal and parietal regions. These results suggest an important role of subcortical regions (i.e. caudate nucleus) in non-cued attention switching, with increasing recruitment of cortical regions with age.     

Interaction of prime and target in the subliminal affective priming effect

It has been found that an emotional stimulus such as a facial expression presented subliminally can affect subsequent information processing and behavior, usually by shifting evaluation of a subsequent stimulus to a valence congruent with the previous stimulus. This phenomenon is called subliminal affective priming. The present study was conducted to replicate and expand previous findings by investigating interaction of primes and targets in the affective priming effect. Two conditions were used. Prime (subliminal presentation 35 msec.) of an angry face of a woman and a No Prime control condition. Just after presentation of the prime, an ambiguous angry face or an emotionally neutral face was presented above the threshold of awareness (500 msec.). 12 female undergraduate women judged categories of facial expressions (Anger, Neutral, or Happiness) for the target faces. Analysis indicated that the Anger primes significantly facilitated judgment of anger for the ambiguous angry faces; however, the priming effect of the Anger primes was not observed for neutral faces. Consequently, the present finding suggested that a subliminal affective priming effect should be more prominent when affective valence of primes and targets is congruent.