Acceptance and commitment therapy: model, processes and outcomes

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.     

EEG correlates of behavioural laterality: ear dominance

To examine whether ear dominance in a dichotic pitch-discrimination task is associated with asymmetrical activation of the two cortical hemispheres, ear dominance scores and electroencephalographic (EEG) laterality were correlated in two independent samples (ns=46 and 128). The results indicate that ear dominance can partly be attributed to a relatively stronger activation of the contralateral prefrontal cortex. The observed association may reflect the tendency to direct attention preferably to one ear.     

Suicide survivors' perceptions of the treating clinician

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.     

Stress and emotional valence effects on children's versus adolescents’ true and false memory

Despite considerable interest in understanding how stress influences memory accuracy and errors, particularly in children, methodological limitations have made it difficult to examine the effects of stress independent of the effects of the emotional valence of to-be-remembered information in developmental populations. In this study, we manipulated stress levels in 7–8- and 12–14-year-olds and then exposed them to negative, neutral, and positive word lists. Shortly afterward, we tested their recognition memory for the words and false memory for non-presented but related words. Adolescents in the high-stress condition were more accurate than those in the low-stress condition, while children's accuracy did not differ across stress conditions. Also, among adolescents, accuracy and errors were higher for the negative than positive words, while in children, word valence was unrelated to accuracy. Finally, increases in children's and adolescents’ cortisol responses, especially in the high-stress condition, were related to greater accuracy but not false memories and only for positive emotional words. Findings suggest that stress at encoding, as well as the emotional content of to-be-remembered information, may influence memory in different ways across development, highlighting the need for greater complexity in existing models of true and false memory formation.     

Shame and Dissociation in Survivors of High and Low Betrayal Trauma

Shame and dissociation cooccur in trauma survivors. Bypassed shame theory posits that dissociation reduces pain by interrupting shame. We tested this theory by inducing dissociation. The hypothesis that higher baseline shame would predict larger increases in dissociation following the induction was marginally supported. However, in contrast to bypassed shame theory, shame scores increased rather than decreased following the induction. An alternative theory, betrayal trauma theory (BTT), proposes that dissociation reduces awareness of betrayal to protect a needed relationship. Shame might also serve this function. We aimed to replicate prior research indicating traumas higher in betrayal (HBT) are uniquely related to both shame and dissociation compared to traumas lower in betrayal (LBT). The hypothesis that HBT would relate to higher shame was supported. The results suggest that other explanations than bypassed shame theory, such as BTT, might better account for the relationship between shame and dissociation in trauma survivors.     

Narcissism Predicts Heightened Cortisol Reactivity to a Psychosocial Stressor in Men

Narcissists' sensitivity to social evaluation should increase their physiological reactivity to evaluative stressors. However, very few studies have assessed the physiological correlates of narcissism. In this study, participants completed an evaluative laboratory stressor or a non-evaluative control task. Cortisol reactivity-a marker of the hypothalamic-pituitary-adrenal (HPA) axis stress response-and negative affect (NA) were higher in the stress versus control condition. However, men showed larger cortisol responses and, among men, higher narcissism scores predicted greater cortisol reactivity and larger increases in NA. Narcissism was unrelated to cortisol reactivity and NA among women and in the control condition. These findings highlight the influence of defensive personality traits on HPA reactivity and suggest a pathway through which narcissistic traits might influence long-term health outcomes.     

A unified approach to the perception of motion,stereo, and static-flow patterns

This paper presents a unified approach for studying the perception of motion, stereopsis, and static-flow (Glass) patterns. The objective is to address the same issues across these “modalities.” To this end, a new class of stimuli and procedures were developed, the key feature of which is the incorporation of a forced-choice competition paradigm into the random-dot stimuli paradigm that has traditionally been used in these modalities. The two competing percepts that are pitted against each other are opposite directions for motion, near/far depth planes for stereopsis, and orthogonal global patterns for Glass patterns. The differences in qualitative predictions for competing hypotheses are generally well pronounced, and the results provide clear evidence for deciding between alternative hypotheses. This approach has been used to confirm that covariance is the preferred metric for eliciting global correlations in all the modalities and to investigate the nature of front-end processes in each modality. It has the potential for neurophysiological studies for both single-cell and neuronal ensemble recording.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

The verifiability approach to deception detection: A preregistered direct replication of the information protocol condition of Nahari,Vrij, and Fisher (2014b)

Nahari, Vrij, and Fischer [(2014b), Applied Cognitive Psychology, 28, 122–128] found that, when participants were forewarned that their statements would be checked for verifiable details, truth tellers gave much more verifiable details than liars. In this direct replication (n = 72), participants wrote a statement claiming they had carried out their regular campus activities, whereas liars had actually stolen an exam. Statements were coded for verifiable details. Our primary prediction was confirmed: Truth tellers provided significantly more verifiable details than liars. Of note, the replication effect size (d = 0.49) was less than half that of the original (d = 1.14), and – like in the original study – was smaller than the lie‐truth effect size for total details (verifiable and unverifiable details combined; d = 0.80). We hope this will stimulate other independent investigations of VA to tell whether or not coding for verifiability will pass Ockham's razor test.     

Teaching happiness at school: Non-randomised controlled mixed-methods feasibility study on the effectiveness of Personal Well-Being Lessons

The paper presents an educational initiative to develop a separate well-being curriculum for a federation of schools in south-east London. A mixed-methods study was undertaken to evaluate the feasibility of the curriculum run biweekly in Year 7 (age 11–12, N = 96). The study utilised a non-randomised repeated measures design with a control group (N = 68) using general life satisfaction, domain life satisfaction and affect balance as outcome variables. In addition, semi-structured interviews were conducted with four students, two teachers and the principal of the intervention school. The results indicated significant buffering effect of the intervention in protecting students against the decline of satisfaction with self, satisfaction with friends, positive affect and the increase in negative affect throughout the first year of middle school. The qualitative data shed light on explicit learning, psychological outcomes and challenges associated with the programme. Overall, the data indicate a positive impact of the well-being curriculum.