Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial

The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW-I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.     

Associations between financial strain and the diurnal salivary cortisol secretion of long-term unemployed individuals

Objective: The study investigated the associations between self-rated financial strain and overall diurnal salivary cortisol levels, as well as secretory patterns among long-term unemployed individuals.Methods: Psychosocial and life-style variables were assessed by means of questionnaires among 85 participants (mean age 42±9 years; 56% females). Salivary cortisol was sampled on four occasions during a 24-hour period and data was analysed separately for men and women.Results: Among females, high financial strain was related to higher overall cortisol levels, and to elevated levels in the evening. These associations did not reach significance among men. Multivariate analyses showed that evening levels of cortisol were positively associated with financial strain, but largely unrelated to life-style variables and psychological distress.Conclusions: The results suggest that high financial strain influences the diurnal cortisol secretion of unemployed individuals in terms of elevated cortisol levels in the evening. The mediating mechanisms are in need of further investigation.     

The importance of impaired physical health and age in normal cognitive aging

The objective of this study was to investigate the importance of impaired physical health and age in normal cognitive aging. In our cross-sectional, clinical and explorative study, medical and neuropsychological data from 118 voluntary healthy controls aged 26-91 years were collected from five recruitment occasions. Health was assessed according to a criterion reflecting clinical and subclinical severity. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological assessment. Regression analyses showed a significant incidence of clinical and subclinical medical disorders that explained 10.8% of the variation in cognitive performance, while age-related impairment explained 5.6%. Findings of the central nervous system were important but various other medical findings explained about half of the health-related variation. Cognitively demanding tasks were more susceptible to impaired physical health while tasks comprising salient motor- and visual spatial elements were more prone to be impaired by age. Our findings suggest (1) that impaired physical health is more important than chronological age in accounting for cognitive impairment across the adult lifespan, (2) that age and health dissociate with regard to cognitive functions affected, and (3) that selection for so-called "super healthy" elderly people might be justified in cognitive research. Because the prevalent diseases in normal aging are potentially preventable, the present findings promise good prospect for prevention of future cognitive disability among elderly people.     

Intersubject variability in fearful face processing: the linkbetween behavior and neural activation

Stimuli that signal threat show considerable variability in the extents to which they enhance behavior, even among healthy individuals. However, the neural underpinning of this behavioral variability is not well understood. By manipulating expectation of threat in an fMRI study of fearful versus neutral face categorization, we uncovered a network of areas underlying variability in threat processing in healthy adults. We explicitly altered expectations by presenting face images at three different expectation levels: 80 %, 50 %, and 20 %. Subjects were instructed to report as quickly and accurately as possible whether the face was fearful (signaled threat) or not. An uninformative cue preceded each face by 4 s. By taking the difference between reaction times (RTs) to fearful and neutral faces, we quantified an overall fear RT bias (i.e., faster to fearful than to neutral faces) for each subject. This bias correlated positively with late-trial fMRI activation (8 s after the face) during unexpected-fearful-face trials in bilateral ventromedial prefrontal cortex, the left subgenual cingulate cortex, and the right caudate nucleus, and correlated negatively with early-trial fMRI activation (4 s after the cue) during expected-neutral-face trials in bilateral dorsal striatum and the right ventral striatum. These results demonstrate that the variability in threat processing among healthy adults is reflected not only in behavior, but also in the magnitude of activation in medial prefrontal and striatal regions that appear to encode affective value.     

Visual-Verbal Self/Other-Referential Processing Task: Direct vs. indirect assessment, valence, and experiential correlates

This study evaluated a new methodology for assessing valenced Self-Referential Processing (SRP) in comparison with Other-Referential Processing (ORP). Participants viewed pictures of themselves during certain trials and same-gender strangers during others, intermixed between valenced words. Participants internally-rehearsed the words “I am” or “He/she is” when presented with the respective pictures and read the valenced words, thereby associating the self/other with positivity/negativity on different trials. Participants self-monitored their affective response, and their degree of attention and/or rate of internal speech/reading speed was measured indirectly via button-press response time (RT). Results in 91 young adults demonstrated a self-positivity bias in survey ratings, stronger affective responses during SRP than ORP, slower RT during SRP than ORP, and slower RT during positive than negative valence. Difference scores between SRP of negative- vs. positive-valence trials, and between SRP vs. ORP of negative-valence trials, were correlated among survey ratings, affective responses, and RT. Finally, content analyses of phenomenological reports showed that task conditions differentially provoked a number of socioemotional experiences during both SRP and ORP (e.g., jealousy-envy, sympathy-pity, good will/pride). We discuss potential applications of the task in the study of personality and individual differences.     

Cognitive deficits in relation to personality type and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in women with stress-related exhaustion

Exhaustion caused by long-term work-related stress may cause cognitive dysfunction. We explored factors that may link chronic stress and cognitive impairment. Personality, psychiatric screening, and behavior were assessed by self-reporting measures in 20 female patients (mean age 39.3 years; range 26-53) with a preliminary diagnosis of stress-related exhaustion and in 16 healthy matched controls. Cognitive performance was investigated with a detailed neuropsychological test battery. Cortisol axis function was assessed by urinary and saliva collections of cortisol, dexamethasone suppression, Synacthen response, and corticotropin-releasing hormone (CRH) tests. Proinflammatory cytokines were measured. Hippocampal volumes were estimated by magnetic resonance imaging. Multivariate and univariate statistical methods were used to explore putative differences between groups and factors linked to cognitive impairment. Cognitive function clearly differed between groups, with decreased attention and visuospatial memory in the patient group, suggesting frontal cortex/medial temporal cortex-network dysfunction. Increased harm avoidance and persistence was present among patients, with lowered self-directedness linked to lower quality of life, increased anxious and depressive tendencies, and experiences of psychosocial stress. Attention was decreased with concomitantly impaired visuospatial memory. The pituitary (adrenocorticotropic hormone, ACTH) response to CRH was decreased in patients, with an increased cortisol/ACTH response to CRH. However, cortisol production rates, diurnal or dexamethasone-suppressed saliva cortisol levels, and the cortisol response to Synacthen were unaltered. Hippocampal volumes did not differ between groups. These findings suggest that cognitive dysfunction in stress-related exhaustion is linked to distinct personality traits, low quality of life, and a decreased ACTH response to CRH.     

Dual-Route and Connectionist Models: A Step Towards a Combined Model

Current models of word recognition are mainly constructed within the frameworks of either dual-route or connectionist theories. The most important test of a word recognition model is how it succeeds in accounting for various reading behaviors. In the present paper dual-route and connectionist word recognition models are briefly described and evaluated. As a further development of these models, a combined framework is proposed. An amalgamation of the two main types of models might give a more satisfactory account of various phenomena within word recognition.     

Sex-role orientation as related to psychological and physiological responses during achievement and orthostatic stress

The Bem sex-role inventory was used to select, from an Irish student population, females and males who differed with regard to feminine and masculine personality characteristics. Four groups were established for each sex: (1) subjects with low scores in both femininity and masculinity, i.e., undifferentiated subjects; (2) subjects with high scores in both femininity and masculinity, i.e., androgynous subjects; (3) subjects with high scores in femininity and low scores in masculinity; (4) subjects with high scores in masculinity and low scores in femininity. The Cattell 16 PF scale showed that the undifferentiated groups were more reserved and detached and more cautious and taciturn than the androgynous groups. Each subject was exposed to mental stress in one session and orthostatic stress in another session. Mental stress was induced by five different intellectual performance tests. Males and females differed significantly only on a test of perceptual speed, with females performing better than males, as expected. The group of androgynous females was superior to all other groups on four of the five performance tasks. The group of androgynous males was not superior in terms of objective performance but reported feeling more confident andThis collaboration was made possible by a twinning grant to Dr. John Cullen and Professor Marianne Frankenhaeuser from the European Training Programme in Brain and Behaviour Research, European Science Foundation. Financial support was also obtained by grants from the Swedish Medical Research Council (Project No. 997) and the Swedish Council for Research in the Humanities and Social Sciences. satisfied with their performance than most other groups, particularly the undifferentiated males. Blood pressure and heart rate were significantly elevated in all groups during both stress conditions. Heart rate was significantly higher in the high-femininity and androgynous females than in the other female groups.