Psychoanalytic patients in the U.S., CANADA,and Australia: I. DSM-III-R disorders,indications, previous treatment,medications, and length of treatment

To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n = 342) for the U.S., 67.2% (n = 117) for Canada, and 73.9% (n = 51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD = 3.66; median = 4; mode = 3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.     

Are high school students accurate or clueless in estimating substance use among peers?

The purpose of this study was to assess adolescents' estimations of the prevalence of alcohol and other drug use and to examine the consistency between these estimations and reported use. A survey was administered to 223 students in three northwestern U.S. high schools. Results showed that students in each of the three high schools grossly overestimated the prevalence of substance use when compared to self-reports of use. Still, students were not entirely clueless about the relative normativeness of substance use when comparing estimates and rates of use among the three schools. The school with the highest estimated prevalence of a particular substance use behavior generally also had the highest self-reported use of that same substance. These findings imply the need for high school personnel to provide students with accurate information about the actual prevalence of substance use within each school.     

Thought-shape fusion in anorexia nervosa: an experimental investigation

Cognitive biases and cognitive distortions have been implicated as important factors in the development and maintenance of many disorders. The concept of thought-shape fusion (TSF) in eating disorders was developed by Shafran, Teachman, Kerry, and Rachman (British Journal of Clinical Psychology 38 (1999) 167) as a variant of thought-action fusion, described by Shafran, Thordarson and Rachman (Journal of Anxiety Disorders 10 (1996) 379). TSF occurs when thinking about eating certain types of food increases a person's estimate of their shape and/or weight, elicits a perception of moral wrongdoing, and/or makes the person feel fat. Shafran et al. (1999) examined both the psychometric and experimental properties of TSF in an undergraduate sample. This paper reports an extension of this work to a clinical group (N=20) of patients with anorexia nervosa. After completing a set of relevant questionnaires, participants were asked to think about a food which they considered extremely fattening. They were then asked to write out the sentence, "I am eating--.", inserting the name of the fattening food in the blank. After being asked to rate their anxiety, guilt, feelings about their weight, morality, etc., participants were given the opportunity to neutralize their statement in any way they chose. The majority of the participants neutralized in ways consistent with the findings of Shafran et al. (1999). The results are discussed in terms of cognitive-behavioural formulations of eating disorders, and of the influence of cognitive biases and cognitive distortions on the processing of information relevant to food, weight and shape in anorexia nervosa.     

What do you think I think you think?: Strategic reasoning in matrix games

In reasoning about strategic interpersonal situations, such as in playing games, an individual's representation of the situation often includes not only information about the goals and rules of the game, but also a mental model of other minds. Often such mental models involve a hierarchy of reflexive reasoning commonly employed in social situations ("What do you think I think you think..."), and may be related to the developmental notion of 'theory of mind'. In two experiments, the authors formally investigate such interpersonal recursive reasoning in college-age adults within the context of matrix games. Participants are asked to predict the moves of another player (experimenter's confederate) in a two-choice, sequential-move game that may terminate at various stages with different payoffs for each player. Participants are also asked to decide optimally on their own moves based on the prediction made. Errors concerning the prediction, or translation of those predictions into decisions about one's action, were recorded. Results demonstrate the existence of a "default" mental model about the other player in the game context that is dynamically modified as new evidence is accumulated. Predictions about this other player's behavior are, in general, used consistently in decision-making, though the opponent tends to be modeled, by default, to behave in a myopic fashion not anticipating the participant's own action.     

Rich interpretation vs. deflationary accounts in cognitive development: the case of means-end skills in 7-month-old infants

Seven-month-old infants appear to learn means-end skills, such as pushing a button to retrieve a distant toy (Psychological Review 104 (1997) 686). The present studies tested whether such apparent means-end behaviors are genuine, or simply the repetition of trained behaviors under conditions of greatest arousal, as suggested by a dynamic systems reinterpretation. When infants were trained to repeat behaviors that did not serve as means to retrieving toys (pushing a button to light a set of distant lights), their button-pushing differed significantly from infants for whom button-pushing served as a means for retrieving toys. Further, infants demonstrated means-end skills with behaviors that they had not been trained to repeat. Implications for early means-end abilities and for debates surrounding the interpretation of infant behavior are discussed.     

Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia?

Dysfunctional beliefs and attitudes about sleep are presumed to play an important mediating role in perpetuating insomnia. The present study evaluated the impact of cognitive-behavioral and pharmacological treatments for insomnia on sleep-related beliefs and attitudes and the relationship between those changes and sleep improvements. The participants were older adults with chronic and primary insomnia. They received cognitive-behavior therapy (CBT), pharmacotherapy (PCT), combined CBT+PCT (COMB), or a medication placebo (PLA). In addition to daily sleep diaries and sleep laboratory measures, the participants completed the dysfunctional beliefs and attitudes about sleep scale (DBAS) at baseline and posttreatment, and at 3-, 12- and 24-month follow-up assessments. The results showed that CBT and COMB treatments produced greater improvements of beliefs and attitudes about sleep at posttreatment than PCT and PLA. Reductions of DBAS scores were significantly correlated with improvements of sleep efficiency as measured by daily sleep diaries and by polysomnography. In addition, more adaptive beliefs and attitudes about sleep at posttreatment were associated with better maintenance of sleep improvements at follow-ups. These findings highlight the importance of targeting sleep-related beliefs and attitudes in the treatment of insomnia.     

Perception of the symmetrical patterning of human gait by infants

Two experiments tested 3- and 5-month-old infants' sensitivity to properties of point-light displays of human gait. In Experiment 1, infants were tested for discrimination of point-light displays of a walker and a runner, which, although they differed in many ways, were equivalent with regard to the phasing of limb movements. Results revealed that 3-month-old, but not 5-month-old, infants discriminated these displays. In Experiment 2, the symmetrical phase-patterning of the runner display was perturbed by advancing two of its limbs by 25% of the gait cycle. Both 3- and 5-month-old infants discriminated the walker display from this new phase-shifted runner display. These findings suggest that 3-month-old infants respond to the absolute and relative motions within a single limb, whereas 5-month-old infants respond primarily to the relations between limbs and, in particular, to the bilateral symmetry between the limbs.