Interpretation and Expectation in Childhood Anxiety Disorders: Age Effects and Social Specificity

Theory and treatment for childhood anxiety disorders typically implicates children’s negative cognitions, yet little is known about the characteristics of thinking styles of clinically anxious children. In particular, it is unclear whether differences in thinking styles between children with anxiety disorders and non-anxious children vary as a function of child age, whether particular cognitive distortions are associated with childhood anxiety disorders at different child ages, and whether cognitive content is disorder-specific. The current study addressed these questions among 120 7–12 year old children (53% female) who met diagnostic criteria for social anxiety disorder, other anxiety disorder, or who were not currently anxious. Contrary to expectations, threat interpretation was not inflated amongst anxious compared to non-anxious children at any age, although older (10–12 year old) anxious children did differ from non-anxious children on measures of perceived coping. The notion of cognitive-content specificity was not supported across the age-range. The findings challenge current treatment models of childhood anxiety, and suggest that a focus on changing anxious children’s cognitions is not warranted in mid-childhood, and in late childhood cognitive approaches may be better focussed on promoting children’s perceptions of control rather than challenging threat interpretations.     

The Goal Circuit Model: A Hierarchical Multi‐Route Model of the Acquisition and Control of Routine Sequential Action in Humans

Human control of action in routine situations involves a flexible interplay between (a) task‐dependent serial ordering constraints; (b) top‐down, or intentional, control processes; and (c) bottom‐up, or environmentally triggered, affordances. In addition, the interaction between these influences is modulated by learning mechanisms that, over time, appear to reduce the need for top‐down control processes while still allowing those processes to intervene at any point if necessary or if desired. We present a model of the acquisition and control of goal‐directed action that goes beyond existing models by operationalizing an interface between two putative systems—a routine and a non‐routine system—thereby demonstrating how explicitly represented goals can interact with the emergent task representations that develop through learning in the routine system. The gradual emergence of task representations offers an explanation for the transfer of control with experience from the non‐routine goal‐based system to the routine system. At the same time it allows action selection to be sensitive both to environmental triggers and to biasing from multiple levels within the goal system.     

State-based versus reward-based motivation in younger and older adults

Recent decision-making work has focused on a distinction between a habitual, model-free neural system that is motivated toward actions that lead directly to reward and a more computationally demanding goal-directed, model-based system that is motivated toward actions that improve one’s future state. In this article, we examine how aging affects motivation toward reward-based versus state-based decision making. Participants performed tasks in which one type of option provided larger immediate rewards but the alternative type of option led to larger rewards on future trials, or improvements in state. We predicted that older adults would show a reduced preference for choices that led to improvements in state and a greater preference for choices that maximized immediate reward. We also predicted that fits from a hybrid reinforcement-learning model would indicate greater model-based strategy use in younger than in older adults. In line with these predictions, older adults selected the options that maximized reward more often than did younger adults in three of the four tasks, and modeling results suggested reduced model-based strategy use. In the task where older adults showed similar behavior to younger adults, our model-fitting results suggested that this was due to the utilization of a win-stay–lose-shift heuristic rather than a more complex model-based strategy. Additionally, within older adults, we found that model-based strategy use was positively correlated with memory measures from our neuropsychological test battery. We suggest that this shift from state-based to reward-based motivation may be due to age related declines in the neural structures needed for more computationally demanding model-based decision making.     

Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Linking Disjoint Supermatrices and Criteria Clusters

An axiom of the Analytic Network Process (ANP) requires the elements being considered to be strongly connected in order to obtain a meaningful priority vector. A simple example demonstrates the issues that can arise when a decision contains disjoint clusters within the Supermatrix. From the example it can be observed that the necessary information to complete additional linking pin comparisons would have already been collected; and by performing linking pin comparisons a decision maker can convert a disjoint Supermatrix into a strongly connected Supermatrix. The linking process is summarized in five steps and provided in the general form. This linking comparison methodology exploits the fundamental advantages of pairwise comparisons and can also be used to weight the criteria clusters within a decision network. Linking pin comparisons performed at the level of a criterion of a single alternative with respect to another criterion of that same alternative can be used to obtain the criteria cluster weights. Linking pin comparisons at this level can reduce the decision maker's cognitive burden in comparison to totality comparisons. The ability to strongly connect an otherwise disjoint Supermatrix and reduce the decision maker's cognitive burden demonstrates the usefulness of linking pin comparisons in ANP decision models. Copyright © 2016 John Wiley & Sons, Ltd.     

Patient preference as a predictor of outcomes in a pilot trial of person-centred counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face).     

Antisocial Behavior,Moral Disengagement,Empathy and Negative Emotion: A Comparison Between Disabled and Able-Bodied Athletes

Theories of morality suggest that negative emotions associated with antisocial behavior should diminish motivation for such behavior. Two reasons that have been proposed to explain why some individuals repeatedly harm others are that (a) they use mechanisms of moral disengagement to justify their actions, and (b) they may not empathize with and vicariously experience the negative emotions felt by their victims. With the aim of testing these proposals, the present study compared spinal cord injured disabled athletes and able-bodied athletes to determine the effect of reduced visceral afferent feedback caused by spinal cord injury on antisocial behavior, moral disengagement, empathy, and negative emotion (i.e., anger, anxiety, and dejection). Disabled athletes reported less frequent antisocial behavior and lower moral disengagement than able-bodied athletes. Group differences in antisocial behavior were mediated by differences in moral disengagement. The two groups did not differ in empathy or negative emotion. The findings of this study suggest that antisocial behavior may be regulated by mechanisms of moral disengagement.