Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Development and validation of a brief self-report measure of trauma exposure: the Trauma History Screen

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.     

The role of encoding strategies in the verbal memory performance in patients with schizophrenia

Background. Verbal learning and memory is often compromised in patients with schizophrenia who prefer encoding words in order of their presentation (serial clustering) rather than using semantic categories (semantic clustering). Method. One hundred and four in‐patients with schizophrenia were assessed twice with the California Verbal Learning Test. Results. Patients showed significantly less semantic than serial clustering at both assessment times. Usage of encoding strategies were not stable over time. An increase in semantic clustering improved recall and recognition performance. Conclusions. Patients with schizophrenia should be taught to use the more effective encoding strategy of semantic clustering in order to improve their memory performance.     

The importance of context information for the spatial specificity of gaze cueing

In three experiments, we investigated the spatial allocation of attention in response to central gaze cues. In particular, we examined whether the allocation of attentional resources is influenced by context information—that is, the presence or absence of reference objects (i.e., placeholders) in the periphery. On each trial, gaze cues were followed by a target stimulus to which participants had to respond by keypress or by performing a target-directed saccade. Targets were presented either in an empty visual field (Exps. 1 and 2) or in previewed location placeholders (Exp. 3) and appeared at one of either 18 (Exp. 1) or six (Exps. 2 and 3) possible positions. The spatial distribution of attention was determined by comparing response times as a function of the distance between the cued and target positions. Gaze cueing was not specific to the exact cued position, but instead generalized equally to all positions in the cued hemifield, when no context information was provided. However, gaze direction induced a facilitation effect specific to the exact gazed-at position when reference objects were presented. We concluded that the presence of possible objects in the periphery to which gaze cues could refer is a prerequisite for attention shifts being specific to the gazed-at position.     

Three Assistants on Boltzmann

The three demi-articles presented here would give a brief biographical account of Ludwig Boltzmann’s life plus some details about his Vienna laboratories first in the 1860’s in the Erdberg and second in Türkenstrasse from 1894. Josef Nabl’s account discusses J. J. Thomson’s Laboratory in Cambridge, which allows a provisional comparison between two different largely contemporary institutes. Nabl’s second letter also mentions Lord Kelvin’s late rejection of the kinetic gas theory of Maxwell and Boltzmann, rejection which on top of the negative attitude of Mach, Zermelo, and Poincaré probably did not benefit Boltzmann’s state of mind and may have contributed to the extreme character of Boltzmann’s anti-philosophical counterattack starting in 1903. This revised version was published online in June 2006 with corrections to the Cover Date.     

The Effects of Framing, Reflection, Probability, and Payoff on Risk Preference in Choice Tasks

A meta-analysis of Asian-disease-like studies is presented to identify the factors which determine risk preference. First the confoundings between probability levels, payoffs, and framing conditions are clarified in a task analysis. Then the role of framing, reflection, probability, type, and size of payoff is evaluated in a meta-analysis. It is shown that bidirectional framing effects exist for gains and for losses. Presenting outcomes as gains tends to induce risk aversion, while presenting outcomes as losses tends to induce risk seeking. Risk preference is also shown to depend on the size of the payoffs, on the probability levels, and on the type of good at stake (money/property vs human lives). In general, higher payoffs lead to increasing risk aversion. Higher probabilities lead to increasing risk aversion for gains and to increasing risk seeking for losses. These findings are confirmed by a subsequent empirical test. Shortcomings of existing formal theories, such as prospect theory, cumulative prospect theory, venture theory, and Markowitz's utility theory, are identified. It is shown that it is not probabilities or payoffs, but the framing condition, which explains most variance. These findings are interpreted as showing that no linear combination of formally relevant predictors is sufficient to capture the essence of the framing phenomenon.     

Orientation Toward Intrinsic Motivation Mediates the Relationship Between Metacognition and Creativity

Metacognition and motivation are considered key facets of self-regulation in various contexts. Recent studies identified a link between metacognition and creative performance, with metacognitively aware students performing more creatively and exhibiting higher levels of intrinsic and identified extrinsic motivation. The present study aims to examine the relationship between metacognition, orientation toward intrinsic or extrinsic motivation, and creative performance. One hundred nineteen university students completed the Metacognitive Awareness Inventory (MAI) and Scale of Intrinsic versus Extrinsic Orientation in the Classroom and performed four verbal creativity tasks (product improvement task, consequences task, and two unusual uses tasks). The partial correlation network showed that all the creativity tasks were uniquely related to at least one facet of metacognition, and that the most complex task (product improvement task) was linked to both metacognitive knowledge and regulation. Furthermore, the structural equation model indicated that orientation toward intrinsic motivation mediated the relationship between metacognition and creative performance, explaining 16% of the variance in creative performance.     

Test of a potential link between analytic and nonanalytic category learning and automatic, effortful processing

The link between automatic and effortful processing and nonanalytic and analytic category learning was evaluated in a sample of 29 college undergraduates using declarative memory, semantic category search, and pseudoword categorization tasks. Automatic and effortful processing measures were hypothesized to be associated with nonanalytic and analytic categorization, respectively. Results suggested that contrary to prediction strong criterion-attribute (analytic) responding on the pseudoword categorization task was associated with strong automatic, implicit memory encoding of frequency-of-occurrence information. Data are discussed in terms of the possibility that criterion-attribute category knowledge, once established, may be expressed with few attentional resources. The data indicate that attention resource requirements, even for the same stimuli and task, vary depending on the category rule system utilized. Also, the automaticity emerging from familiarity with analytic category exemplars is very different from the automaticity arising from extensive practice on a semantic category search task. The data do not support any simple mapping of analytic and nonanalytic forms of category learning onto the automatic and effortful processing dichotomy and challenge simple models of brain asymmetries for such procedures.