Comment on evaluating cognitive demand

In 2005 Shieh and Chen found differences in EEG responses when using computer- and paper-based display media, which they attributed to different cognitive demands. This paper supports this interpretation by reporting an unpublished study in which cognitive demand was measured using a self-report workload measure.     

Personality traits change in adulthood: reply to Costa and McCrae (2006)

In a response to comments by P. T. Costa, Jr., and R. R. McCrae on the current authors' original article, the authors show that Costa and McCrae's writings on personality suggest a belief in immutability of personality traits. The authors agree with Costa and McCrae that new personality trait models that provide an accurate lower order structure of personality traits are needed and explain why the Revised NEO Personality Inventory is not the correct model for that purpose. The authors provide direct evidence refuting the hypothesis that personality traits change only because of biologically based intrinsic maturation. The authors present arguments supporting the contention that meta-analyses should be preferred to single longitudinal studies when drawing inferences about general patterns of personality development. Finally, the authors point out why the differences between their position and Costa and McCrae's are important.     

Emotion Concepts and Self-Focused Attention: Exploring Parallel Effects of Emotional States and Emotional Knowledge

Many experiments have found that emotional experience affects self-focused attention. Several approaches to cognition and emotion predict that conscious emotional experience may be unnecessary for this effect. To test this hypothesis, two experiments primed emotion concepts without affecting emotional experience. In Experiment 1, subliminal exposure to sad faces (relative to happy faces and neutral faces) increased self-focused attention but not subjectively experienced affect. In Experiment 2, a scrambled-sentences task that primed happy and sad emotion concepts increased self-focused attention relative to a neutral task. Thus, simply activating knowledge about emotions was sufficient to increase self-focused attention. The discussion considers implications for research on how emotional states affect self-awareness.

Using "Bubbles" with babies: a new technique for investigating the informational basis of infant perception

The 'Bubbles' technique (Gosselin, F. & Schyns, P.G. (2001). Bubbles: A technique to reveal the use of information in recognition tasks. Vision Research, 41, 2261-2271) has been widely used to reveal the information adults use to make perceptual categorizations. We present, for the first time, an adapted form of Bubbles, suitable for use with young infants.     

The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial

The outcome of a randomized controlled trial of cognitive behavior therapy in addition to treatment as usual (CBT plus TAU) compared with TAU alone (TAU) in one hundred and six participants meeting diagnostic criteria for borderline personality disorder is described. We anticipated that CBT plus TAU would decrease the number of participants with in-patient psychiatric hospitalizations or accident and emergency room contact or suicidal acts over twelve months treatment and twelve months follow-up, compared with TAU. We also anticipated that CBT plus TAU would lead to improvement in a range of secondary outcomes of mental health and social functioning compared to TAU. Of the 106 participants randomized, follow-up data on 102 (96%) was obtained at two years. Those randomized to CBT were offered an average of 27 sessions over 12 months and attended on average 16 (range 0 to 35). We found that the global odds ratio of a participant in the CBT plus TAU group compared with the TAU alone group having any of the outcomes of a suicidal act, in-patient hospitalization, or accident and emergency contact in the 24 months following randomization was 0.86 (95% confidence interval [CI] 0.45 to 1.66, p = 0.66). The corresponding global odds ratio, excluding accident and emergency room contact, was 0.75 (95% CI 0.37 to 1.54, p = 0.44). In terms of the number of suicidal acts, there was a significant reduction over the two years in favor of CBT plus TAU over TAU, with a mean difference of -0.91 (95% CI -1.67 to -0.15, p = 0.020). Across both treatment arms there was gradual and sustained improvement in both primary and secondary outcomes, with evidence of benefit for the addition of CBT on the positive symptom distress index at one year, and on state anxiety, dysfunctional beliefs and the quantity of suicidal acts at two year follow-up. CBT can deliver clinically important changes in relatively few clinical sessions in real clinical settings.     

Risk Reduction Behaviors and Provider Communication Following Genetic Counseling and BRCA1 Mutation Testing in an African American Kindred

Little is known about the impact of cancer genetic counseling and testing on health behaviors in racial and ethnic subgroups. This prospective observational study examined use of risk reduction strategies following BRCA1 counseling and testing. Participants were female members of an African American kindred who received genetic education, counseling and testing (n = 40) and completed a 1-year follow-up interview. Mutation carriers were more likely to opt for breast (100%, 7/7) and ovarian (25%; 1 of 4) cancer surveillance than prophylactic surgery. Following genetic counseling, 71% (5/7) of the BRCA1 carriers who opted for surveillance reported having a mammogram within the year following receipt of their genetic test results. Ovarian cancer screening among mutation carriers increased from 0% at baseline to 25% (one of four) at 1 year. Compared to noncarriers (23%, 7/30), carriers (70%, 7/10) were more likely to discuss their BRCA1 test results with their primary health care providers. Surveillance for breast cancer was preferred to prophylactic surgery and chemoprevention as a way to reduce risk for these cancers. Our data indicate that patient-provider communication about BRCA1 test results is suboptimal.     

Managed Care's Reconstruction of Human Existence: The Triumph of Technical Reason

To achieve its goals of managing and restricting access to psychiatric care, managed care organizations rely on an instrument, the outpatient treatment report, that carries significant implications about how they view psychiatric patients and psychiatric care. In addition to involving ethical transgressions such as violation of patient confidentiality, denial of access to care, spurious use of concepts like quality of care, and harassment of practitioners, the managed care approach also depends on an overly technical, instrumental interpretation of human beings and psychiatric treatment. It is this grounding of managed care in technical reason that I will explore in this study. I begin with a review of a typical outpatient treatment report and show how, with its dependence on the DSM-IV, on behavioral symptoms and patient 'functioning', on the biomedical model of psychiatric illness, and on gross quantitative measures, the report results in a crude, skeletonized view of the human being as a congeries of behavioral symptoms and functions. I then develop the managed care construal of human existence further by showing its grounding in technical reason, exploring the latter in its modern embodiment and deriving it and its opposite, practical reason, from Aristotle's distinction between technical and practical reason, techne and phronesis. In this analysis of the role of technical reason in managed care, I point out that managed care did not have to develop its rationale de novo but could rather lift its arguments, e.g. the biomedical model, from contemporary psychiatry and simply apply them in a restrictive manner. Finally, I conclude this study by arguing for psychiatry's status as a discipline of practical knowledge.     

Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb

Studies in academic research centres with selected patients have shown that several cognitive behaviour therapies are effective in the treatment of PTSD following traumas affecting individuals or small groups. Little information is available on the extent to which these positive findings will generalize to more routine clinical settings with less selected patients or to a trauma that affects a whole community. The present study addresses these generalization issues. A consecutive series of 91 patients with PTSD resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by Ehlers and Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in CBT for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service.