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.     

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

Journal of Child and Family Studies - To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work....     

Predictors of Self-Reported Prospective and Retrospective Memory in a Population-Based Sample of Older Adults

In this article, the authors examined predictors of self-reported everyday memory failures using the Prospective and Retrospective Questionnaire (PRMQ; Smith, Della Sala, Logie, &; Maylor, 2000 Smith, G. V., Della Sala, S., Logie, R. H. and Maylor, E. A. M. 2000. Prospective and retrospective memory in normal ageing and dementia: A questionnaire study. Memory, 8: 311–321. [Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) in a population-based sample of older adults (age range = 60–90 years; N = 250). The results showed that a higher frequency of reported failures was associated with lower scores on the personality dimension of self-directedness as assessed by the Temperament and Character Inventory (TCI; Cloninger, Dragan, Svrakic, &; Przybeck, 1993 Cloninger, R. C., Dragan, M. S., Svrakic, D. M. and Przybeck, T. R. 1993. A psychobiological model of temperament and character. Archives of General Psychiatry, 50: 975–990. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and more depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977 Radloff, L. S. 1977. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1: 385–401. [Crossref], [Web of Science ®] , [Google Scholar]). However, PRMQ scores showed no relationships with objective memory ability, as reflected by a series of retrospective memory measures and a measure of prospective memory. Neither were the PRMQ scales associated with general cognitive functioning as assessed by the Mini-Mental State Examination (MMSE; Folstein, Folstein, &; McHugh, 1977). Taken together, the results indicate that within the older population, self-reported memory as assessed by the PRMQ may reflect mood-state and personality factors rather than individual differences in memory and cognitive ability.     

Cytokines and memory across the mature life span of women

Increasing evidence suggests a role of the immune system in modulation of cognition, but details on affected memory systems are largely lacking. We therefore aimed to study the relation between selected cytokines and subsets of memory, and the impact of age in these relations. From a random population-based sample (the Betula Prospective Cohort Study), 298 women (age 45-90) were studied in terms of episodic recall and recognition, semantic fluency and knowledge, and prospective memory. Circulating cytokines of relevance for cognition and aging were measured with ELISA. Levels of interleukin (IL)-6 and sIL-2R were significantly and negatively associated with most cognitive variables, while the opposite was true for IL-1β. Age shared substantial variance with both cytokines and memory, and turned most correlations non-significant when controlled for together with education, BMI and presence of disease. Interactions between age and cytokines were further analyzed in multiple regressions. For IL-6, significant negative interactions with age were found for semantic fluency (p<0.05) and prospective memory (p<0.01), and for sIL-2R in predicting semantic knowledge (p<0.05), indicating an increased negative impact of these cytokines on memory with increasing age. In conclusion, the study indicates a relation between cytokines and memory that appears to be largely mediated by age, and supports the suggestion that cytokine dysregulation with higher age may interact with cognitive aging.     

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI_asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI_asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.     

The effect of childhood bilingualism on episodic and semantic memory tasks

Kormi-Nouri, Moniri and Nilsson (2003) demonstrated that Swedish-Persian bilingual children recalled at a higher level than Swedish monolingual children, when they were tested using Swedish materials. The present study was designed to examine the bilingual advantage of children who use different languages in their everyday life but have the same cultural background and live in their communities in the same way as monolingual children. In four experiments, 488 monolingual and bilingual children were compared with regard to episodic and semantic memory tasks. In experiments 1 and 2 there were 144 boys and 144 girls in three school groups (aged 9-10 years, 13-14 years and 16-17 years) and in three language groups (Persian monolingual, Turkish-Persian bilingual, and Kurdish-Persian bilingual). In experiments 3 and 4, there were 200 male students in two school groups (aged 9-10 years and 16-17 years) and in two language groups (Persian monolingual and Turkish-Persian bilingual). In the episodic memory task, children learned sentences (experiments 1-3) and words (Experiment 4). Letter and category fluency tests were used as measures of semantic memory. To change cognitive demands in memory tasks, in Experiment 1, the integration of nouns and verbs within sentences was manipulated by the level of association between verb and noun in each sentence. At retrieval, a recognition test was used. In experiments 2 and 3, the organization between sentences was manipulated at encoding in Experiment 2 and at both encoding and retrieval in Experiment 3 through the use of categories among the objects. At retrieval, free recall or cued recall tests were employed. In Experiment 4, the bilingual children were tested with regard to both their first and their second language. In all four experiments, a positive effect of bilingualism was found on episodic and semantic memory tasks; the effect was more pronounced for older than younger children. The bilingual advantage was not affected by changing cognitive demands or by using first/second language in memory tasks. The present findings support the cross-language interactivity hypothesis of bilingual advantage.     

Inventing the wheel once more or learning from the history of psychotherapy research methodology: Reply to Gaudiano's comments on review

Gaudiano's criticism of one part of my review of ACT outcome research (Öst, 2008) is refuted on all issues but one. It is clear that the average amount of grant support for the ACT-studies was smaller than that of CBT-studies, even if the proportion of studies having grant support was not lower. However, that fact should only influence 25% (2 out of 8) of the methodology variables on which ACT-studies had lower mean scores than CBT-studies. It is not acceptable that a relatively new treatment, such as ACT, should be evaluated by more lenient criteria than already established therapies like CBT. If proponents of a new treatment wish to claim that their therapy is empirically supported then they have to accept to be evaluated by the APA Task Force criteria. It is time that ACT researchers start using the current psychotherapy research methodology.     

Physiological responses in blood phobics

Eighteen patients with blood phobia were shown a film of thoracic operations containing large amounts of blood. Their heart rate (HR) and blood pressure (BP) were measured continuously before, during and after the watching of the film. The group data showed a diphasic response; an increase in HR and BP from baseline to the beginning of the film, and then a sharp drop in these parameters with the lowest values 4 min after the film was turned off. Individual data from 5 patients who fainted or were on the edge of doing so, showed massive bradycardia or drop in BP or both. In all of these patients at least one (range 1–33) 5-sec period of asystole was recorded. Possible theoretical explanations for this characteristic response pattern are discussed.     

Individual response patterns and the effects of different behavioral methods in the treatment of social phobia

The importance of individual response patterns in the treatment of phobic patients was examined in the present study. Forty psychiatric outpatients with social phobia were assessed with a social interaction test which was videotaped. Heart rate was continuously monitored during the test. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns; behavioral and physiological reactors. Within each group half of the patients were randomly assigned to a behaviorally focused method (social skills training) while the other half received a physiologically focused method (applied relaxation). The patients were treated individually in 10 sessions. The within-group comparisons showed that both treatments yielded significant improvements on most measures. The between-group comparisons showed that for the behavioral reactors, social skills training was significantly better than applied relaxation on six out of ten measures, and for the physiological reactors applied relaxation was significantly better than social skills training on three of the measures. The results support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern.     

A component analysis of action events

Summary Three experiments are reported, that examine the basis of the recall superiority of subject-performed tasks (SPTs) over verbal-memory tasks (VTs), and the interitem variability for SPTs. In Experiments 1 and 2 a component analysis of SPTs is undertaken in order to explore the importance of (a) involvement of external objects, (b) multimodality, and (c) enactment, for the superior memory performance for SPTs over that for VTs. In Experiment 3 the role of retrieval support, in terms of a high degree of match between the encoding and retrieval situations, was investigated in order to find out why some SPTs are easier to recall than others. The results indicate that it is difficult to separate out a single component as the most critical one for the superiority of SPT recall over VT recall, and that a high degree of match between encoding and retrieval conditions improves SPT recall. It is suggested that, in order to explain the large differences in memorability between SPTs and VTs, it is sufficient to consider the more supportive encoding situation for SPTs, but to explain differences in recallability between various SPTs, the compatibility between encoding and test has to be taken into consideration.