A systematic review of enhanced resurgence paradigms

Following successful treatment in which problem behavior is reduced, it may reemerge as a function of changes in contextual stimuli or the worsening of reinforcement conditions for an alternative response. Although understudied, preliminary research suggests that simultaneous changes in contextual stimuli and reinforcement conditions may represent particularly exigent treatment challenges that create the condition for additive or superadditive relapse. The purpose of the present review was to systematically examine the relapse literature involving simultaneous changes in contextual stimuli and reinforcement conditions in relapse tests and experimental preparations arranged to evaluate their effect on response recovery. We identified 16 empirical articles spanning 27 experiments. Although all experiments included at least one condition that experienced a change in contextual stimuli and worsening of alternative reinforcement conditions, only two experiments included the comparison conditions needed to precisely evaluate additive and superadditive relapse. Our findings establish the preclinical generality of relapse effects associated with simultaneous changes to reinforcement conditions and contextual stimuli across a range of subjects, schedule arrangements, response topographies, reinforcers, and types of contextual changes. We make several recommendations for future research based on our findings from this nascent and clinically relevant subdomain of the relapse literature.     

Extended Family Impact of Genetic Testing: The Experiences of X-linked Carrier Grandmothers

In many cases, X-linked conditions are transmitted through families “silently” until the first affected individual is diagnosed. Grandmothers are often then tested to help determine the risk to other family members. To date, psychosocial research on carriers of X-linked conditions has focused primarily on mothers and sisters of affected males. In the wider social science literature, studies on grandparents of children with disabilities have centered on their role within the family and relationship with the grandchild. We therefore know little about the impact of carrier testing for a genetic condition on grandparents. This qualitative study aims to contribute towards filling that gap. This study included thirteen grandmothers in families with Fragile X or Duchenne muscular dystrophy; ten had living affected grandsons and three had daughters who chose not to continue with affected male pregnancies after prenatal diagnosis. All thirteen took part in semi-structured interviews and provided a rich and varied data source for conducting thematic analysis. Most of the grandmothers expressed recurring feelings of guilt and a strong sense of responsibility for what had occurred in the family. Other themes included feelings of shock after receiving their test result, changes in family relationships and searching to make sense of the inheritance within the context of the family’s experience. This study provides evidence that X-linked carrier testing can have a profound and lasting impact on grandmothers. Although genetic counseling for X-linked conditions is often focused on the potential reproductive implications for carriers, these findings suggest that grandmothers should also be offered genetic counseling when tests are carried out, because of the likely psychosocial impact of a positive test result.     

Predictors of Perceived Need for Medical Care in an Inpatient Rehabilitation Unit: An Update

Limited awareness of illness, or poor insight, has been associated with poor treatment outcomes and prognoses in both psychiatric and medical populations. We examined predictors of insight in a sample of 403 patients in an inpatient rehabilitation unit at a Midwest Veterans Affairs Medical Center. A multiple regression analysis revealed that age, depression, IQ, and a measure of judgment were significant predictors of acknowledgement of illness. Younger age, higher IQ, better judgment, and depression were associated with better insight. By identifying risk factors for poor insight, these findings have significant clinical implications for healthcare providers.     

Effects of modality on the neural correlates of encoding processes supporting recollection and familiarity

Prior research has demonstrated that the neural correlates of successful encoding ("subsequent memory effects") partially overlap with neural regions selectively engaged by the on-line demands of the study task. The primary goal of the present experiment was to determine whether this overlap is associated solely with encoding processes supporting later recollection, or whether overlapping subsequent memory and study condition effects are also evident when later memory is familiarity-based. Subjects (N = 17) underwent fMRI scanning while studying a series of visually and auditorily presented words. Memory for the words was subsequently tested with a modified Remember/Know procedure. Auditorily selective subsequent familiarity effects were evident in bilateral temporal regions that also responded preferentially to auditory items. Although other interpretations are possible, these findings suggest that overlap between study condition-selective subsequent memory effects and regions selectively sensitive to study demands is not uniquely associated with later recollection. In addition, modality-independent subsequent memory effects were identified in several cortical regions. In every case, the effects were greatest for later recollected items, and smaller for items later recognized on the basis of familiarity. The implications of this quantitative dissociation for dual-process models of recognition memory are discussed.     

Effects of stress and motivation on performing a spatial task

Learning is ubiquitous in the animal kingdom but has been studied extensively in only a handful of species. Moreover, learning studied under laboratory conditions is typically unrelated to the animal's natural environment or life history. Here, we designed a task relevant to the natural behavior of male African cichlid fish (Astatotilapia burtoni), to determine if they could be trained on a spatial task to gain access to females and shelter. We measured both how successfully animals completed this task over time and whether and how immediate early gene and hormone expression profiles were related to success. While training fish in a maze, we measured time to task completion, circulating levels of three key hormones (cortisol, 11-ketotestosterone, and testosterone) and mRNA abundance of seven target genes including three immediate early genes (that served proxies for brain activity) in nine brain regions. Data from our subjects fell naturally into three phenotypes: fish that could be trained (learners), fish that could not be trained (non-learners) and fish that never attempted the task (non-attempters). Learners and non-learners had lower levels of circulating cortisol compared to fish that never attempted the task. Learners had the highest immediate early gene mRNA levels in the homologue of the hippocampus (dorsolateral telencephalon; Dl), lower cortisol (stress) levels and were more motivated to accomplish the task as measured by behavioral observations. Fish that never attempted the task showed the lowest activity within the Dl, high stress levels and little to no apparent motivation. Data from non-learners fell between these two extremes in behavior, stress, and motivation.     

Attachment Anxiety, Verbal Immediacy, and Blood Pressure: Results from a Laboratory-Analogue Study Following Marital Separation

Marital separation and divorce increase risk for all-cause morbidity and mortality. Using a laboratory analogue paradigm, the present study examined attachment anxiety, language use, and blood pressure (BP) reactivity among 119 (n = 43 men, 76 women) recently separated adults who were asked to mentally reflect on their relationship history and separation experience. We created a language use composite of verbal immediacy from participants' stream-of-consciousness recordings about their separation experience as a behavioral index of attachment-related hyperactivation. Verbal immediacy moderated the association between attachment anxiety and BP at the beginning of a divorce-specific activation task. Participants reporting high attachment anxiety who discussed their separation in a first-person, present-oriented and highly engaged manner evidenced the highest levels of BP at the start of the divorce-specific task. Results provide a deeper understanding of the association between marital dissolution and health and suggest that verbal immediacy may be a useful behavioral index of hyperactivating coping strategies.     

Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, yet the reasons for their comorbidity remain poorly understood. In the present experiment, we tested whether a tendency to engage in negative, repetitive thinking constitutes a common risk process for the two disorders. A mixed sample of adults with comorbid GAD–MDD (n = 50), GAD only (n = 35), MDD only (n = 34), or no lifetime psychopathology (n = 35) was administered noncontingent failure and success feedback on consecutive performance tasks. Perseverative thought (PT), measured by negative thought intrusions during a baseline period of focused breathing, emerged as a powerful prospective predictor of responses to this experimental challenge. Participants reporting more frequent negative thought intrusions at baseline, irrespective of thought content or diagnostic status, exhibited a stronger negative response to failure that persisted even after subsequent success. Higher PT over the course of the experiment was associated with later behavioral avoidance, with negative affect and other traits closely linked to anxiety and depression, and with the presence and severity of GAD and MDD. These findings provide evidence for a broadly-defined PT trait that is shared by GAD and MDD and contributes to adverse outcomes in these disorders.     

A meta-analysis of the effect of cognitive bias modification on anxiety and depression

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed.