Relapse/Recurrence Prevention in Major Depressive Disorder: 26-Month Follow-Up of Mindfulness-Based Cognitive Therapy Versus an Active Control

We conducted a 26-month follow-up of a previously reported 12-month study that compared mindfulness-based cognitive therapy (MBCT) to a rigorous active control condition (ACC) for depressive relapse/recurrence prevention and improvements in depressive symptoms and life satisfaction. Participants in remission from major depression were randomized to an 8-week MBCT group (n = 46) or the ACC (n = 46). Outcomes were assessed at baseline; postintervention; and 6, 12, and 26 months. Intention-to-treat analyses indicated no differences between groups for any outcome over the 26-month follow-up. Time to relapse results (MBCT vs. ACC) indicated a hazard ratio = .82, 95% CI [.34, 1.99]. Relapse rates were 47.8% for MBCT and 50.0% for ACC. Piecewise analyses indicated that steeper declines in depressive symptoms in the MBCT vs. the ACC group from postintervention to 12 months were not maintained after 12 months. Both groups experienced a marginally significant rebound of depressive symptoms after 12 months but were still improved at 26 months compared to baseline (b = –4.12, p <= .008). Results for life satisfaction were similar. In sum, over a 26-month follow-up, MBCT was no more effective for preventing depression relapse/recurrence, reducing depressive symptoms, or improving life satisfaction than a rigorous ACC. Based on epidemiological data and evidence from prior depression prevention trials, we discuss the possibility that both MBCT and ACC confer equal therapeutic benefit. Future studies that include treatment as usual (TAU) control conditions are needed to confirm this possibility and to rule out the potential role of time-related effects. Overall findings underscore the importance of comparing MBCT to TAU as well as to ACCs.     

Emotional intelligence (EI), conflict resolution patterns,and relationship satisfaction: Actor and partner effects revisited

This study tested for actor and partner effects in the relationship between ability-based EI and adaptive marital relationships and satisfaction employing a standard dyadic design involving 100 young heterosexual couples. Participants were assessed on the MSCEIT along with measures of conflict resolution patterns and perceived marital satisfaction. A series of path analyses provided support for actor effects—but not partner effects—in the association of EI, assessed as ability, and marital variables. Overall, the data provide only partial support for the common claim and some prior research suggesting that EI plays a pivotal role in marital relationships.     

Eye movements during recall of aversive memory decreases conditioned fear

Cognitive-behavioral therapy for anxiety disorders typically involves exposure to the conditioned stimulus (CS). Despite its status as an effective and primary treatment, many patients do not show clinical improvement or relapse. Contemporary learning theory suggests that treatment may be optimized by adding techniques that aim at revaluating the aversive consequence (US) of the feared stimulus. This study tested whether US devaluation via a dual task – imagining the US while making eye movements – decreases conditioned fear. Following fear acquisition one group recalled the US while making eye movements (EM) and one group merely recalled the US (RO). Next, during a test phase, all participants were re-presented the CSs. Dual tasking, relative to the control condition, decreased memory vividness and emotionality. Moreover, only in the dual task condition reductions were observed in self-reported fear, US expectancy, and CS unpleasantness, but not in skin conductance responses. Findings provide the first evidence that the dual task decreases conditioned fear and suggest it may be a valuable addition to exposure therapy.     

Is there less to social anxiety than meets the eye? Emotion experience,expression, and bodily responding

Emotions are widely held to involve changes in experiential, behavioural, and physiological systems. It is not clear, however, just how tightly coupled these changes are during emotional responding. To examine this issue, we induced social anxiety in 47 high trait social anxiety (HTSA) and 50 low trait social anxiety (LTSA) participants using an impromptu speech paradigm. We assessed anxiety experience, behaviour, perceived physiological activation, and actual physiological activation. HTSA participants felt more anxious, perceived greater physiological activation, and exhibited more anxiety behaviour than LTSA participants. Unexpectedly, the two groups did not differ in objectively measured physiological responding. Internal analyses indicated that for both HTSA and LTSA participants, anxiety experience was associated with perceived physiological activation, but not with actual physiological responding. These results suggest that anxiety experience and perceived physiological activation may be less tightly coupled with actual physiological responses than is typically thought.     

Psychological disturbance in children with physical disabilities: Continuity and change in a 5-year follow-up

This study measures continuity in behavioral disturbance over a 5-year period among 255 children with physical disabilities who were 6 to 18 years old at first assessment. The pattern of the results differed from that reported previously for a sample of the general population of children. Disabled children showed little stability in aggression, an area in which stability over time had been consistently reported for the general child population. Furthermore, important differences were observed between children with cystic fibrosis and children with cerebral palsy, myelodysplasia, or multiple physical handicaps, all conditions involving brain abnormality. Children with cystic fibrosis followed the trend toward better adjustment seen among the general population of children. In contrast, among children with conditions involving the brain, the majority of those who had been classified as psychologically severely impaired remained at this level of impairment 5 years later. In two behavioral domains, Mentation Problems and Isolation, children with conditions involving the brain maintained, on the average, the same markedly high score they had initially. Among children with physical conditions involving the brain, Mentation Problems and Isolation signify persistent problems that do not subside as the children mature.This study was supported by NIH grant No. HD-16821, by Research Scientist Development Award No. MH-00380 from NIMH, and by grants from the Cleveland Foundation and the Charles S. Mott Foundation.     

Tones inferior to eye movements in the EMDR treatment of PTSD

Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder (PTSD). During EMDR, patients make eye movements (EMs) while recalling traumatic memories, but recently therapists have replaced EMs by alternating beep tones. There are no outcome studies on the effects of tones. In an earlier analogue study, tones were inferior to EMs in the reduction of vividness of aversive memories. In a first EMDR session, 12 PTSD patients recalled trauma memories in three conditions: recall only, recall + tones, and recall + EMs. Three competing hypotheses were tested: 1) EMs are as effective as tones and better than recall only, 2) EMs are better than tones and tones are as effective as recall only, and 3) EMs are better than tones and tones are better than recall only. The order of conditions was balanced, each condition was delivered twice, and decline in memory vividness and emotionality served as outcome measures. The data strongly support hypothesis 2 and 3 over 1: EMs outperformed tones while it remained unclear if tones add to recall only. The findings add to earlier considerations and earlier analogue findings suggesting that EMs are superior to tones and that replacing the former by the latter was premature.     

The effects of photographs and event plausibility in creating false beliefs

Recent studies have shown that using photographs as memory retrieval aids can significantly increase the likelihood of false memories. The current study further investigated this effect by examining the interactive effects of photographs and event plausibility in developing false beliefs. At Time 1 and two weeks later at Time 2, participants rated 20 events on the Life Events Inventory (LEI) as to whether each occurred to them in childhood. One week after Time 1, participants were told that two target events were plausible and two were implausible. They then used event-related photographs to visualize one plausible and one implausible event. Occurrence ratings significantly increased from Time 1 to Time 2 for plausible events in the photo condition. These results suggest that the use of photographs as a memory enhancing technique is unlikely to cause false memories for events that are not perceived personally plausible.     

The fate of the oedipus complex: Dissolution or waning

Abstract

Fried R. Personal and Classical Myth; A Confrontation on the Acropolis. Int Forum Psychoanal 1997;6:715. Stockholm, ISSN 0803-706X.

On his only visit to Greece, Sigmund Freud experienced brief but unsettling feelings of alienation as he stood on the Acropolis. Haunted by this experience, Freud did not succeed in analyzing it to his own satisfaction until 32 years after the event, in 1936. His interpretation, that he had felt guilt about superseding his father, did not convince most of the critics who have commented on it. The aim of this essay is to demonstrate that while Freud's critics were right in sensing that his explanation was only partial, none were able to decipher his secret. Prominent among the reasons for these repeated failures was lack of acquaintance with the Acropolis itself. Anyone standing where Freud stood becomes enabled to understand otherwise incomprehensible details of his essay. Seeing what Freud saw, however, still is not enough unless one also attempts to acquire some of his knowledge of archaeology and mythology. His competence in these areas made him aware of contradictions (e.g. between classical and archaic architecture and myth) that do not trouble the casual tourist. But his knowledge also furnished him with the tools for mastering his anxiety, turning fear of death into confidence in immortality, and gratifying desires even more ambitious than that of superseding his father.     

Visual spatial skill: a consequence of learning to read?

Does learning to read influence one’s visual skill? In Study 1, kindergartners from Hong Kong, Korea, Israel, and Spain were tested on word reading and a task of visual spatial skill. Chinese and Korean kindergartners significantly outperformed Israeli and Spanish readers on the visual task. Moreover, in all cultures except Korea, good readers scored significantly higher on the visual task than did less good readers. In Study 2, we followed 215 Hong Kong Chinese kindergartners across 1 year, with word reading and visual skills tested twice. In this study, word reading at Time 1 by itself predicted 13% of unique variance in visual skill at Time 2. Together, these results underscore the potential importance of the process of learning to read for shaping one’s visual spatial skill development.