Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy

Internet based cognitive behavioural therapy (CBT) is efficacious for the treatment of anxiety and depression. The current study aimed to examine the effectiveness of internet based CBT prescribed by primary care clinicians for the treatment of depression and generalised anxiety disorder. Psychological distress data from 302 patients who completed an online CBT course for depression and 361 patients who completed an online CBT course for generalised anxiety disorder were subjected to growth mixture analysis. For both disorders psychological distress decreased across each lesson in a quadratic trend. Two classes of individuals were identified with different trajectories of change: a large group of individuals who responded well to the courses and a smaller group of individuals with a lower response. Both groups were similar with respect to socio-demographic characteristics however the Low Responders tended to have higher levels of symptom severity and psychological distress at baseline in comparison to the responders. For the majority of patients (75-80%) the internet CBT courses for depression and generalised anxiety disorder were effective. Further research is required to identify and effectively treat the smaller proportion of patients who did not improve during internet CBT.     

Therapist effects and the dissemination of cognitive behavior therapy for chronic fatigue syndrome in community-based mental health care

ObjectiveThe purpose of the present study was to explore the role of the therapist in the dissemination of manualized cognitive behavior therapy (CBT) for chronic fatigue syndrome (CFS) outside specialized treatment settings.MethodWe used the routinely collected outcome data of three community-based mental health care centers (MHCs) which implemented and sustained CBT for CFS during the course of the study. Ten therapists, who all received the same training in CBT for CFS, and 103 patients with CFS were included.ResultsRandom effects modeling revealed a significant difference in mean post-treatment fatigue between therapists. The effect of the therapist accounted for 21% of the total variance in post-treatment fatigue in our sample. This effect could be explained by the therapists’ attitude toward working with evidence-based treatment manuals as well as by the MHC where CBT for CFS was delivered.ConclusionThe context in which CBT for CFS is delivered may play an important role in the accomplishment of established therapy effects outside specialized treatment settings. Due to the small sample size of MHCs and the different implementation scenarios in which they were engaged, our findings should be interpreted as preliminary results which are in need for replication.     

Low diversity and low frequency of participation in leisure activities compromise working memory efficiency in young adults

People perform leisure activities (LA) every day; pursuits that entail applying cognitive, physical and social abilities. As in old age, doing LA during early and middle adulthood is related to a reduced risk of dementias, probably by generating a cognitive reserve. As it is possible that a relation between doing LA and working memory (WM) efficiency exists in young adults, we assessed whether the diversity and frequency of LA are related to WM efficiency in this population. Ninety-three healthy young subjects solved the n-back task at two levels of difficulty (2, 3), and answered an LA questionnaire on the activities in which they had participated in the month prior to the experiment. Subjects were classified separately on their scores for (1) diversity (high/low) and (2) frequency (high/low) in order to test the relation between each variable and WM efficiency. Though no differences were found, a subsequent analysis of the average of diversity and frequency ratios of LA performance taken together-the diversity/frequency index-showed that low diversity plus low frequency was significantly associated with reduced WM efficiency at this age; results that suggest that frequent participation in diverse LA during youth is related to WM efficiency.     

Asymmetric switch-costs and ERPs reveal facial identity dominance over expression

Previous studies on face processing have revealed an asymmetric overlap between identity and expression, as identity is processed irrespective of expression while expression processing partly depends on identity. To investigate whether this relative interaction is caused by dominance of identity over expression, participants performed familiarity and expression judgments during task switching. This paradigm reveals task-set dominance with a paradoxical asymmetric switch-cost (i.e., greater difference between switch and repeat trials when switching toward the dominant task). Event-related potentials (ERPs) were recorded to find the neural signature of the asymmetric cost. As expected, greater switch-cost was shown in the familiarity task with respect to response times, indicating its dominance over the expression task. Moreover, a left-sided ERP correlate of this effect was observed at the level of the frontal N2 component, interpreted as an index of modulations in endogenous executive control. Altogether, these results confirm the overlap between identity and expression during face processing and further indicate their relative dominance.     

Aging and mental health in the decade ahead: what psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society.     

Dopamine, working memory, and training induced plasticity: implications for developmental research

Cognitive deficits and particularly deficits in working memory (WM) capacity are common features in neuropsychiatric disorders. Understanding the underlying mechanisms through which WM capacity can be improved is therefore of great importance. Several lines of research indicate that dopamine plays an important role not only in WM function but also for improving WM capacity. For example, pharmacological interventions acting on the dopaminergic system, such as methylphenidate, improve WM performance. In addition, behavioral interventions for improving WM performance in the form of intensive computerized training have recently been associated with changes in dopamine receptor density. These two different means of improving WM performance--pharmacological and behavioral--are thus associated with similar biological mechanisms in the brain involving dopaminergic systems. This article reviews some of the evidence for the role of dopamine in WM functioning, in particular concerning the link to WM development and cognitive plasticity. Novel data are presented showing that variation in the dopamine transporter gene (DAT1) influences improvements in WM and fluid intelligence in preschool-age children following cognitive training. Our results emphasize the importance of the role of dopamine in determining cognitive plasticity.     

Sounds exaggerate visual shape

While perceiving speech, people see mouth shapes that are systematically associated with sounds. In particular, a vertically stretched mouth produces a /woo/ sound, whereas a horizontally stretched mouth produces a /wee/ sound. We demonstrate that hearing these speech sounds alters how we see aspect ratio, a basic visual feature that contributes to perception of 3D space, objects and faces. Hearing a /woo/ sound increases the apparent vertical elongation of a shape, whereas hearing a /wee/ sound increases the apparent horizontal elongation. We further demonstrate that these sounds influence aspect ratio coding. Viewing and adapting to a tall (or flat) shape makes a subsequently presented symmetric shape appear flat (or tall). These aspect ratio aftereffects are enhanced when associated speech sounds are presented during the adaptation period, suggesting that the sounds influence visual population coding of aspect ratio. Taken together, these results extend previous demonstrations that visual information constrains auditory perception by showing the converse - speech sounds influence visual perception of a basic geometric feature.     

Increasing magnitude counts more: asymmetrical processing of ordinality in 4-month-old infants

While infants' ability to discriminate quantities has been extensively studied, showing that this competence is present even in neonates, the ability to compute ordinal relations between magnitudes has received much less attention. Here we show that the ability to represent ordinal information embedded in size-based sequences is apparent at 4months of age, provided that magnitude changes involve increasing relations. Infants in Experiments 1A and 1B discriminated changes in ordinal relations after habituation to ascending sequences, but did not show evidence of discrimination after habituation to descending sequences. In Experiment 2 we replicated this asymmetry in magnitude discrimination even when additional cues known to boost ordinal competence were provided. The presence of an asymmetry between ascending vs. descending order during infancy suggests a developmental continuity in the underlying code used to represent magnitude, whereby the reported addition advantage in children and adults' arithmetic performance emerges.     

From racial discrimination to risky sex: prospective relations involving peers and parents

This study investigated how early experience with racial discrimination affected the subsequent risky sexual behaviors of a diverse sample of African American youths (N = 745). The analyses focused on 3 risk-promoting factors thought to mediate the hypothesized discrimination → risky sex relation: negative affect, affiliation with deviant peers, and favorable attitudes toward risky sex. In addition, attentive parenting was examined as a protective factor. Analyses using structural equation modeling revealed that youths who perceived more racial discrimination at age 10 or 11 were engaging in more sexual risk taking at age 18 or 19. This relation was mediated by the hypothesized risk-promoting factors via pathways that were consistent with our conceptual model. Results also indicated a prospective reciprocal relation between parenting and children's deviant affiliations: deviant peer affiliations at age 10 or 11 predicted more attentive parenting behaviors by the parents; this response from the parents, in turn, predicted relatively fewer deviant affiliations when the youths were 15 or 16. Study findings are discussed in terms of their relevance to the disproportionately high rates of sexually transmitted infections among African Americans.     

Longitudinal effects of theory of mind on later peer relations: the role of prosocial behavior

Children's peer relations represent a key aspect of school adjustment. However, little is known about their social-cognitive precursors. To address this gap, the authors followed 70 children across the transition to primary school. At Time 1 (age 5), Time 2 (age 6), and Time 3 (age 7), children were assessed on their theory of mind, prosocial behavior, and verbal ability. In addition, at Time 2 and at Time 3, the authors gathered peer nominations. Results supported the authors' mediational hypothesis of indirect paths from early theory of mind to subsequently lower peer rejection and higher peer acceptance, via improvements in prosocial behavior. The authors discuss implications of these longitudinal effects for the understanding of the impact of social-cognitive achievements for children's developing social relations.