A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication

BackgroundCognitive behaviour therapy (CBT) has been shown to be effective in an open trial for people with psychotic disorders who have not been taking antipsychotic medication. There is little known about predictors of outcome in CBT for psychosis and even less about hypothesised mechanisms of change.Method20 participants with schizophrenia spectrum disorders received CBT in an exploratory trial. Our primary outcome was psychiatric symptoms measured using the PANSS. Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning, and hypothesised mechanisms of change included appraisals of psychotic experiences, dysfunctional attitudes and cognitive insight. We also measured patient characteristics that may be associated with outcome.ResultsT-tests revealed that several of the hypothesised mechanisms did significantly change over the treatment and follow-up periods. Correlational analyses showed that reductions in negative appraisals of psychotic experiences were related to improvements on outcome measures and that shorter duration of psychosis and younger age were associated with greater changes in symptoms.ConclusionsCBT based on a specific cognitive model appears to change the hypothesised cognitive mechanisms, and these changes are associated with good outcomes. CBT may be more effective for those who are younger with shorter histories of psychosis.     

Disease-avoidant behaviour and its consequences

Medical conditions that are non-contagious, but that appear contagious, seem to result in the sufferer being avoided. Error management theory (EMT), suggests that such false alarms occur because the cost of infection poses a greater threat to ones fitness than avoidance. Study 1 attempted to demonstrate a disease-related false alarm effect by asking participants, to evaluate a series of vignettes, featuring people with infectious diseases, non-infectious diseases that looked infectious and non-infectious diseases that did not. Judgements of contracting infection under varying levels of contact, and desire to avoid were obtained. Consistent with EMT, a false alarm effect was evident. Study 2 examined the importance of the face as a key indicator of real and apparent infection, by determining whether facial symptoms result in a greater desire to avoid people with infectious and non-infectious diseases. Consistent with expectation, participants reported a greater desire to avoid people with facially displayed symptoms. Together, these results support the idea that humans have evolved a general tendency to avoid individuals with disease signs, especially if displayed upon the face. One consequence is that where a facially displayed disease sign persists, even if known to be benign, its bearer will experience chronic avoidance.     

An intervention to increase walking requires both motivational and volitional components: a replication and extension

An intervention to increase walking has previously been developed, consisting of three motivational techniques, designed to increase self-efficacy, and three volitional techniques, designed to help translate intentions into action. Previous research found large effects (d?=?0.90) on the objectively measured walking behaviour of 130 English adult volunteers, mediated by self-efficacy. The present study aimed to replicate this intervention, and decompose the intervention to assess whether both motivational and volitional intervention components are necessary. A three-group experimental design was employed, with n?=?35 adult volunteers randomly allocated to receive one of three interventions: (a) a "combined" intervention, containing motivational and volitional components in session at T1 and a filler task at T2, (b) a "motivation first" intervention, where the motivational components were received at T1 and the volitional components at T2, or (c) a "volition first" intervention, where the volitional components were received at T1 followed by motivational components at T2. At T2, there was a significant main effect of time, such that there was an increase in walking, but this did not differ between groups. At T3, the "combined" intervention group showed a large (d?=?1.06) and significant (p?=?0.036) increase in walking behaviour, in contrast to both other interventions (time?×?groups interaction, p?=?0.003). The "combined" intervention also produced a significant increase in self-efficacy, relative to the two other interventions. This study demonstrates generalisability of previous large intervention effects and suggests that use of both motivational and volitional components is optimal in producing change in walking behaviour. Future research should explore the mechanisms by which techniques to increase self-efficacy and planning interact.     

Production of spontaneous and posed facial expressions in patients with Huntington's disease: Impaired communication of disgust

Several studies have reported impairment in the recognition of facial expressions of disgust in patients with Huntington's disease (HD) and preclinical carriers of the HD gene. The aim of this study was to establish whether impairment for disgust in HD patients extended to include the ability to express the emotion on their own faces. Eleven patients with HD, and 11 age and education matched healthy controls participated in three tasks concerned with the expression of emotions. One task assessed the spontaneous production of disgust-like facial expressions during the smelling of offensive odorants. A second assessed the production of posed facial expressions during deliberate attempts to communicate emotion. The third task evaluated HD patients’ ability to imitate the specific facial configurations associated with each emotion. Foul odours induced fewer disgust-like facial reactions in HD patients than in controls, and patients’ posed facial expressions of disgust were less accurate than the posed disgust expressions of controls. The effect was selective to disgust; patients had no difficulty posing expressions of other emotions. These impairments were not explained by compromised muscle control: HD patients had no difficulty imitating the facial movements required to display disgust. Viewed together with evidence of difficulty in other aspects of disgust in HD, the findings suggest that a common substrate might participate in both the processing and the expression of this emotion.     

Six Levels of Mentality

Abstract

Examination of recent debates about belief shows the need to distinguish:

• (a)?non–linguistic informational states in animal perception;

• (b)?the uncritical use of language, e.g. by children;

• (c)?adult humans' reasoned judgments.

If we also distinguish between mind-directed and object–directed mental states, we have: 1. Perceptual ‘beliefs’ of animals and infants about their material environment.

2. ‘Beliefs’ of animals and infants about the mental states of others.

3. Linguistically-expressible beliefs about the world, resulting from e.g. the uncritical tendency to believe what we are told.

4. Uncritically-formed beliefs about the mental states.

5. Beliefs about the material world arrived at by the weighing of evidence.

6. Beliefs about mental states formed by critical assessment.

     

Exploring the Relationship between Psychopathy and Helping Behaviors in Naturalistic Settings: Preliminary Findings

This study examined the helping behavior of participants with high (High-P; 15 males, 13 females) and low (Low-P; 14 males, 16 females) psychopathic traits without their awareness. In the first of three tests, we found Low-P participants offered more help to an apparently lost female confederate than High-P participants. In the second test, High-P compared to Low-P males offered more help to an “injured” female experimenter, the reverse was true for females. In the third test, High-P compared to Low-P females offered more help to a female confederate who had apparently dropped papers they were carrying; whereas the reverse was true for males. Our preliminary findings indicate that context, gender and psychopathic traits interact and impact helping behavior.     

A comparison of sniff bottle staircase and olfactometer-based threshold tests

Olfactometers have been gaining popularity as research tools, but they have yet to replace established testing procedures in a variety of laboratory and clinical settings, including absolute threshold tests. In this research, we designed and operated a simple olfactometer with which to assess threshold. To do this, we used a method-of-adjustment test that was compared to the three-alternative forced choice ascending sniff bottle staircase method, which is currently a standard threshold test procedure. We found that the olfactometer threshold test correlated highly with the staircase method, and that it possessed suitable test–retest reliability. The advantages of the olfactometer threshold test include faster test time and reduced cleaning and reassembly demands. Future use of the olfactometer in olfactory identification and/or detection thresholds amongst odors is also outlined.     

Search asymmetry, sustained attention, and response inhibition

In the present experiment, we used search asymmetry to test whether the sustained attention to response task is a better measure of response inhibition or sustained attention. Participants performed feature present and feature absent target detection tasks using either a sustained attention to response task (SART; high Go low No-Go) or a traditionally formatted task (TFT; high No-Go low Go) response format. In addition to performance, we employed functional near infrared spectroscopy (fNIRS) to measure lateral cerebral oxygenation levels and self-reports of Tense Arousal, Energetic Arousal, task related and unrelated thoughts occurring during the tasks. Detections were lower and reaction times longer in the feature absent search than the feature present search regardless of response format. Detections were lower, but reaction times shorter in the SART than the TFT regardless of feature search. Greater right than left frontal hemisphere activation occurred in the SART than the TFT. In addition, the SART was more fatiguing based on self-reports than the TFT, but there were no differences in Task-Unrelated Thoughts across task conditions. Overall, the results suggest the SART places high response inhibition, not necessarily sustained attention, demands on participants.