Counselling in primary care: a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost‐effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non‐specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost‐effectiveness trials are needed together with surveys of more typical users of primary care services.     

Examinations of identity invariance in facial expression adaptation

Faces provide a wealth of information essential to social interaction, including both static features, such as identity, and dynamic features, such as emotional state. Classic models of face perception propose separate neural-processing routes for identity and facial expression (Bruce & Young, 1986), but more recent models suggest that these routes are not independent of each other (Calder & Young, 2005). Using a perceptual adaptation paradigm in the present study, we attempted to further examine the nature of the relation between the neural representations of identity and emotional expression. In Experiment 1, adaptation to the basic emotions of anger, surprise, disgust, and fear resulted in significantly biased perception away from the adapting expression. A significantly decreased aftereffect was observed when the adapting and the test faces differed in identity. With a statistical model that separated surface texture and reflectance from underlying expression geometry, Experiment 2 showed a similar decrease in adaptation when the face stimuli had identical underlying prototypical geometry but differed in the static surface features supporting identity. These results provide evidence that expression adaptation depends on perceptual features important for identity processing and thus suggest at least partly overlapping neural processing of identity and facial expression.     

The effects of physical and vocal attractiveness on impression formation of politicians

In order to investigate the nature of the combination of varying levels of vocal and physical attractiveness on the perception of hypothetical political candidates, 90 adults rated photographs of target politicians on scales for the dimensions of competency, trustworthiness, qualification, and leadership ability. It was hypothesized and confirmed that the halo effect (higher ratings for highly attractive targets) elicited by physical attractiveness is stronger and more robust than the halo effect elicited by vocal attractiveness; however vocal attractiveness did impact the perception of the candidates by lowering the ratings associated with candidates that were presented as highly attractive but possessing an unattractive voice. This work was sponsored by the Jean D. Smith Center for Democracy and Citizenship at the New Hampshire Institute of Politics at Saint Anselm College. We are grateful to Donald Bucolo for helpful comments.     

Racial Bias in Juridic Judgment at Private and Public Levels

Mock jurors (college students and prospective jurors) made individual decisions regarding liability and damages (before and after deliberation) in response to a case of sexual harassment. There were no significant differences in damage awards from college students and prospective jurors. There was evidence of racial bias among White mock jurors against plaintiffs who accused a Black supervisor of sexual harassment: Lower damages were recommended for plaintiffs who accepted an offer to meet for drinks in a Black supervisor's room than for plaintiffs who accepted the same offer from a White supervisor. There was also evidence of racial bias among White mock jurors against Black plaintiffs: Lower damages were recommended for Black plaintiffs than for White plaintiffs. These effects were present in the individual judgments of college students and prospective jurors. However, these forms of racial bias did not carry over into the decisions made by juries comprised of college students or prospective jurors. Subtle racial biases operating primarily at a subconscious level may get washed out in the complex task of coming to agreement on an appropriate award. The effects of manipulated variables on damage awards probably are overestimated in general in mock juror studies that do not examine group verdicts.     

The smell of cooperativeness: Do human body odours advertise cooperative behaviours?

Several physical features influence the perception of how cooperative a potential partner is. While previous work focused on face and voice, it remains unknown whether body odours influence judgements of cooperativeness and if odour-based judgements are accurate. Here, we first collected axillary odours of cooperative and uncooperative male donors through a public good game and used them as olfactory stimuli in a series of tasks examining whether and how they influence cooperative decision-making in an incentivized economic game and ratings of cooperativeness. Our results show that having access to the donor's body odours provided a strategic advantage to women during economic decisions (but not to men): with age, women were more likely to cooperate with cooperative men and to avoid interacting with uncooperative men. Ratings of cooperativeness were nonetheless unrelated to the donors’ actual cooperativeness. Finally, while men with masculine and intense body odours were judged less cooperative, we found no evidence that donors’ actual cooperativeness was associated with less masculine or less intense body odour. Overall, our findings suggest that, as faces and voices, body odours influence perceived cooperativeness and might be used accurately and in a non-aware manner as olfactory cues of cooperativeness, at least by women.     

Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke

The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed patients within 48h of left hemisphere stroke to determine the frequency and distribution of types of right USN using cognitive testing and MRI imaging. The distribution of USN types was different from the previously reported distribution following acute right hemisphere stroke. In this left hemisphere stroke population, allocentric neglect was more frequent than egocentric neglect.     

Characteristics and reversibility of dementia in Normal Pressure Hydrocephalus

Studies of the cognitive outcome after shunt insertion for treatment of Normal Pressure Hydrocephalus have reported widely mixed results. We prospectively studied performance of 60 patients with Normal Pressure Hydrocephalus on a comprehensive battery of neuropsychological tests before and after shunt surgery to determine which cognitive functions improve with shunt insertion. We also administered a subset of cognitive tests before and after temporary controlled drainage of cerebrospinal fluid to determine if change on this brief subset of tests after drainage could predict which patients would show cognitive improvement three to six months after shunt insertion. There was a significant improvement in learning, retention, and delayed recall of verbal memory three to six months after surgery (using paired t-tests). The majority (74%) of patients showed significant improvement (by at least one standard deviation) on at least one of the memory tests. Absence of improvement on verbal memory after temporary drainage of cerebrospinal fluid had a high negative predictive value for improvement on memory tests at 3-6 months after surgery (96%; p=0.0005). Also, the magnitude of improvement from Baseline to Post-Drainage on few specific tests of learning and recall significantly predicted the magnitude of improvement after shunt surgery on the same tests (r2=0.32-0.58; p=0.04-0.001). Results indicate that testing before and after temporary drainage may be useful in predicting which patients are less likely to improve in memory with shunting.     

Comparison of treatment seeking compulsive buyers in Germany and the United States

OBJECTIVE: The aim of this pilot study was to compare a German (Bavaria) and an American (North Dakota) sample of women suffering from compulsive buying. METHOD: Thirty-eight German and 39 American female compulsive buyers were screened with the Compulsive Buying Scale (CBS), and the Yale-Brown Obsessive Compulsive Scale-Shopping Version (Y-BOCS-SV) prior to entering a group treatment study. Psychiatric co-morbidity was assessed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID). RESULTS: There were no statistically significant differences between the German sample and the American sample with regard to age (mean 43.7 and 45 years, respectively), and with regard to the scores on the CBS and the Y-BOCS-SV. A high lifetime co-morbidity rate with Axis I disorders, especially mood disorders, anxiety disorders, substance use disorders, OCD, and binge eating disorder was detected in both samples. Almost all participants met criteria for at least one lifetime Axis I disorder. However, German compulsive buyers showed significantly higher current prevalence rates of any affective disorder, and higher current and lifetime prevalence rates of any anxiety disorder and somatoform disorder. In addition, German compulsive buyers were significantly more likely to have more than one Axis I disorder. CONCLUSION: The groups did not differ with regard to age and with regard to the severity of compulsive buying and showed a high co-morbidity with Axis I disorders. However, the German compulsive buying sample presented with significantly more psychiatric co-morbidity compared to the American sample. Further research is needed to provide a better understanding of this disorder in general and cross-culturally.     

Graded auditory Stroop effects generated by gender words

Two auditory Stroop experiments requiring identification of the speaker's sex were conducted. An auditory Stroop effect was expected, analogous to visual effects found in Stroop literature. In Exp. 1 the speaker's sex was identified faster when sex labels ("male" and "female") and words that imply a sex (e.g., father, grandmother) were congruent with the speaker's sex. In Exp. 2, an auditory semantic gradient was established in which words that were more meaningfully tied to a particular sex produced more Stroop interference. This auditory semantic gradient is analogous to effects found in the visual Stroop literature of a semantic gradient related to color.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.