CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.     

Large-scale neural network for sentence processing

Our model of sentence comprehension includes at least grammatical processes important for structure-building, and executive resources such as working memory that support these grammatical processes. We hypothesized that a core network of brain regions supports grammatical processes, and that additional brain regions are activated depending on the working memory demands associated with processing a particular grammatical feature. We used functional magnetic resonance imaging (fMRI) to test this hypothesis by comparing cortical activation patterns during coherence judgments of sentences with three different syntactic features. We found activation of the ventral portion of left inferior frontal cortex during judgments of violations of each grammatical feature. Increased recruitment of the dorsal portion of left inferior frontal cortex was seen during judgments of violations of specific grammatical features that appear to involve a more prominent working memory component. Left posterolateral temporal cortex and anterior cingulate were also implicated in judging some of the grammatical features. Our observations are consistent with a large-scale neural network for sentence processing that includes a core set of regions for detecting and repairing several different kinds of grammatical features, and additional regions that appear to participate depending on the working memory demands associated with processing a particular grammatical feature.     

The Nature and Time Course of Pragmatic Plausibility Effects

The experiments reported in this article used a delayed same/different sentence matching task with concurrent measurement of eye movements to investigate the nature of the plausibility effect. The results clearly show that plausibility effects are not due to low level lexical associative processes, but arise as a consequence of the processing of the earliest or most basic form of sentential meaning. In fact, when sentential implausibility and lexical association are varied simultaneously, it is only sentential implausibility that exerts an effect. Effects of implausibility occur rapidly—sometimes parafoveally—and are localised in the regions of the sentence where the implausibility occurs, suggesting an incremental interpretive process progressing on a roughly word-by-word basis. It is suggested that plausibility effects result from the operation of a heuristically-driven process of sentential interpretation. This appears to behave in a ‘modular’ fashion, despite being influenced by real world knowledge and probabilities.Particular thanks are due to Ken Forster for kindling the ideas which led to much of this work and to Merrill Garrett for posing impossible challenges, which, probably to everyone’s surprise, could in fact be met. I am also much indebted to Claire Boissiere, Emma Clayes, Clare Dobbin, Alan Kennedy, Julie-Ann Marshall, Ashley Murray, and Murray Rowan for their collaboration in this research.     

A cognitive architecture that combines internal simulation with a global workspace

This paper proposes a brain-inspired cognitive architecture that incorporates approximations to the concepts of consciousness, imagination, and emotion. To emulate the empirically established cognitive efficacy of conscious as opposed to non-conscious information processing in the mammalian brain, the architecture adopts a model of information flow from global workspace theory. Cognitive functions such as anticipation and planning are realised through internal simulation of interaction with the environment. Action selection, in both actual and internally simulated interaction with the environment, is mediated by affect. An implementation of the architecture is described which is based on weightless neurons and is used to control a simulated robot.     

A smart unconscious? Procedural origins of automatic partner attitudes in marriage

The paper examines potential origins of automatic (i.e., unconscious) attitudes toward one’s marital partner. It tests the hypothesis that early experiences in conflict-of-interest situations predict one’s later automatic inclination to approach (or avoid) the partner. A longitudinal study linked daily experiences in conflict-of-interest situations in the initial months of new marriages to automatic evaluations of the partner assessed four years later using the Implicit Associations Test. The results revealed that partners who were initially (1) treated less responsively and (2) evidenced more self-protective and less connectedness-promoting “if-then” contingencies in their thoughts and behavior later evidenced less positive automatic partner attitudes. However, these factors did not predict changes in love, satisfaction, or explicit beliefs about the partner. The findings hint at the existence of a “smart” relationship unconscious that captures behavioral realities conscious reflection can miss.     

Impasse and Resonance Across Multiple Relational Realms: Reply to Commentaries

In my response to the commentaries by Anthony Bass, Irwin Hirsch, and Margaret Crastnopol, I focus on conscious and unconscious factors that open or close potential space across relational realms, including that of analyst and patient, parent and child. I then extend these notions to the supervisory relationship. I describe how these issues affected the writing process for me, and explore the impact that writing has had on the ongoing treatment with my patient. I consider too the ways in which shame travels intersubjectively, shutting down transitional space and interfering with aliveness, authenticity, and creativity.     

The Effects of a Teacher–Child Play Intervention on Classroom Compliance in Young Children in Child Care Settings

The current study evaluated the effects of a teacher-conducted play intervention on preschool-aged children’s compliance in child care settings. Study participants included 8 children ranging in age from 3 to 5 years and 5 early childhood education teachers within 5 classrooms across 5 child care centers. A combination ABAB and multiple baseline design was used to demonstrate the effects of the play intervention. Pretreatment observations revealed varying degrees of child compliance difficulties. The play intervention was associated with improved rates of compliance for each participant child. The intervention is discussed with regard to its potential as a proactive, nonintrusive strategy for improving young children’s classroom compliance.     

Group Counseling and Group Psychotherapy with Rehabilitation Clients

An instrument designed to measure components of two distinct alcoholism aftercare treatments was developed and evaluated for reliability and validity. Trained judges reliably rated audiotaped samples of coping skills and interactional group therapy sessions. Coping skills groups engaged in significantly more education and skill training, problem solving, and role playing. Interactional groups showed more interpersonal learning, expression/exploration of feelings, and here-and-now focus. Groups that employed more education and skill training, less expression and exploration of feelings, and less her e-and-now focus were associated with fewer members reporting subsequent drinking-related problems. None of the ratings of group activities was related to abstinence.