Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.     

Personality and the predisposition to engage in risky or problem behaviors during adolescence

Longitudinal data from a representative sample of 1,978 Black and White adolescents were used to examine the role of personality in multiple risk or problem behaviors. Results indicate that covariation among diverse behaviors (educational underachievement, delinquent behavior, substance use, sexual behavior) can be adequately modeled by a single higher order factor, and that impulsivity and avoidance coping serve as generalized risk factors for involvement in these behaviors. Whereas none of the personality variables examined explained change in problem behaviors once established, avoidance coping prospectively predicted involvement among a subgroup of adolescents with little or no prior involvement. Results suggest that dysfunctional styles of regulating emotions and emotionally driven behaviors are core features of risky or problem behaviors during adolescence.     

Knowing in advance: the impact of prior event information on memory and event knowledge

We examined the influence of newly acquired information on children's memory and general representation of a personally experienced event. Thirty-five children between the ages of 5 and 7 years participated in the novel event (Visiting the Pirate). The day before participating, children were: (1) provided with new information specific to the up-coming event; (2) engaged in a discussion generally related to the event topic based on existing knowledge; or (3) discussed an unrelated topic. Advance information specific to the event led to better recall and, in particular, to better integration of the experience into a general event representation both soon after the event and at a follow-up interview 4 months later, whereas general discussion of the topic without the event specific information neither enhanced memory reports nor facilitated the integration of event information. Providing information in advance can have significant effects on memory and knowledge acquisition although many variables, including those relating to the specific content of the information, will affect this relation.     

Age constraints on first versus second language acquisition: evidence for linguistic plasticity and epigenesis

Does age constrain the outcome of all language acquisition equally regardless of whether the language is a first or second one? To test this hypothesis, the English grammatical abilities of deaf and hearing adults who either did or did not have linguistic experience (spoken or signed) during early childhood were investigated with two tasks, timed grammatical judgement and untimed sentence to picture matching. Findings showed that adults who acquired a language in early life performed at near-native levels on a second language regardless of whether they were hearing or deaf or whether the early language was spoken or signed. By contrast, deaf adults who experienced little or no accessible language in early life performed poorly. These results indicate that the onset of language acquisition in early human development dramatically alters the capacity to learn language throughout life, independent of the sensory-motor form of the early experience.     

Modeling unipolar depression as a chaotic process

This study inspected the deterministic structure of unipolar depression. Two women self-monitored sadness hourly 10 times a day for 6 months. One woman had a recurrent history of unipolar depression, and the other did not. Data were analyzed by visual inspection, examination of the Fourier transforms of the time plots, and the correlation dimension. Results suggested that in addition to a strong periodic component that existed only within the depressed subject's mood time series, a low-dimensional chaotic process might have been operating. In the nondepressed control subject, no such periodicity or process could be identified. The findings support maladaptive deterministic theories of mood disorders and have implications for the assessment of unipolar depression.     

I don't think that's what really happened: the effect of cross-examination on the accuracy of children's reports

In the courtroom, child witnesses must undergo cross-examination. Prior research has shown that children change their original testimony under cross-examination, but the effect of these changes on the accuracy of children's testimony is unknown. The authors examined the effect of cross-examination on the accuracy of 5- and 6-year-old children's (N=46) reports of a contrived event. Consistent with prior research, children made changes to their original responses during cross-examination. Furthermore, these changes occurred irrespective of original accuracy. Finally, prior exposure to misleading information did not affect children's responses to cross-examination. Even children with no prior exposure to misinformation altered their original responses, decreasing their ultimate levels of accuracy. These findings demonstrate that cross-examination style questioning is inappropriate for young children.     

A Question of Two Answers: Difference and Determination in Barth and von Balthasar

This essay uses the motif of 'the woman as answer' in Barth and von Balthasar to explore aspects of their accounts of sexual difference in relation to ontological and trinitarian difference. In both cases the motif is shown to be problematic for reasons which become apparent in christology. Barth's characterisation of woman as the 'sufficient answer' to the prior 'question' posed by man indicates a tendency towards the elision of difference in his anthropology, which is reflected in the nonsexuality of Christ - the 'true Man' Ð and in aspects of his trinitarian theology. Von Balthasar's 'double answer' of woman to man moves beyond viewing sexual difference as the locus of man's self-completion, but the overdetermination of 'woman' in his mariology undermines this. The pneumatology of von Balthasar's 'Spiritus Creator' suggests possibilities for the development of a christologically-focused anthropology which maintains difference.     

Quality of Life and Neurological Illness: A Review of the Literature

This article highlights some of the conceptual and methodological problems associated with quality of life (QoL) measurement in individuals with neurological illness. It is suggested that these problems have contributed to the underdeveloped status of QoL research in neurological settings. Many of the existing QoL measures that have been used, or show potential for use with individuals with neurological illness, are reviewed in terms of their theoretical basis, content, and practicality. A large proportion of these measures fail to meet adequate psychometric standards and/or have rarely been psychometrically tested. The confusion that surrounds adequate psychometric standards is discussed, and the dynamic nature of QoL is highlighted as a factor that requires further attention. Research addressing the discrepancies between proxy and patient ratings of patient QoL is also warranted. More focused research in these areas may contribute to a clearer understanding of how to assess QoL in individuals with neurological illness.