Economic Impact of Third-Wave Cognitive Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials

The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration’s tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.     

Why do superiors attend to negative stereotypic information about their subordinates? Effects of power legitimacy on social perception

Power can be defined as control over other people's outcomes. Using this definition, we explored the impact of power on attentional processes involved in impression formation. Because powerful individuals may want to maintain and justify their position, powerful participants should pay particular attention to negative stereotype‐consistent information about their subordinates. In contrast, powerless participants should devote their attention to stereotype‐inconsistent information in an attempt to increase their control over the social context. Study 1 directly manipulated control by assigning participants to the role of leader or subordinate in a task group. Results showed that, compared to subordinates, leaders devoted more attention to negative stereotypic attributes. Study 2 manipulated the legitimacy of power and replicated the pattern found in Study 1 but only when power was illegitimate. Our findings suggest that the experience of power can be associated with feelings of threat, especially when power is illegitimate, thereby orienting impression‐formation processes toward information likely to maintain the existing social structure. We discuss our results in the context of current work on motivated social cognition, social identity, and legitimisation. Copyright © 2000 John Wiley & Sons, Ltd.     

On the dual nature of maternal aggression in rats

Presentation of a natural predator, a cat, was used to differentiate elements of maternal attack by female rats on a male intruder. Following exposure (without direct physical contact) of post-partum females to a cat or to a toy stuffed cat (control group), the females were replaced in their home cages and presented with a male intruder rat. Cat exposure reliably decreased lateral attack to the intruder, as well as locomotion, but had no effect on either jump attack or an upright defensive posture (boxing). Since predator exposure produces a somewhat durable increase in defense, along with inhibition of nondefensive behavior, these results suggest that maternal aggression represents a mixture of offensive, usually related to competition, and defensive (protective) behaviors. The results indicate that maternal aggression, as a parental care behavior, appears to be at least partially resistant to fear. © 1996 Wiley-Liss, Inc.     

A teleological account of Cartesian sensations?

Alison Simmons, in Simmons (1999), argues that Descartes in Meditation Six offered a teleological account of sensory representation. According to Simmons, Descartes’ view is that the biological function of sensations explains both why sensations represent what they do (i.e., their referential content) and why they represent their objects the way they do (i.e., their presentational content). Moreover, Simmons claims that her account has several advantages over other currently available interpretations of Cartesian sensations. In this paper, I argue that Simmons’ teleological account cannot be sustained for both theoretical and textual reasons and that it does not have the advantages it is claimed to have.     

Perception of parental socialization strategies in adoptive and non-adoptive families

Although parental socialization styles have been investigated in recent years, little research has been carried out on the issue of parental styles in adoptive families. The aim of this research is to analyse parental styles both from the point of view of the parents and of adopted and non-adopted adolescents, taking as covariables the adolescents' sex and age. The sample was made up of 55 adopted adolescents (20 boys and 35 girls with an age range of 11-17 years) and their 55 adoptive parents, and 402 non-adopted adolescents (200 boys and 202 girls with an age range of 11-17 years), and their 258 parents. Two scales evaluated parental styles: the Affect Scale and the Rules and Demands Scale. The results showed that, both from the point of view of the parents and of the adolescents, adoptive families are more affective, communicative and inductive, and less critical and indulgent than non-adoptive families. No differences were found between adopted and non-adopted adolescents on the Parents' Rigidity Scale.     

Bilingual aphasia and language control: A follow-up fMRI and intrinsic connectivity study

In a world that is becoming more multilingual, bilingual aphasia is a clinical problem with a major clinical impact. However, at present we lack causal explanations of the many features of recovery patterns and there is no consensus about the language in which the patient should receive speech therapy. Further advance requires an understanding of the dynamics of recovery. In a novel longitudinal, single-case study, we combine fMRI and dynamic causal modeling to examine the effects of specific language treatment for picture naming on the representation and control of language areas during the course of recovery. Improved performance in the treated language was associated with increased activation in language areas. Consistent with theoretical expectations, causal modeling indicated increased connectedness of the control and language networks for the treated language. This functional approach holds great promise for investigating recovery patterns and the effects of specific language treatment in bilingual aphasic patients.     

Computer-mediated communication and time pressure induce higher cardiovascular responses in the preparatory and execution phases of cooperative tasks

The cardiovascular (CV) response to social challenge and stress is associated with the etiology of cardiovascular diseases. New ways of communication, time pressure and different types of information are common in our society. In this study, the cardiovascular response to two different tasks (open vs. closed information) was examined employing different communication channels (computer-mediated vs. face-to-face) and with different pace control (self vs. external). Our results indicate that there was a higher CV response in the computer-mediated condition, on the closed information task and in the externally paced condition. These role of these factors should be considered when studying the consequences of social stress and their underlying mechanisms.     

When subordinates think of their ideals: power, legitimacy and regulatory focus

Power influences the way people set and pursue their goals. Recent Studies have shown that powerful people, when compared with powerless individuals, have greater accessibility of their promotion goals (for instance, their ideals, their aspirations, etc.). In the current research we aim to explore the moderating role of power's legitimacy in such effect. In Study 1, after manipulating power and legitimacy, the accessibility of ideals was measured. Results showed that in the legitimate condition, the powerful, compared to the powerless people, showed greater accessibility of their ideals. However, in the illegitimate condition the opposite was true. In Study 2, the accessibility of a different type of goal: oughts, was explored. Results showed that the illegitimate powerholders, when compared with legitimate ones, had their oughts more accessible. The importance of these results is discussed in line with recent theorizing within social psychology of power.     

Disordered eating behaviors and body image in a longitudinal pilot study of adolescent girls: What happens 2 years later?

We assessed the prospective association of risk factors for eating and body image disturbances after a 2-year follow-up in a community sample of Spanish adolescent girls. The participants included 128 Spanish girls aged 12–14, who took part in a 28-month prospective study. Aspects assessed were eating attitudes (Eating Attitudes Test), influence of the body shape model (questionnaire on influences of the aesthetic body shape model), extreme weight-control behaviors (Eating Disorder Examination-Questionnaire), body image (Body Image Questionnaire) and Body Mass Index (BMI). BMI, extreme weight-control behaviors and body image problems emerged as potential predictors of an increase in eating disturbances. An increased influence of the thinness model was significantly associated with reduced body satisfaction and body image problems. Preventive programs are needed to contribute reducing the impact of sociocultural influences with regard to thinness, the use of extreme weight-control behaviors and overweight in adolescents.     

An augmented reality system validation for the treatment of cockroach phobia

Augmented reality (AR) is a new technology in which various virtual elements are incorporated into the user's perception of the real world. The most significant aspect of AR is that the virtual elements add relevant and helpful information to the real scene. AR shares some important characteristics with virtual reality as applied in clinical psychology. However, AR offers additional features that might be crucial for treating certain problems. An AR system designed to treat insect phobia has been used for treating phobia of small animals, and positive preliminary data about the global efficacy of the system have been obtained. However, it is necessary to determine the capacity of similar AR systems and their elements that are designed to evoke anxiety in participants; this is achieved by testing the correspondence between the inclusion of feared stimuli and the induction of anxiety. The objective of the present work is to validate whether the stimuli included in the AR-Insect Phobia system are capable of inducing anxiety in six participants diagnosed with cockroach phobia. Results support the adequacy of each element of the system in inducing anxiety in all participants.