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.     

Knowledge Grounded on Pure Reasoning

In this paper, I deal with epistemological issues that stem from the hypothesis that reasoning is not only a means of transmitting knowledge from premise‐beliefs to conclusion‐beliefs but also a primary source of knowledge in its own right. The idea is that one can gain new knowledge on the basis of suppositional reasoning. After making some preliminary distinctions, I argue that there are no good reasons to think that purported examples of knowledge grounded on pure reasoning are just examples of premise‐based inferences in disguise. Next, I establish what kinds of true propositions can to a first approximation be known on the basis of pure reasoning. Finally, I argue that beliefs that are competently formed on the basis of suppositional reasoning satisfy both externalist and internalist criteria of justification.     

Validation of eating disorder examination questionnaire (EDE-Q)--Spanish version--for screening eating disorders

This research examines the internal consistency, convergent validity, and sensitivity, specificity, and positive and negative predictive value of the Spanish version of the Eating Disorder Examination-Self-Report Questionnaire (S-EDE-Q), as a screening questionnaire for eating disorders (ED) in a community sample. Participants were 1543 male and female Spanish-speaking students (age range: 12-21 years), who volunteered to complete the S-EDE-Q and the EAT-40. The Spanish version of the Eating Disorders Examination (S-EDE) interview, 12th edition, was administered to 602 of the students. Acceptable internal consistency for the four subscales of the S-EDE-Q was obtained (alpha > or = .74). Corrected point-biserial correlation performed with the 22 items included in the S-EDE-Q subscales showed acceptable values for all the items. The EAT-40 Dieting subscale correlated highly and positively with the four S-EDE-Q subscales (r > or = .70). Acceptable results in sensitivity, specificity, and positive and negative predictive value when compared with the EDE were found. Correlation between S-EDE and S-EDE-Q diagnoses was positive and significant. Overall, results support the psychometric adequacy of the S-EDE-Q as a screening questionnaire for ED in community samples.     

From Incubation to Insight: Working Memory and the Role of the Cerebellum

An experiment involving 90 students in the 1st, 3rd, and 5th grades investigated how visual examples and grade (our surrogate for age) affected variability in a drawing task. The task involved using circles as the main element in a set of drawings. There were two examples: One was simple and single (a smiley face inside a circle); the other, complex and dual (a fishbowl extending outside a circle and a bicycle using two circles). There were significant effects of both example and grade on variability. Between-grades, 3rd and 5th graders were more variable than 1st graders with the complex (but not the simple) set of examples. Within-grades, 3rd and 5th graders were more variable with the complex (compared to the simple) set of examples. First graders' variability levels did not change with examples. The discussion focuses on how examples have and should be used to increase variability in drawings of both younger and older children.     

Neural connectivity patterns underlying symbolic number processing indicate mathematical achievement in children

In early childhood, humans learn culturally specific symbols for number that allow them entry into the world of complex numerical thinking. Yet little is known about how the brain supports the development of the uniquely human symbolic number system. Here, we use functional magnetic resonance imaging along with an effective connectivity analysis to investigate the neural substrates for symbolic number processing in young children. We hypothesized that, as children solidify the mapping between symbols and underlying magnitudes, important developmental changes occur in the neural communication between the right parietal region, important for the representation of non‐symbolic numerical magnitudes, and other brain regions known to be critical for processing numerical symbols. To test this hypothesis, we scanned children between 4 and 6 years of age while they performed a magnitude comparison task with Arabic numerals (numerical, symbolic), dot arrays (numerical, non‐symbolic), and lines (non‐numerical). We then identified the right parietal seed region that showed greater blood‐oxygen‐level‐dependent signal in the numerical versus the non‐numerical conditions. A psychophysiological interaction method was used to find patterns of effective connectivity arising from this parietal seed region specific to symbolic compared to non‐symbolic number processing. Two brain regions, the left supramarginal gyrus and the right precentral gyrus, showed significant effective connectivity from the right parietal cortex. Moreover, the degree of this effective connectivity to the left supramarginal gyrus was correlated with age, and the degree of the connectivity to the right precentral gyrus predicted performance on a standardized symbolic math test. These findings suggest that effective connectivity underlying symbolic number processing may be critical as children master the associations between numerical symbols and magnitudes, and that these connectivity patterns may serve as an important indicator of mathematical achievement.