Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration

This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Applicability of a cognitive model of worry to children and adolescents

BackgroundIntolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents.MethodPrimary and secondary school students (n = 515; aged 7–19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency.ResultsSignificant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7–12 years) and adolescents (aged 13–19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents.ConclusionsCognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth.     

Metacognitive therapy in treatment-resistant depression: a platform trial

Patients with treatment-resistant depression received up to 8 sessions of metacognitive therapy (MCT) targeting attentional control, rumination, worry, and metacognitive beliefs. A baseline period was followed by weekly sessions with follow-up assessments at 6 and 12 months post treatment. Large and statistically significant improvements occurred in all symptom measures at post treatment and were maintained over follow-up. Two out of 3 process measures significantly improved at post treatment and all of these measures were improved at follow-up. Treatment was associated with similar response rates on the BDI and Hamilton rating scale. Using liberal criteria 80% of completers were classified as recovered at post treatment and 70% at follow-up on the BDI. In the intention to treat sample 66.6% were recovered at post treatment and 58.3% at follow-up. More stringent criteria showed 60% recovery rates at post treatment and at 12 m. The results suggest that MCT could be a brief and effective treatment and they provide a precedent for more definitive randomized controlled trials.     

Greater emotional arousal predicts poorer long-term memory of communication skills in couples

Many studies have examined the importance of learning skills in behaviorally based couple interventions but none have examined predictors of long-term memory for skills. Associations between emotional arousal and long-term recall of communication skills delivered to couples during a behaviorally based relationship distress prevention program were examined in a sample of 49 German couples. Fundamental frequency (f(0)), a vocal measure of encoded emotional arousal, was measured during pre-treatment couple conflict. Higher levels of f(0) were linked to fewer skills remembered 11 years after completing the program, and women remembered more skills than men. Implications of results for behaviorally based couple interventions are discussed.     

The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a waitlist control/delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur.     

Out of sight, out of mind: the presence of forensic evidence counts more than its absence

Recent evidence suggests that decision makers in criminal procedures are susceptible to biases. We previously found support for the presence of a feature positive effect (FPE, i.e., people attach more meaning to present than to absent information) in legal-decision making. In this study, we tried to uncover the mechanisms behind the FPE. Taking a cue from the literature on situation models in language comprehension, we investigated whether a FPE manifests itself in the memorization and use of forensic evidence. Students read a case file about a fistfight as well as additional evidence. The forensic evidence was manipulated such that a FPE on guilt estimation and conviction rate could be assessed. While subjects read additional forensic evidence, their eye movements were recorded to explore the presence of FPE in online processing. Afterwards, subjects were asked to decide on the suspect's guilt. They had to recall all information they remembered from the case file and indicate which parts of information they considered relevant to this decision. The results provided evidence for the occurrence of FPE in memorization and use of information and can be explained by the theoretical construct of situation models.     

Offline improvement occurs for temporal stability but not accuracy following practice of integer and non-integer rhythms

Procedural learning benefits from memory processes occurring outside practice resulting in offline learning. Offline gains have been demonstrated almost exclusively for the ordinal structure of sequential motor tasks. Many skills also demand that the correct serial order of events be appropriately timed. Evidence indicates that the temporal aspect of a procedural skill can be encoded independent of serial order knowledge and governed by at least two distinct neural circuits. The present experiment determined if (a) offline gains emerge for temporal learning, and (b) if such gains occur for timing supervised by distinct timing systems. Participants experienced 216 practice trials of a 7-key press sequence that involved integer- or non-integer timing rhythms. Twenty-four hours after training 30 test trials were administered. Results revealed robust offline enhancement for timing performance of the non-integer based temporal sequences. This improvement was localized to stabilization of the required relative but not absolute time profiles. The neural circuitry central to supporting the performance of non-integer timing sequences is also a principal constituent of what is described as the "cognitive" timing system. Timing governed by this system appears most susceptible to offline gains via consolidation.     

Asymmetric switch-costs and ERPs reveal facial identity dominance over expression

Previous studies on face processing have revealed an asymmetric overlap between identity and expression, as identity is processed irrespective of expression while expression processing partly depends on identity. To investigate whether this relative interaction is caused by dominance of identity over expression, participants performed familiarity and expression judgments during task switching. This paradigm reveals task-set dominance with a paradoxical asymmetric switch-cost (i.e., greater difference between switch and repeat trials when switching toward the dominant task). Event-related potentials (ERPs) were recorded to find the neural signature of the asymmetric cost. As expected, greater switch-cost was shown in the familiarity task with respect to response times, indicating its dominance over the expression task. Moreover, a left-sided ERP correlate of this effect was observed at the level of the frontal N2 component, interpreted as an index of modulations in endogenous executive control. Altogether, these results confirm the overlap between identity and expression during face processing and further indicate their relative dominance.