The development of a psychoanalytic outcome study: choices, conflicts, and consensus

This article tells the story of the development of an outcome study of psychoanalysis and describes the debate that took place over critical methodological issues. The protocol committee included career psychotherapy researchers who have conducted rigorous outcome studies, clinical psychoanalysts, study methodologists, and a statistician with clinical trial expertise. The committee worked for two years to develop the study design. This project is based on the premise that clinical psychoanalysis is a treatment. Areas specifically addressed are the goals and hypothesis of the study, inclusion and exclusion criteria, choice of psychotherapies as comparison treatments, definition of treatments and selection of therapists, use of medication, development of a treatment adherence measure, randomization of patient assignment vs. patient self-selection, and primary outcome measures. The execution of this outcome study will require significant effort and resources. A positive result would boost the standing of psychoanalysis, but the results may not support the primary hypothesis that there are therapeutic benefits unique to psychoanalysis and that psychoanalysis can effect demonstrable changes in a patient's mental life and adaptation that are not achieved by treatments of different orientation and/or lesser intensity. However, more important than whatever specific results emerge is what executing such a study requires of our field: the process of addressing the clinical issues that a study design requires, the creation of a network of analysts around the country working on a common project, and the joining of the clinical psychoanalytic community with a community of psychodynamic researchers.     

Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability

We know little about why some people get better after psychological treatments for pain disability, whereas other people do not. In order to understand differences in treatment response, we need to explore processes of change during treatment. It has been suggested that people with pain complaints who change early in treatment have better outcomes. Therefore, we aimed to investigate whether changes in psychological variables at different time points are related to outcome, and whether early or late changes are better predictors of outcome. We used the fear avoidance model as a theoretical framework. We followed 64 patients weekly over 6–7 weeks and then determined outcome. Our findings indicate that people who decrease in catastrophizing and function early in treatment as well as in depressive symptoms, worry, fear avoidance beliefs and function late in treatment have better outcomes. Early decreases in function, and late decreases in depressive symptoms and worry uniquely predict improvements in disability. While early and late changes covaried concurrently, there were no significant sequential relationships between early and late changes. Changes in the proposed process variables in the fear avoidance model, early as well as late in treatment, thus add valuable information to the explanation of outcome.     

Safety behavior can hamper the extinction of fear of movement-related pain: An experimental investigation in healthy participants

Excessive fear of movement-related pain (FMRP), and its associated avoidance behavior, is considered a major risk factor for disability in chronic musculoskeletal pain. The current study aimed to investigate whether engaging in safety behavior, conceptualized as an avoidance response, hampers the extinction of FMRP. In a differential conditioning paradigm, we used joystick movements as conditioned stimuli (CSs) and a painful electrocutaneous stimulus as the unconditioned stimulus (US). In the Safety group, participants received the opportunity to avoid the pain-US by pressing a safety button during the extinction phase, whereas in the Control group, this option was not included. In a subsequent test phase, this safety button was no longer available. In two experiments, results demonstrate successful acquisition and extinction. Retrospective FMRP ratings in both experiments revealed a return of fear of pain in the test phase in the Safety group, but not in the Control group. In Experiment 1, mean eyeblink startle reflex amplitudes partly corroborated the self-report findings on fear of pain. The present results suggest that performing safety behavior during cognitive-behavioral interventions, i.e., exposure, might increase the risk of a return of FMRP.     

Correspondence of back pain patients' self-reports of sick leave and Swedish National Insurance Authority register

While self-reports of sick absenteeism days are often practical for research, it is not clear how accurate these reports are. 192 Swedish participants recorded the number of days they had been off work for all illnesses, as well as for back pain specifically, for each month during the past 6 mo. These data were then compared to records from the National Insurance Authority in Sweden. The similarity between the data sets was very high, with the correspondence for those reporting 0 to 30 days off being 98%. For those with more than 30 days of self-reported sick leave, the correspondence was 81%, but the reason for the discrepancy may have been a lack of clarity in the question. It is concluded that self-reports correspond well with recorded data and that their use in research is justified.     

Some thoughts on essence placeholders, interactionism, and heritability: reply to Haslam (2011) and Turkheimer (2011)

In the target article (Dar-Nimrod & Heine, 2011), we provided a social-cognitive framework which identified genetic essentialist biases and their implications. In their commentaries, Haslam (2011) and Turkheimer (2011) indicated their general agreement with this framework but highlighted some important points for consideration. Haslam suggested that neuroessentialism is a comparable kind of essentialist bias and identified similarities with the genetic essentialism framework. In response, we acknowledge similarities but also identify qualitative and quantitative differences between genetic essentialism and other kinds of essentialist biases. Turkheimer challenged us to extend our discussion to address the question of how should people respond to genetic etiological information, critiqued the use of heritability coefficients, and identified a new construct (1 - rMZ), which may be termed a free-will coefficient. In response, we emphasize the need to transform interactionist explanations from being empty platitudes to becoming the default conceptual framework; we wholeheartedly accept his critical view of heritability coefficient estimates (but acknowledge a more limited utility for them); and we are intrigued by his conceptual interest in identifying free-will coefficients yet warn against falling into pitfalls similar to those that were stumbled into in the past.     

Your heart makes my heart move: Cues of social connectedness cause shared emotions and physiological states among strangers

Two experiments tested the hypothesis that cues of social connectedness could lead even new interaction partners to experience shared emotional and physiological states. In Experiment 1, a confederate prepared for a stress-inducing task. Participants who had been led to feel socially connected to the confederate reported feeling greater stress than participants who had not. In Experiment 2, a confederate ran vigorously in place. Socially-connected participants had greater cardiovascular reactivity (heart rate and blood pressure) than controls. Each study held constant exposure to the confederate. The results suggest that the sharing of psychological and physiological states does not occur only between long-standing relationship partners, but can also result from even subtle experiences of social connectedness. These findings illustrate the dynamic and fluid ways in which important aspects of self can change in response to cues of social relatedness.     

Effects of spatial and selective attention on basic multisensory integration

When participants respond to auditory and visual stimuli, responses to audiovisual stimuli are substantially faster than to unimodal stimuli (redundant signals effect, RSE). In such tasks, the RSE is usually higher than probability summation predicts, suggestive of specific integration mechanisms underlying the RSE. We investigated the role of spatial and selective attention on the RSE in audiovisual redundant signals tasks. In Experiment 1, stimuli were presented either centrally (narrow attentional focus) or at 1 of 3 unpredictable locations (wide focus). The RSE was accurately described by a coactivation model assuming linear superposition of modality-specific activation. Effects of spatial attention were explained by a shift of the evidence criterion. In Experiment 2, stimuli were presented at 3 locations; participants had to respond either to all signals regardless of location (simple response task) or to central stimuli only (selective attention task). The RSE was consistent with task-specific coactivation models; accumulation of evidence, however, differed between the 2 tasks.     

Attachment and the management of empathic accuracy in relationship-threatening situations

The current studies tested how attachment orientations are related to empathic accuracy (i.e., the accuracy with which one infers a partner's private thoughts and feelings) during attachment-relevant discussions. In Study 1, married couples were videotaped discussing a severe or a less severe relationship issue that involved intimacy or jealousy. In Study 2, dating couples were videotaped trying to resolve a relationship conflict. Consistent with the revised empathic accuracy model, highly avoidant individuals were less empathically accurate in both studies. Relative to less anxious persons, highly anxious individuals were more empathically accurate when discussing intimacy issues that posed a potential threat to their relationship (in Study 1) and when they were rated as more distressed when discussing a relationship conflict (in Study 2). The findings are discussed in terms of how highly anxious and highly avoidant people differentially manage empathic accuracy to regulate negative affect and facilitate their interpersonal goals.     

Doxastic Voluntarism and the Function of Epistemic Evaluations

Control of our own beliefs is allegedly required for the truth of epistemic evaluations, such as “S ought to believe that p”, or “S ought to suspend judgment (and so refrain from any belief) whether p”. However, we cannot usually believe or refrain from believing at will. I agree with a number of recent authors in thinking that this apparent conflict is to be resolved by distinguishing reasons for believing that give evidence that p from reasons that make it desirable to believe that p whether or not p is true. I argue however that there is a different problem, one that becomes clearer in light of this solution to the first problem. Someone’s approval of our beliefs is at least often a non-evidential reason to believe, and as such cannot change our beliefs. Ought judgments aim to change the world. But ‘ought to believe’ judgments can’t do that by changing the belief, if they don’t give evidence. So I argue that we should instead regard epistemic ought judgments as aimed mainly at influencing assertions that express the belief and other actions based on the belief, in accord with recent philosophical claims that we have epistemic norms for assertion and action.