On the astonishing clinical irrelevance of neuroscience

The clinical work of psychoanalysts can be thought of in both a narrow and a broad sense. In the narrow sense, it refers to what is commonly thought of as psychoanalytic technique, the methods analysts use to understand their patients and to convey that understanding to them. In the broad sense, it refers to the entirety of their work as clinicians: the content of understanding, as well as such things as diagnosing, estimating analyzability, recommending therapy, and prescribing medication. The current enthusiastic expectation that neuroscience will have an immediate and direct impact on clinical work in the narrow sense is misguided, but neuroscientific discoveries, it is argued, will have a major impact on psychoanalytic theory in the not too distant future. The resulting changes in metapsychology will ultimately have reverberations on clinical work in the broad sense, although psychoanalytic technique, the analyst's basic approach to patients, will remain essentially the same.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

The Mental Representation of Human Action

Various theories of moral cognition posit that moral intuitions can be understood as the output of a computational process performed over structured mental representations of human action. We propose that action plan diagrams—“act trees”—can be a useful tool for theorists to succinctly and clearly present their hypotheses about the information contained in these representations. We then develop a methodology for using a series of linguistic probes to test the theories embodied in the act trees. In Study 1, we validate the method by testing a specific hypothesis (diagrammed by act trees) about how subjects are representing two classic moral dilemmas and finding that the data support the hypothesis. In Studies 2–4, we explore possible explanations for discrete and surprising findings that our hypothesis did not predict. In Study 5, we apply the method to a less well‐studied case and show how new experiments generated by our method can be used to settle debates about how actions are mentally represented. In Study 6, we argue that our method captures the mental representation of human action better than an alternative approach. A brief conclusion suggests that act trees can be profitably used in various fields interested in complex representations of human action, including law, philosophy, psychology, linguistics, neuroscience, computer science, robotics, and artificial intelligence.     

Factors that encourage generalization from extinction to test reduce resurgence of an extinguished operant response

Two experiments investigated methods that reduce the resurgence of an extinguished behavior (R1) that occurs when reinforcement for an alternative behavior (R2) is discontinued. In Experiment 1, R1 was first trained and then extinguished while R2 was reinforced during a 5‐ or 25‐session treatment phase. For half the rats, sessions in which R2 was reinforced alternated with sessions in which R2 was extinguished. Controls received the same number of treatment sessions, but R2 was never extinguished. When reinforcement for R2 was discontinued, R1 resurged in the controls. However, the alternating groups showed reduced resurgence, and the magnitude of the resurgences observed during their R2 extinction sessions decreased systematically over Phase 2. In Experiment 2, R1 was first reinforced with one outcome (O1). The rats then had two types of double‐alternating treatment sessions. In one type, R1 was extinguished and R2 produced O2. In the other, R1 was unavailable and R2 produced O3. R1 resurgence was weakened when O2, but not O3, was delivered freely during testing. Together, the results suggest that methods that encourage generalization between R1 extinction and resurgence testing weaken the resurgence effect. They are not consistent with an account of resurgence proposed by Shahan and Craig (2017).     

Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective

The trajectory of assessment in structural family therapy moves from a linear perspective, in which problems are located in the identified patient, to an interactional perspective, in which problems are seen as involving other members of the family. Minuchin, Nichols, & Lee (2007) developed a 4‐step model for assessing couples and families consisting of: (1) broadening the definition of the presenting complaint to include its context, (2) identifying problem‐maintaining interactions, (3) a structurally focused exploration of the past, and (4) developing a shared vision of pathways to change. To study how experts actually implement this model, judges coded video recordings of 10 initial consultations conducted by three widely recognized structural family therapists. Qualitative analyses identified 25 distinct techniques that these clinicians used to challenge linear thinking and move families toward a systemic understanding of their problems. We discuss and locate these techniques in the framework of the 4‐step model.     

Treatment Effects for Common Outcomes of Child Sexual Abuse: A Current Meta-Analysis

The present meta-analysis examined the effects of psychosocial treatments at reducing deleterious outcomes of sexual abuse. The meta-analysis included a total of 35 published and unpublished studies written in English, focusing on youth under the age of 18, and evaluating the effectiveness of treatments for the most common negative outcomes of sexual abuse: PTSD symptoms, externalizing problems, and internalizing problems. Results revealed medium effect sizes for PTSD symptoms, externalizing problems, and internalizing problems following treatment for sexual abuse. This study also examined the potential moderating effects of treatment (e.g., modality, duration, inclusion of caregiver) and participant (e.g., age, gender, ethnicity) characteristics. Results indicated that longer interventions were associated with greater treatment gains while group and individual treatments were equally effective. These findings shed new light on treatment effectiveness and provide useful information regarding the conditions under which treatment may be most effective. Future directions for research in this area are discussed.     

Is EBM an Appropriate Model for Research into the Effectiveness of Psychotherapy?

Topoi - EBM, and the hierarchy of evidence it prescribes, is a controversial model when it comes to research into the effectiveness of psychotherapeutic treatments. This is due in part to the...     

Coping and sensitivity to aversive events

To test further the sensitivity to aversive events hypothesis, males and females varying in level of depressed mood listened to positive, negative, and neutral social scenes while psychophysiological measurements were obtained. In addition, the relations among response styles, coping strategies, and psychological adjustment were examined. Results indicated that only dysphoric females responded in ways consistent with the sensitivity hypothesis, exhibiting greater electrodermal responses to negative social scenes compared to nondysphoric females. No differences in psychophysiological sensitivity were found between dysphoric and nondysphoric males. Dysphoric students engaged in more ruminative type responses in reaction to their depressed mood and reported using more avoidant coping strategies in response to stress. In particular, females utilized more ruminative strategies in response to a depressed mood and more emotion-focused coping strategies in response to stressful events in general. The implications for these results are discussed within a diathesis-stress framework.