CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.     

The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury

The authors examined the temporal relation among posttraumatic stress disorder symptom clusters, using data derived from a longitudinal study of survivors of orofacial injury (N = 264). They conducted cross-lagged panel analyses, with self-reported symptom data collected at 1, 6, and 12 months postinjury. Results demonstrate that hyperarousal was a potent predictor of subsequent symptoms of reexperiencing and avoidance as well as hyperarousal. By contrast, neither reexperiencing nor avoidance was significantly related to other symptom clusters other than themselves over time. These findings underscore the distinctive nature of hyperarousal in the manifestation of posttraumatic psychological distress over time. Implications for theory, clinical intervention, and future research are discussed.     

Psychiatric hospitalization after deliberate self-poisoning

The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for: age 25 or older, homelessness, unemployment, previous self-harm, psychiatric inpatient treatment within 12 months, earlier psychiatric inpatient treatment, suicidal ideation or plan, mood or psychotic disorders, and lower clinician experience; and lower risk for being married/defacto, and after hours presentation. Recommendation for psychiatric hospitalization was based on complex decision making. These findings have implications for clinical practice guidelines, service costs, and service organization.     

An examination of learning processes during critical incident training: implications for the development of adaptable trainees

Three experiments are reported that examined the process by which trainees learn decision-making skills during a critical incident training program. Formal theories of category learning were used to identify two processes that may be responsible for the acquisition of decision-making skills: rule learning and exemplar learning. Experiments 1 and 2 used the process dissociation procedure (L. L. Jacoby, 1998) to evaluate the contribution of these processes to performance. The results suggest that trainees used a mixture of rule and exemplar learning. Furthermore, these learning processes were influenced by different aspects of training structure and design. The goal of Experiment 3 was to develop training techniques that enable trainees to use a rule adaptively. Trainees were tested on cases that represented exceptions to the rule. Unexpectedly, the results suggest that providing general instruction regarding the kinds of conditions in which a decision rule does not apply caused them to fixate on the specific conditions mentioned and impaired their ability to identify other conditions in which the rule might not apply. The theoretical, methodological, and practical implications of the results are discussed.     

Reinforcement value and substitutability of sucrose and wheel running: implications for activity anorexia

Choice between sucrose and wheel-running reinforcement was assessed in two experiments. In the first experiment, ten male Wistar rats were exposed to concurrent VI 30 s VI 30 s schedules of wheel-running and sucrose reinforcement. Sucrose concentration varied across concentrations of 2.5, 7.5, and 12.5%. As concentration increased, more behavior was allocated to sucrose and more reinforcements were obtained from that alternative. Allocation of behavior to wheel running decreased, but obtained wheel-running reinforcement did not change. Overall, the results suggested that food-deprived rats were sensitive to qualitative changes in food supply (sucrose concentration) while continuing to defend a level of physical activity (wheel running). In the second study, 15 female Long Evans rats were exposed to concurrent variable ratio schedules of sucrose and wheel-running, wheel-running and wheel-running, and sucrose and sucrose reinforcement. For each pair of reinforcers, substitutability was assessed by the effect of income-compensated price changes on consumption of the two reinforcers. Results showed that, as expected, sucrose substituted for sucrose and wheel running substituted for wheel running. Wheel running, however, did not substitute for sucrose; but sucrose partially substituted for wheel running. We address the implications of the interrelationships of sucrose and wheel running for an understanding of activity anorexia.     

Large-scale neural network for sentence processing

Our model of sentence comprehension includes at least grammatical processes important for structure-building, and executive resources such as working memory that support these grammatical processes. We hypothesized that a core network of brain regions supports grammatical processes, and that additional brain regions are activated depending on the working memory demands associated with processing a particular grammatical feature. We used functional magnetic resonance imaging (fMRI) to test this hypothesis by comparing cortical activation patterns during coherence judgments of sentences with three different syntactic features. We found activation of the ventral portion of left inferior frontal cortex during judgments of violations of each grammatical feature. Increased recruitment of the dorsal portion of left inferior frontal cortex was seen during judgments of violations of specific grammatical features that appear to involve a more prominent working memory component. Left posterolateral temporal cortex and anterior cingulate were also implicated in judging some of the grammatical features. Our observations are consistent with a large-scale neural network for sentence processing that includes a core set of regions for detecting and repairing several different kinds of grammatical features, and additional regions that appear to participate depending on the working memory demands associated with processing a particular grammatical feature.     

The Nature and Time Course of Pragmatic Plausibility Effects

The experiments reported in this article used a delayed same/different sentence matching task with concurrent measurement of eye movements to investigate the nature of the plausibility effect. The results clearly show that plausibility effects are not due to low level lexical associative processes, but arise as a consequence of the processing of the earliest or most basic form of sentential meaning. In fact, when sentential implausibility and lexical association are varied simultaneously, it is only sentential implausibility that exerts an effect. Effects of implausibility occur rapidly—sometimes parafoveally—and are localised in the regions of the sentence where the implausibility occurs, suggesting an incremental interpretive process progressing on a roughly word-by-word basis. It is suggested that plausibility effects result from the operation of a heuristically-driven process of sentential interpretation. This appears to behave in a ‘modular’ fashion, despite being influenced by real world knowledge and probabilities.Particular thanks are due to Ken Forster for kindling the ideas which led to much of this work and to Merrill Garrett for posing impossible challenges, which, probably to everyone’s surprise, could in fact be met. I am also much indebted to Claire Boissiere, Emma Clayes, Clare Dobbin, Alan Kennedy, Julie-Ann Marshall, Ashley Murray, and Murray Rowan for their collaboration in this research.     

A cognitive architecture that combines internal simulation with a global workspace

This paper proposes a brain-inspired cognitive architecture that incorporates approximations to the concepts of consciousness, imagination, and emotion. To emulate the empirically established cognitive efficacy of conscious as opposed to non-conscious information processing in the mammalian brain, the architecture adopts a model of information flow from global workspace theory. Cognitive functions such as anticipation and planning are realised through internal simulation of interaction with the environment. Action selection, in both actual and internally simulated interaction with the environment, is mediated by affect. An implementation of the architecture is described which is based on weightless neurons and is used to control a simulated robot.     

A smart unconscious? Procedural origins of automatic partner attitudes in marriage

The paper examines potential origins of automatic (i.e., unconscious) attitudes toward one’s marital partner. It tests the hypothesis that early experiences in conflict-of-interest situations predict one’s later automatic inclination to approach (or avoid) the partner. A longitudinal study linked daily experiences in conflict-of-interest situations in the initial months of new marriages to automatic evaluations of the partner assessed four years later using the Implicit Associations Test. The results revealed that partners who were initially (1) treated less responsively and (2) evidenced more self-protective and less connectedness-promoting “if-then” contingencies in their thoughts and behavior later evidenced less positive automatic partner attitudes. However, these factors did not predict changes in love, satisfaction, or explicit beliefs about the partner. The findings hint at the existence of a “smart” relationship unconscious that captures behavioral realities conscious reflection can miss.