Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

Controlling the unconscious: attentional task sets modulate subliminal semantic and visuomotor processes differentially

Are unconscious processes susceptible to attentional influences? In two subliminal priming experiments, we investigated whether task sets differentially modulate the sensitivity of unconscious processing pathways. We developed a novel procedure for masked semantic priming of words (Experiment 1) and masked visuomotor priming of geometrical shapes (Experiment 2). Before presentation of the masked prime, participants performed an induction task in which they attended to either semantic or perceptual object features designed to activate a semantic or perceptual task set, respectively. Behavioral and electrophysiological effects showed that the induction tasks differentially modulated subliminal priming: Semantic priming, which involves access to conceptual meaning, was found after the semantic induction task but not after the perceptual induction task. Visuomotor priming was observed after the perceptual induction task but not after the semantic induction task. These results demonstrate that unconscious cognition is influenced by attentional control. Unconscious processes in perceptual and semantic processing streams are coordinated congruently with higher-level action goals.     

Leaning to the left makes the Eiffel Tower seem smaller: posture-modulated estimation

In two experiments, we investigated whether body posture influences people's estimation of quantities. According to the mental-number-line theory, people mentally represent numbers along a line with smaller numbers on the left and larger numbers on the right. We hypothesized that surreptitiously making people lean to the right or to the left would affect their quantitative estimates. Participants answered estimation questions while standing on a Wii Balance Board. Posture was manipulated within subjects so that participants answered some questions while they leaned slightly to the left, some questions while they leaned slightly to the right, and some questions while they stood upright. Crucially, participants were not aware of this manipulation. Estimates were significantly smaller when participants leaned to the left than when they leaned to the right.     

Sensitivity of different measures of the visibility of masked primes: influences of prime-response and prime-target relations

Visual masking of primes lowers prime visibility but spares processing of primes as reflected in prime–target congruence and prime–response compatibility effects. However, the question is how to appropriately measure prime visibility. Here, we tested the influence of three procedural variables on prime visibility measures: prime–target similarity, prime–response similarity, and the variability of prime–response mappings. Our results show that a low prime–target similarity is a favorable condition for a prime visibility measure because it increases the sensitivity of this measure in comparison to a high prime–target similarity.     

The influence of dichotical fusion on the redundant signals effect,localization performance,and the mismatch negativity

In two experiments, each including a simple reaction time (RT) task, a localization task, and a passive oddball paradigm, the physical similarity between two dichotically presented auditory stimuli was manipulated. In both experiments, a redundant signals effect (RSE), high localization performance, and a reliable mismatch negativity (MMN) was observed for largely differing stimuli, suggesting that these are coded separately in auditory memory. In contrast, no RSE and a localization rate close to chance level (experiment 1) or at chance (experiment 2) were observed for stimuli differing to a lesser degree. Crucially, for such stimuli a small (experiment 1) or no (experiment 2) MMN were observed. These MMN results indicate that such stimuli tend to fuse into a single percept and that this fusion occurs rather early within information processing.     

The initial stage of visual selection is controlled by top-down task set: new ERP evidence

Salient visual singleton stimuli produce spatial cueing effects indicative of attentional capture only when they match current task sets, suggesting that capture is subject to top-down control. However, such task-set contingent capture effects could be associated with the top-down controlled disengagement of attention from non-matching stimuli that follows their initial bottom-up salience-driven selection. Using the N2pc component as an event-related potential marker of attentional capture, we demonstrate that top-down task set already controls the initial rapid selection of salient visual singleton stimuli prior to any subsequent attentional disengagement. These findings provide new evidence for the primacy of top-down control over bottom-up salience in attentional capture.     

Elaborative rehearsal of nontemporal information interferes with temporal processing of durations in the range of seconds but not milliseconds

The distinct timing hypothesis suggests a sensory mechanism for processing of durations in the range of milliseconds and a cognitively controlled mechanism for processing of longer durations. To test this hypothesis, we employed a dual-task approach to investigate the effects of maintenance and elaborative rehearsal on temporal processing of brief and long durations. Unlike mere maintenance rehearsal, elaborative rehearsal as a secondary task involved transfer of information from working to long-term memory and elaboration of information to enhance storage in long-term memory. Duration discrimination of brief intervals was not affected by a secondary cognitive task that required either maintenance or elaborative rehearsal. Concurrent elaborative rehearsal, however, impaired discrimination of longer durations as compared to maintenance rehearsal and a control condition with no secondary task. These findings endorse the distinct timing hypothesis and are in line with the notion that executive functions, such as continuous memory updating and active transfer of information into long-term memory interfere with temporal processing of durations in the second, but not in the millisecond range.     

A psychometric study of the Drug Use Disorders Identification Test-Extended in a Norwegian sample

Motivation is a widely used concept in substance use treatment, and is commonly seen as a premise for change during treatment. Different measures of motivation have been suggested. A relatively new instrument is the Drug Use Disorders Identification Test-Extended (DUDIT-E), developed in Sweden. This instrument has recently been introduced in Norway. The present study examined the Motivational Index of the Norwegian version of the Drug Use Disorders Identification Test-Extended (DUDIT-E). We tested whether the three-factor model ("Positive aspects of substance abuse"; "Negative aspects of substance abuse"; and "Treatment readiness") suggested by previous studies could be replicated in a sample of Norwegian inpatients. Responses to the DUDIT-E were obtained from 105 patients admitted to inpatient substance abuse treatment in Northern Norway. Exploratory common factor analyses were used to compare the factor structure from the current sample with the Swedish sample of mainly detoxification patients and prison inmates. The current sample did not include prison inmates, and it consisted of more women than the Swedish sample. The samples did not differ according to age or substance dependency. The analyses suggested that six primary factors was the most efficient way of combining the item scores, and not 11 as in the Swedish sample. A second-order factor analysis found best support for a two-factor solution, and hence, did not replicate the previously suggested three-factor model either. Several regression analyses comparing the efficiency of the different ways of combining the DUDIT scores in primary or secondary factor scores indicated that the model involving six sum scores had best merit and should be explored further.     

For my eyes only: gaze control, enmeshment, and relationship quality

Perceived closeness that preserves the distinctness of each partner enhances intimate relationship quality, whereas pseudocloseness or enmeshment--reflecting an inability to distinguish one's own thoughts and emotions from a partner's--may have more negative outcomes (R. J. Green & P. D. Werner, 1996). Two studies investigated whether a dispositional inability to differentiate self from other is manifested at the attentional level as reduced capacity to inhibit following the gaze of another (A. Frischen, A. P. Bayliss, & S. P. Tipper, 2007). Among healthy elderly spouses in Study 1, superior gaze control predicted superior sociocognitive functioning, and those with poorer gaze control abilities were perceived by the partner as constricting the perceiving partner's autonomy, which in turn predicted lower relationship satisfaction among the latter. Moreover, these links were mediated by enmeshment, as indicated by the percentage of "we"-focused versus "I"- or partner-focused thoughts and emotions in the partners' independent accounts of the same relationship events. Extending these findings in a sample of Parkinson's disease patients and their spouses, Study 2 revealed a biphasic effect of self-other differentiation on relationship dynamics: In the early stages of the disease, increased couple focus promoted superior relationship quality, whereas lack of self-other differentiation predicted poorer relationship quality later. Thus, dispositional variations in fundamental social-perceptual processes predict both close relationship dynamics and long-term relationship quality.     

Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder

Several studies have demonstrated a positive relationship between competence and outcome in CBT for depression but studies of CBT for anxiety disorders are lacking. The present study explores the relationship between competence and outcome in cognitive therapy (CT) for social anxiety disorder, using hierarchical linear modeling analyses (HLM). Data were drawn from a multicenter randomized controlled trial. Five trained raters evaluated videotapes of two therapy sessions per patient using the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP). Overall adherence to the treatment manual and patient difficulty were also assessed. Patient outcome was rated by other assessors using the Clinical Global Impression Improvement Scale (CGI-I) and the Liebowitz Social Anxiety Scale (LSAS). Results indicated that competence significantly predicted patient outcome on the CGI-I (β = .79) and LSAS (β = .59). Patient difficulty and adherence did not further improve prediction. The findings support the view that competence influences outcome and should be a focus of training programs. Further research is needed to compare different ways of assessing competence and to understand the complex relationships between competence and other therapy factors that are likely to influence outcome.