Effects of facial expression and gaze direction on approach–avoidance behaviour

Humans must coordinate approach–avoidance behaviours with the social cues that elicit them, such as facial expressions and gaze direction. We hypothesised that when someone is observed looking in a particular direction with a happy expression, the observer would tend to approach that direction, but that when someone is observed looking in a particular direction with a fearful expression, the observer would tend to avoid that direction. Twenty-eight participants viewed stimulus faces with averted gazes and happy or fearful expressions on a computer screen. Participants were asked to grasp (approach) or withdraw from (avoid) a left- or right-hand button depending on the stimulus face's expression. The results were consistent with our hypotheses about avoidance responses, but not with respect to approach responses. Links between social cues and adaptive behaviour are discussed.     

The exemplary social emotion guilt: Not so relationship-oriented when another person repairs for you

Guilt is considered by many researchers to be the hallmark social emotion. Guilt theories perceive guilt to be a negative emotion with positive interpersonal consequences, and empirical research has shown guilt to motivate prosocial behaviours aimed at restoring the relationship with one's victims. The current research questions the relationship-oriented nature of this emotion. Five experiments reveal that when a person repairs the transgressor's damage caused to a victim, the transgressor's guilt feelings, reparative intentions, and prosocial behaviour decrease. These findings suggest that it is not the relationship with the victim that is important in the regulation of guilt feelings, but rather the reparative actions that have been undertaken. Implications for theory and behavioural research on guilt are discussed.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Health Anxiety in Children: Development and Psychometric Properties of the Childhood Illness Attitude Scales

The course of severe anxiety surrounding health issues is unknown. The available literature suggests that adults who are overly anxious about health issues often interpret or misinterpret their bodily signs and symptoms to be indicative of a serious illness. The construct of health anxiety has not been examined in children and, to date, there has not been an instrument developed for this purpose. The Illness Attitude Scales is one of the most commonly used instruments for evaluating fears, beliefs, and attitudes that are associated with hypochondriasis and abnormal illness behaviour in adults. We sought to adapt the Illness Attitude Scales for use with children ages 8–15 years. The adapted Illness Attitude Scales was renamed the Childhood Illness Attitude Scales. Revisions to the adult version consisted of simplification of language, revision of Likert scale (i.e. 5-point to 3-point scale), and the addition of 7 questions to evaluate the role parents/guardians play in facilitating medical attention or treatment. Correlations between Childhood Illness Attitude Scales total scores and other self-report measures were supportive of the construct-related validity of the Childhood Illness Attitude Scales and suggested that it is a useful measure of health anxiety in school-age children. Practical and theoretical implications of the present results are discussed.     

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.     

Developments in child psychotherapy in Australia: an introduction

This article describes a type of intervention with parents that attempts to stimulate and encourage empathic imagination in relation to their child's difficult behaviour. Some barriers to this process are explored in the context of wider cultural influences, particularly as they pertain to the USA. Basic cultural assumptions about children, their emotional life and development, are contrasted to basic assumptions in British Object Relations Theory. Examples of parent consultations are offered and theoretical reference points are suggested.     

Experiences in running a staff group

This study examines an activating mechanism of aggressive behaviour in young children. Many studies on attachment theories have indicated disorganised attachment as a significant risk factor for externalising problems and have explained the aetiology of disorganised attachment in terms of deficits in affect, behaviour and cognitive functions from a traumatic or inconsistent environment. Via the moment-to-moment analysis of the play therapy process with a three-year-old, this paper attempts to identify how these emotional, behavioural and cognitive factors interact in actual situations and can lead to an observable behaviour: aggressive behaviour. The findings from this study indicate that the child with disorganised attachment was going through a dual process, one with her therapist and the other with her internalised caregivers. When anxiety and an ambiguous social cue from an unpredictable situation were added to the child's repetition of previous attachment experience, this ‘click’ lowered the threshold of regulation of affect, behaviour and cognition. The child turned to disorganised and aggressive behaviour, relying on her physiological signals regarding the perceived threat. Finally, this paper describes how these difficulties can be channelled by symbolic play via displacement and containment.     

Young children's ability to solve spatial problems involving a choice

When do young children become able to make an adequate choice between two alternatives based on spatial information? Children of 20, 30, and 40 months of age were either presented with two objects with different cross-sections and one aperture, or one object and two different apertures. In each trial there was one object – aperture match and the task was to find that match and insert the object. All the children understood the task and tried to solve the problems but the 20-month-olds performed randomly and not even the 40-month-olds chose all the correct correspondences consistently. The results also showed that it is easier to choose between apertures than objects. This contrasts with the ability to solve the insertion problem once the choice was made. When choosing the correct object or aperture, the 40-month-olds inserted the triangle successfully in 85% of the cases. The boys and girls were equally good at solving the task, but the boys did it faster. The results show that making a choice adds significantly to the difficulty of solving spatial problems. It requires systematic examination of the objects and apertures involved, a working memory that can handle at least three items at a time, and an ability to inhibit an incorrect choice. Such executive functions are typically found in older preschool children but the present task shows that with an appropriate setup their development can be traced from a much earlier age.