Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Three-month-olds' visual preference for faces and its underlying visual processing mechanisms

This study was aimed at investigating the face preference phenomenon and its underlying mechanisms at 3 months of age. Using an eye-tracker apparatus, Experiment 1 demonstrated that 3-month-olds prefer natural face images to unnatural ones, replicating and extending previous evidence obtained with schematic facelike stimuli. Experiments 2 and 3 showed that the general mechanisms that induce face preference in newborns could not explain the same phenomenon at 3 months of age, when infants are attracted by perceptual cues more specific to faces. This suggests that signs of a process of cognitive specialization are already present in 3-month-olds' visual behavior toward faces.     

What's in a name? Typicality and relatedness effects in children

We studied how category typicality and out-of-category relatedness affect speeded category verification (vote "yes" if pictured object is clothing) in typically developing 4- to 14-year-olds and adults. Stimuli were typical and atypical category objects (e.g., pants, glove) and related and unrelated out-of-category objects (e.g., necklace, soup). Typical and unrelated out-of-category objects exhibited preferential processing (faster reaction times and fewer errors). Variations in typicality and relatedness disproportionately influenced children's performance, with developmental improvement associated with both verbal and nonverbal factors. Underextension versus overextension errors seemed to be associated with independent factors, namely multifaceted maturational factors versus receptive vocabulary skill, respectively. Errors were infrequent, suggesting spontaneous taxonomic classification by all participants. An experiment with printed words in adults replicated results, indicating that typicality and relatedness effects reflected organizational principles of the semantic system, not picture-related processes. This research establishes the viability of an online approach to assessing automatic components of semantic organization in children.     

CAN RATIONAL-EMOTIVE BEHAVIOR THERAPY (REBT) AND ACCEPTANCE AND COMMITMENT THERAPY (ACT) RESOLVE THEIR DIFFERENCES AND BE INTEGRATED?

Rational-Emotive Behavior Therapy (REBT) is a pioneering form of Cognitive Behavior Therapy (CBT). Acceptance and Commitment Therapy (ACT) is part of the new wave of CBTs. In this article, I discuss the papers of Ciarrochi, Robb, and Godsell, and of Ciarrochi and Robb, who propose that REBT and ACT can be quite suitably integrated, and the paper of Steven Hayes, the originator of ACT and of Relational Frame Theory, who is skeptical about the feasibility of Ciarrochi, Robb, and Godsell’s proposals. My own view is that ACT and REBT significantly overlap in their theory and practice and that they can be successfully integrated if both therapies make some changes.     

Detached Mindfulness In Cognitive Therapy: A Metacognitive Analysis And Ten Techniques

This paper describes the nature and information processing requirements of detached mindfulness. The construct emerged from the self-regulatory information processing theory of emotional disorder (Wells & Matthews, 1994), and is viewed as a metacognitive state that facilitates change in core underlying pathological processes. Detached mindfulness has multiple components, requiring the activation of metacognitive knowledge, metacognitive monitoring and control, suspension of conceptual processing, attentional flexibility, and a de-centered relationship with thoughts. A model of the cognitive structures and processes supporting the state is presented. Implications of the model for the scientific development and effective use of mindfulness techniques are discussed. Ten techniques for rapidly achieving detached mindfulness in the course of metacognitive therapy are described.Address correspondence to Professor Adrian Wells, Academic Division of Clinical Psychology, The University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; e-mail: Adrian.Wells@manchester.ac.uk.     

The sensory‐cognition association in adulthood: Different magnitudes for processing speed,inhibition, episodic memory,and false memory?

One hundred and forty-six participants (age range = 20-80) completed a battery of tests designed to measure visual acuity, processing speed, inhibition, episodic memory and false memory. The relations between visual acuity and general cognitive ability, as well as between visual acuity and the indicators of this construct, were evaluated with structural equation modeling. The measurement model confirmed that the indicators of the individual cognitive abilities could be grouped into a general cognitive functioning factor. However, the relation between episodic and false memory was not completely explained by the shared association with this general factor. Furthermore, visual acuity predicted approximately half of the age-related variance in the general cognition factor. Also, the proportion of age-related variance shared with vision was highest in inhibition and lowest in false memory. The results are discussed in the light of common cause accounts of cognitive aging.     

Marginal maximum likelihood estimation for a psychometric model of discontinuous development

Item response theory models posit latent variables to account for regularities in students' performances on test items. Wilson's “Saltus” model extends the ideas of IRT to development that occurs in stages, where expected changes can be discontinuous, show different patterns for different types of items, or even exhibit reversals in probabilities of success on certain tasks. Examples include Piagetian stages of psychological development and Siegler's rule-based learning. This paper derives marginal maximum likelihood (MML) estimation equations for the structural parameters of the Saltus model and suggests a computing approximation based on the EM algorithm. For individual examinees, empirical Bayes probabilities of learning-stage are given, along with proficiency parameter estimates conditional on stage membership. The MML solution is illustrated with simulated data and an example from the domain of mixed number subtraction. The authors' names appear in alphabetical order. We would like to thank Karen Draney for computer programming, Kikumi Tatsuoka for allowing us to use the mixed-number subtraction data, and Eric Bradlow, Chan Dayton, Kikumi Tatsuoka, and four anonymous referees for helpful suggestions. The first author's work was supported by Contract No. N00014-88-K-0304, R&T 4421552, from the Cognitive Sciences Program, Cognitive and Neural Sciences Division, Office of Naval Research, and by the Program Research Planning Council of Educational Testing Service. The second author's work was supported by a National Academy of Education Spencer Fellowship and by a Junior Faculty Research Grant from the Committee on Research, University of California at Berkeley. A copy of the Saltus computer program can be obtained from the second author.     

Route-based travel and shared routes in sympatric spider and woolly monkeys: cognitive and evolutionary implications

Many wild primates occupy large home ranges and travel long distances each day. Navigating these ranges to find sufficient food presents a substantial cognitive challenge, but we are still far from understanding either how primates represent spatial information mentally or how they use this information to navigate under natural conditions. In the course of a long-term socioecological study, we investigated and compared the travel paths of sympatric spider monkeys (Ateles belzebuth) and woolly monkeys (Lagothrix poeppigii) in Amazonian Ecuador. During several field seasons spanning an 8-year period, we followed focal individuals or groups of both species continuously for periods of multiple days and mapped their travel paths in detail. We found that both primates typically traveled through their home ranges following repeatedly used paths, or “routes”. Many of these routes were common to both species and were stable across study years. Several important routes appeared to be associated with distinct topographic features (e.g., ridgetops), which may constitute easily recognized landmarks useful for spatial navigation. The majority of all location records for both species fell along or near identified routes, as did most of the trees used for fruit feeding. Our results provide strong support for the idea that both woolly and spider monkey use route-based mental maps similar to those proposed by Poucet (Psychol Rev 100:163–182, 1993). We suggest that rather than remembering the specific locations of thousands of individual feeding trees and their phenological schedules, spider and woolly monkeys could nonetheless forage efficiently by committing to memory a series of route segments that, when followed, bring them into contact with many potential feeding sources for monitoring or visitation. Furthermore, because swallowed and defecated seeds are deposited in greater frequency along routes, the repeated use of particular travel paths over generations could profoundly influence the structure and composition of tropical forests, raising the intriguing possibility that these and other primate frugivores are active participants in constructing their own ecological niches. Building upon the insights of Byrne (Q J Exp Psychol 31:147–154, 1979, Normality and pathology in cognitive functions. Academic, London, pp 239–264, 1982) and Milton (The foraging strategy of howler monkeys: a study in primate economics. Columbia University Press, New York, 1980, On the move: how and why animals travel in groups. University of Chicago Press, Chicago, pp 375–417, 2000), our results highlight the likely general importance of route-based travel in the memory and foraging strategies of nonhuman primates.

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This contribution is part of the Special Issue “A Socioecological Perspective on Primate Cognition” (Cunningham and Janson 2007).     

Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: a controlled study contrasting methods focusing on the present and methods focusing on childhood memories

This study tested the hypothesis that treatment of childhood memories is an effective way to change personality disorder related schemas and psychopathology in cognitive therapy for personality disorders. To test this hypothesis, a crossover design was used to compare the effectiveness of methods focusing on the present and methods focusing on childhood memories. After the exploration period, the therapist focused either first on the present during 24 sessions and than for 24 sessions on childhood memories, or followed the reverse order. Twenty-one patients with one or more Axis II disorders were included. Participants were randomly assigned to order of focus. Results indicate that CT methods focusing on childhood memories produce good outcomes, comparable to those of methods focusing on the present. There was no significant effect of order, but both patients and therapists preferred the past-present order. Total effects of the package were large and were maintained till one-year follow-up (d's 0.97-1.90). Experience of the therapist with CT for personality disorders was related to better outcome (d=0.73).