Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Modeling college women's perceptions of elite leadership positions with Social Cognitive Career Theory

The utility of Social Cognitive Career Theory (SCCT; Lent, Brown, & Hackett, 1994) for predicting college women's interests and goals for positions of elite leadership was examined with 156 undergraduate women at a public university. They completed measures of elite leadership self-efficacy expectations, outcome expectations, interests, and goals. Results supported SCCT as a theoretical framework for understanding internal factors that may contribute to women's elite leadership interests and goals. Self-efficacy and outcome expectations for elite leadership positions related positively to interests and goals for such positions, and self-efficacy and outcome expectations each contributed unique variance to the prediction of elite leadership interests. Outcome expectations partially mediated the relation between elite leadership self-efficacy and interests, interests partially mediated the relation between elite leadership outcome expectations and goals, and the combination of elite leadership interests and outcome expectations completely mediated the relation between self-efficacy for elite leadership positions and elite leadership goals.     

The effect of attention modification with explicit vs. minimal instructions on worry

In this experiment we investigated the effect of different instructions on the modification of attentional biases, and subsequently on worry persistence. Participants without excessive worry completed a modified dot-probe task, designed to train attention either to threat or neutral words. Half of each group was given explicit instructions regarding the relationship between word valence and target location, and half were given the more usual minimal instructions. Impact on worry persistence was assessed by categorizing the valence of thought intrusions before and after a period of instructed worry. Response latencies to test items on the dot-probe task showed that attention had been successfully manipulated in the expected direction, and explicit instructions led to more effective attention modification. Moreover, participants in the attend-threat group who received explicit instructions reported significantly more negative thought intrusions following instructed worry, as rated by an assessor, whereas participants in the attend-neutral group did not. These findings suggest that an attentional bias towards threatening information plays a role in worry persistence, and that explicit instructions may be helpful in modifying this bias.     

Bayesian parameter estimation in the Expectancy Valence model of the Iowa gambling task

The purpose of the popular Iowa gambling task is to study decision making deficits in clinical populations by mimicking real-life decision making in an experimental context. Busemeyer and Stout [Busemeyer, J. R., & Stout, J. C. (2002). A contribution of cognitive decision models to clinical assessment: Decomposing performance on the Bechara gambling task. Psychological Assessment, 14, 253-262] proposed an “Expectancy Valence” reinforcement learning model that estimates three latent components which are assumed to jointly determine choice behavior in the Iowa gambling task: weighing of wins versus losses, memory for past payoffs, and response consistency. In this article we explore the statistical properties of the Expectancy Valence model. We first demonstrate the difficulty of applying the model on the level of a single participant, we then propose and implement a Bayesian hierarchical estimation procedure to coherently combine information from different participants, and we finally apply the Bayesian estimation procedure to data from an experiment designed to provide a test of specific influence.     

Religion is natural, atheism is not: On why everybody is both right and wrong

After discussing evidence of irreligion and the rise of the so called “New Atheism”, the authors refute the claim that this poses a problem for the cognitive science of religion and its hypothesis that religion is natural. The “naturalness hypothesis” is not deterministic but probabilistic and thus leaves room for atheism. This, the authors maintain, is true of both the by-product and adaptationist stances within the cognitive science of religion. In this context the authors also discuss the memetic or “unnaturalness” hypothesis, i.e. that religion is a “virus of the mind”. The authors criticize accounts of atheism offered by cognitive scientists of religion as being based on unfounded assumptions about the psychology of atheists, and object to the notion that the natural aspects of religion by corollary make atheism unnatural. By considering human cognition in a semiotic framework and emphasizing its natural ability to take part in semiotic systems of signs, atheism emerges as a natural, cognitive strategy. The authors argue that to reach a fuller account of religion, the cognitive (naturalness) and memetic (unnaturalness) hypotheses of religion must be merged. Finally, a preliminary analysis of the “New Atheism” is offered in terms of semiotic and cognitive dynamics.     

Attributions for Memory Performance in Adulthood: Age Differences and Mediation Effects

We examined age differences in attributions to internal (controllable and uncontrollable), external (uncontrollable), and unstable factors for performance on a free recall memory task in 149 young, middle-aged, and older adults. Attributions varied by age and by level of memory performance. Middle-aged and older adults rated internal, uncontrollable factors (ability and genes) as more influential for high performance than for low performance, and they were less likely than young adults to attribute low performance to these factors. Within age groups, only the older adults rated memory ability as more influential than strategy use, even though they were as likely as the other age groups to use a categorization strategy. Attributions to both internal controllable (strategy use) and uncontrollable (ability) factors as well as to health were associated with better memory performance. These attributions partially mediated the relationship between age and memory performance. Thus, attributions may provide some insight into sources of age differences in memory performance.     

Reaction time measures in deception research: Comparing the effects of irrelevant and relevant stimulus–response compatibility

Evidence regarding the validity of reaction time (RT) measures in deception research is mixed. One possible reason for this inconsistency is that structurally different RT paradigms have been used. The aim of this study was to experimentally investigate whether structural differences between RT tasks are related to how effective those tasks are for capturing deception. We achieved this aim by comparing the effectiveness of relevant and irrelevant stimulus–response compatibility (SRC) tasks. We also investigated whether an intended but not yet completed mock crime could be assessed with both tasks. Results showed (1) a larger compatibility effect in the relevant SRC task compared to the irrelevant SRC task, (2) for both the completed and the intended crime. These results were replicated in a second experiment in which a semantic feature (instead of color) was used as critical response feature in the irrelevant SRC task. The findings support the idea that a structural analysis of deception tasks helps to identify RT measures that produce robust group effects, and that strong compatibility effects for both enacted crimes as well as merely intended crimes can be found with RT measures that are based on the manipulation of relevant SRC.     

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.     

Adolescent intelligence and socio-economic wealth independently predict adult marital and reproductive behavior

Counter-intuitively, sociobiological and evolutionary theories predict a negative relationship between g and reproduction when applied to modern humans. Although existing research has documented this dysgenic trend, the association between g and socio-economic factors presents a confound that has not systematically been addressed in prior research. Based on a sample of 325,252 individuals drawn from the nationally representative Project Talent database, we examined the unique effects of g and socio-economic wealth, assessed in adolescence, on marital and reproductive behavior over the next 11 years. Results show that both g and socio-economic wealth have unique, independent negative effects on marital and reproductive behavior such that individuals of higher intelligence and higher wealth delay marriage and reproductive longer than those of lower intelligence and wealth. The effect of g was slightly stronger than that of wealth, though for both variables much of their influence was mediated by educational attainment. Consistent with sociobiological theory, these dysgenic effects were stronger among females than males.