Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Group therapy for pathological gamblers: a cognitive approach

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.     

Does 'mental kinesiophobia' exist?

In this study the relevance of the concept of mental kinesiophobia (respectively cogniphobia or fear of mental exertion) for clients with chronic stress problems was explored. It was hypothesized that cognitive, chronic stress complaints, such as concentration problems or decreased problem solving abilities, could be catastrophized as signs of heightened personal vulnerability, with a chance of becoming permanent. As a consequence, mental exertion is avoided. This line of reasoning comes from the existing concept of kinesiophobia. This concept describes the avoidance behavior in chronic benign pain patients and refers to their fear of inflicting irreversible bodily damage due to physical exertion.An illustrative case of cogniphobia is presented. In an explorative pilot-study it was demonstrated that chronically stressed clients scored significantly higher on an experimental questionnaire measuring avoidance tendencies for mental exertion, compared with actively working employees. Consequences for treatment and suggestions for further study are discussed.     

Learning about life and death in early childhood

have argued that young children initially understand biological phenomena in terms of vitalism, a mode of construal in which "life" or "life-force" is the central causal-explanatory concept. This study investigated the development of vitalistic reasoning in young children's concepts of life, the human body and death. Sixty preschool children between the ages of 3 years, 7 months and 5 years, 11 months participated. All children were initially given structured interviews to assess their knowledge of (1) human body function and (2) death. From this sample 40 children in the Training group were taught about the human body and how it functions to maintain life. The Control group (n=20) received no training. All 60 children were subsequently reassessed on their knowledge of human body function and death. Results from the initial interviews indicated that young children who spontaneously appealed to vitalistic concepts in reasoning about human body functioning were also more sophisticated in their understanding of death. Results from the posttraining interviews showed that children readily learned to adopt a vitalistic approach to human body functioning, and that this learning coincided with significant development in their understanding of human body function, and of death. The overall pattern of results supports the claim that the acquisition of a vitalistic causal-explanatory framework serves to structure children's concepts and facilitates learning in the domain of biology.     

What response times tell of children's behavior on the balance scale task

Analysis of accuracy of responses to balance scale problems gives a global idea of the cognitive processes that underlie problem-solving behavior on this task. We show that response times (RTs) provide additional detailed information about the kind and duration of these processes. We derive predictions about the RTs from Siegler's (1981) model for the balance scale task, including the counterintuitive prediction that young adults are slower than children in solving particular balance scale problems. The predictions were tested in a study in which 191 6- to 22-year-old participants were presented with a computerized balance scale task. RTs were analyzed with regression models. In addition to qualitative differences between items, we also modeled quantitative differences between items in the regression models. Analyses supported the predictions and provided additional knowledge on the rules. Rule II was reformulated as a rule that always involves the encoding, but not always the correct application of the distance cue. RTs provided evidence for the use of a buggy-rule and not an addition-rule. Finally, a relation between rule inconsistency and increased RT was found.     

Confidence judgments in event recall: developmental progression in the impact of question format

Two studies were conducted to examine developmental progression in children's and adults' ability to adequately monitor their own attempts to recall event details as well as the dependence of such metamemorial competencies on question formats. Eight and 10-year-old children as well as adults (Study 1, N=116; Study 2, N=60) rated their confidence when responding to specific questions about an observed event. Confirming most recent results, children and adults gave higher confidence ratings after correct than after incorrect answers. This ability, however, was limited to an unbiased question format. When being asked misleading questions, children's ability to differentiate was undermined, as reflected in equally high confidence judgments after correct and incorrect answers, even when the interview contained a mix of misleading and unbiased questions. When the interviewer "bombarded" the children with an uninterrupted series of misleading questions, children's difficulties appeared to be even more pronounced. These findings highlight the importance of the way in which questions are asked, and point to age-related progression in the relative impact of questioning style.     

Bertrand Russell in His Nineties: Aging and the Problem of Biography

Bertrand Russell, one of the twentieth century's leading philosophers, lived to be ninety-eight, spending his last decade as a vigorous and often unpopular political activist. His generally sympathetic biographers tend to view this last decade through the prism of senility, but the only justification for this judgment would appear to be the objective fact of Russell's age. Almost identical behaviors from his younger years are never attributed to mental shortcomings. The treatment of Russell suggests that biographers are susceptible to powerful, distorting, and fictive predispositions as they shape their subjects' later years.     

Predicting face similarity judgements with a computational model of face space

Current models of face representation involve the notion of a high-dimensional face space. Computational models of face space based on principal components analysis (PCA) have been successfully used to predict human judgements of face sex or race. In this work the capability of PCA-based face spaces to predict human judgements of face similarity is examined. Three different paradigms were used. In Experiment 1 subjects learned face-name associations for 18 faces and identified these faces on tachistoscopic presentation. The number of confusions was used as a measure of face similarity. In Experiment 2 the same subjects subjectively rated the similarity of all 153 possible face pairs. In Experiment 3 reaction time to identify a face in an odd-man-out task was measured as an index of face similarity. These empirical measures were correlated with distance of the faces in PCA-based spaces of different dimensionalities. For Experiments 1 and 2 these correlations were highest for one-or two-dimensional face spaces (r=−0.27 vs. −0.28). For Experiment 3 the correlation was highest for a space consisting of 13 dimensions (r=−0.51). Thus PCA-based spaces seem capable to predict human similarity judgements to some extent. Possible reasons for the differences in predictability between paradigms are discussed.     

Empathic-Cognitive Development in Students of Counseling

Empathy is both crucial to counseling and a desired outcome in higher education. Since the 1960s, many studies have examined the relationship between stages of adult cognitive development and level of empathy, particularly in counselors. Though positive, findings related to this critical research focus have been grounded in small, local samples, leading several investigators to call for a replication using a large, national sample. In response, this study surveyed 340 graduate student members of a large professional counseling association across the United States. Results indicated that more mature forms of thought (according to the Perry scheme) are associated with higher empathy levels (Hogan scale). Implications are drawn for adult development theory, education of counselors, and higher education reform.     

Why? Versus Why Not?: Potentialities of Aging in Shaw's Back to Methuselah

Bernard Shaw's critique of society's sacred cows, as well as his participation in the social, cultural and political marketplace in which he lived, resemble the new historical/cultural materialism of contemporary theory. In Back to Methuselah, Shaw examines the notions of aging and illuminates the degree to which our chronological standards of old age are sociological not biological constructs. This tour de force on aging both dramatizes age as a function of societal and/or individual choice, not as a biological given, and juxtaposes opinions toward aging in such a way that flexible attitudes toward the subject emerge.