Do eating disorder voice characteristics predict treatment outcomes in anorexia nervosa? A pilot study

Individuals with anorexia nervosa often describe experiencing an internal “voice” of their disorder, which previous research has associated with multiple dimensions of eating pathology. This pilot study examined whether eating disorder measures use invoice characteristics at the outset of outpatient therapy predicted changes in disordered eating over the course of treatment. Participants were 14 individuals meeting ICD-10 criteria for anorexia nervosa. Participants completed measures relating to the severity of disordered eating and voice-related characteristics (perceived voice power and metacognitive appraisals about its nature) at the start and end of therapy. Results indicated that the perceived power of the eating disorder was reduced over the course of outpatient therapy, although its other characteristics remained stable. Greater levels of voice power, omnipotence and benevolence at the outset of therapy were related to greater improvements in eating attitudes. No voice-related characteristics were associated with changes in weight. These findings suggest that voice-related appraisals do not obstruct the effectiveness of outpatient therapies for anorexia nervosa. Further studies are needed to ratify these preliminary findings.     

Relationships between health behaviors,posttraumatic stress disorder,and comorbid general anxiety and depression

Poor health outcomes associated with posttraumatic stress disorder (PTSD) may reflect engagement in unhealthy behaviors that increase morbidity risk and disengagement in healthy behaviors that decrease morbidity risk. Although research supports this pattern, findings are not definitive, particularly for healthy behaviors. Many studies have not controlled for effects of concurrent generalized anxiety and depression, which might explain conflicting findings. To address this limitation, we used an online cross-sectional research design and multivariate multilevel modelling to evaluate associations between a multitude of health behaviors (i.e. sedentary behavior, sleep quality, physical activity, eating habits, alcohol use and substance use) and PTSD, while adjusting for comorbid generalized anxiety and depression, in a sample of trauma-exposed individuals (N = 246). Our results indicate that PTSD and comorbid generalized anxiety and depression symptoms were differentially associated with specific health constructs. Specifically, sedentary behavior and poor sleep quality were associated with PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with depression. Both increased alcohol and substance use were associated with generalized anxiety. Results from our study highlight the need to conceptualize associations between health behaviors and specific psychological symptoms in a comprehensive manner as part of clinical presentations of PTSD.     

Relationships between psychoevolutionary fear of evaluation,cognitive distortions,and social anxiety symptoms: A preliminary structural equation model

Social anxiety disorder is a mental health condition that affects 4.7% of Australians each year. The complex interplay between psychoevolutionary and cognitive models has become the focus of research in recent years, particularly with the development of the bivalent fear of evaluation model (i.e., negative and positive evaluation fears). The present study aimed to test a model of social anxiety symptoms using structural equation modelling, integrating previously fragmented evidence. A sample of 255 participants (75.3% female; M_age = 31.9, SD = 10.3) undertook an online survey, including Social Phobia Scale, Brief Fear of Negative Evaluation—Straightforward, Fear of Positive Evaluation, Concerns of Social Reprisal, and Disqualifications of Positive Social Outcomes measures. The hypothesised model for social anxiety symptoms described the data reasonably well (χ²(1) = 4.917, p = .027, CFI = .995, GFI = .992, SRMR = .017), explaining 57.1% of social anxiety variance. Study hypotheses were supported with bivalent fear of evaluation accounting for unique variance in cognitive distortions, which in turn accounted for unique variation in social anxiety symptoms. Effect sizes indicate bivalent fears of evaluation and disqualification of positive social outcomes as important predictors of social anxiety symptoms. Although replication in a clinical cohort and experimental confirmation are needed, the findings suggest a focus on disqualification of positive social outcomes to alleviate social anxiety symptoms.     

Individuals Intolerant of Uncertainty: The Maintenance of Worry and Distress Despite Reduced Uncertainty

The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.     

Treatment of resistance to change in children with autism

“Resistance to change” represents a core symptom of autism that we conceptualized and assessed as resulting in part due to factors known to govern free‐operant choice. During a free‐choice baseline, participants chose between problematic, resistive responses and an appropriate alternative response. During the asymmetrical‐choice condition, we delivered their most highly preferred item if the participant chose the alternative response (i.e., differential reinforcement of alternative behavior [DRA]). During the guided‐ (Experiment 1) and singular‐ (Experiment 2) choice conditions, we prompted participants to choose the alternative response and then delivered their most highly preferred item (i.e., DRA with escape extinction). All participants learned to tolerate (Experiment 1) or choose (Experiment 2) the alternative response when we combined DRA with escape extinction. After exposure to escape extinction, two participants showed strong maintenance effects with DRA alone. We discuss these finding relative to the effects of DRA and escape extinction on resistance to change.     

Behavioral assessment of auditory processing deficits in schizophrenia: Literature review and suggestions for future research

During the last decades, a considerable number of studies about auditory processing deficits in schizophrenia have been published, some of them using the term of Auditory Processing Disorder (APD). Due to heterogeneous methodology and inconsistent results concrete conclusions may not be straightforward. We focused on studies that used at least one behavioral test for the assessment of auditory processing in schizophrenia, in order to identify new evidence on auditory processing deficits in schizophrenia, and to consider fields for future research. 28 studies met inclusion criteria and are presented in this review. The articles were divided into three groups, those that implemented a test battery approach, those that used only Dichotic Listening (DL), those that used DL along with imaging or electrophysiology techniques. Most of the studies that implemented a test battery showed significant performance differences between patients and controls. This indicates APD presence. Due to the limited number of studies implementing a test battery, this is not conclusive. The majority of all studies that used a DL task showed that patients' performance or laterality was significantly lower than that of controls. Age, duration of illness, total and specific positive symptoms seem to affect significantly DL performance and auditory laterality. The results support the existence of various schizophrenia subgroups that differ in their auditory processing performance, and also have structural and functional specificities. Further research in the field is needed, especially studies that implement a test battery, and studies that examine possible correlations between clinical variables and auditory processing deficits.     

Something torn or burst or unbearable: a psychoanalytically-informed exploration of the experience of somatic symptoms

Experiences of and responses to bodily symptoms have long held interest, from earlier roots in hysteria to the most recent category of somatic symptom disorder (SSD) in DSM 5. SSD’s focus on distress implies that symptoms hold meaning for individuals. This study used a psychoanalytically-informed, multiple interview method and analysis to explore such possible meanings. Six participants were interviewed on three occasions each, with four themes emerging as follows: (1) a foreign body in charge; (2) left alone with the foreign body; (3) the body works for the mind; and (4) the body mirrors the mind. Bion’s idea of an active container-contained function and the construct of psychic pain formed a useful framework for understanding themes. The distress that lies in somatic symptoms was formulated as potentially stemming from an initial difficulty with containment in the primary object relationship. It is argued that distress may indicate a struggle with suffering that is not only somatic but also psychological in nature; and that the symptomatic body may have reached its limits in containing psychic pain. Implications for working clinically include the importance of close and sustained attention, through the clinician’s reverie, to somatic and emotional feeling states to help guide treatment.     

The mediating role of joint attention in the relationship between motor skills and receptive and expressive language in siblings at risk for autism spectrum disorder

Language problems are highly prevalent in younger siblings of children with autism spectrum disorder (HR-sibs), yet little is known about early predictors. There is growing evidence that motor and language development are linked and this connection might be mediated by joint attention. Developmental changes in motor abilities change how children interact with objects and people (e.g., by showing), which may influence language development. This association has however not yet been studied in HR-sibs. The interrelationship between motor, joint attention and language skills was explored in younger siblings of typically developing children (LR-sibs, N = 31) and HR-sibs (N = 32). In both groups, motor skills (composite of fine and gross motor skills) at 10 months influenced receptive and expressive language at 36 months directly and indirectly through joint attention at 14 months. Group status moderated this direct and indirect effect with mainly significant effects in HR-sibs. This indicates that lower motor skills can have cascading effects on joint attention and language in HR-sibs. Consequently, assessment of early motor skills in HR-sibs might hold promise for early identification of motor difficulties but can also be indicative of language difficulties later in life, especially when difficulties with joint attention are also present.