Opposite effects of anxiety and depressive symptoms on executive function: The case of selecting among competing options

People constantly face the need to choose one option from among many, such as when selecting words to express a thought. Selecting between many options can be difficult for anyone, and can feel overwhelming for individuals with elevated anxiety. The current study demonstrates that anxiety is associated with impaired selection across three different verbal tasks, and tests the specificity of this finding to anxiety. Anxiety and depression frequently co-occur; thus, it might be assumed that they would demonstrate similar associations with selection, although they also have distinct profiles of symptoms, neuroanatomy and neurochemistry. Here, we report for the first time that anxiety and depressive symptoms counter-intuitively have opposite effects on selection among competing options. Specifically, whereas anxiety symptoms are associated with impairments in verbal selection, depressive symptoms are associated with better selection performance. Implications for understanding the mechanisms of anxiety, depression and selection are discussed.     

What Counts as Behavior? The Molar Multiscale View

Because the definition of behavior changes as our understanding of behavior changes, giving a final definition is impossible. One can, however, rule out some possibilities and propose some others based on what we currently know. Behavior is not simply movement, but must be defined by its function. Also, our understanding of behavior must agree with evolutionary theory. I suggest 4 basic principles: (a) only whole organisms behave; (b) behavior is purposive; (c) behavior takes time; and (d) behavior is choice. Saying that parts of an organism behave is nonsense, and, moreover, evolutionary theory explains the existence of organisms mainly through their adaptive behavior. Behavior is purposive in that behavior is shaped by its consequences, through an organism''s lifetime or through interactions with the environment across many generations of natural selection. Behavior takes time in that behavior is interaction with the environment that cannot take place at a moment. Moreover, at a moment in time, one cannot definitely identify the function of behavior. Identification of an activity requires a span of time. Behavior is choice in the sense that a suitable span of time always includes time spent in more than 1 activity. Activities include parts that are themselves activities on a smaller time scale and compete for time. Thus, behavior constitutes time allocation. An accounting problem arises whenever any behavior is attributed to multiple consequences. In the molar multiscale view, this raises the question of whether 2 activities can occur at the same time. The question remains open.     

Neuropsychological impairments on the NEPSY-II among children with FASD

Background: We examined the pattern of neuropsychological impairments of children with FASD (compared to controls) on NEPSY-II measures of attention and executive functioning, language, memory, visuospatial processing, and social perception.

Methods: Participants included 32 children with FASD and 30 typically developing control children, ranging in age from 6 to 16 years. Children were tested on the following subtests of the NEPSY-II: Attention and Executive Functioning (animal sorting, auditory attention/response set, and inhibition), Language (comprehension of instructions and speeded naming), Memory (memory for names/delayed memory for names), Visual-Spatial Processing (arrows), and Social Perception (theory of mind). Groups were compared using MANOVA.

Results: Children with FASD were impaired relative to controls on the following subtests: animal sorting, response set, inhibition (naming and switching conditions), comprehension of instructions, speeded naming, and memory for names total and delayed, but group differences were not significant on auditory attention, inhibition (inhibition condition), arrows, and theory of mind. Among the FASD group, IQ scores were not correlated with performance on the NEPSY-II subtests, and there were no significant differences between those with and without comorbid ADHD.

Conclusions: The NEPSY-II is an effective and useful tool for measuring a variety of neuropsychological impairments among children with FASD. Children with FASD displayed a pattern of results with impairments (relative to controls) on measures of executive functioning (set shifting, concept formation, and inhibition), language, and memory, and relative strengths on measures of basic attention, visual spatial processing, and social perception.     

Extracorporeal Membrane Oxygenation versus Conventional Treatment: Neurodevelopmental and Social Outcomes at 24 Months

The purpose of this prospective, controlled study was to compare neurodevelopmental and social outcomes at 2 years of age for children treated with extracorporeal membrane oxygenation (ECMO; n = 25) to those of children with severe respiratory illness treated with conventional methods (CT; n = 16) and to matched, healthy full-term (FT; n = 29) children. Mothers' parenting attitudes and children's mental, motor, language, exploratory play, and social competence skills were assessed. A retrospective chart review was also undertaken to further describe the groups with respect to the results of neuroimaging, audiologic, and neuromotor examinations. The FT group had significantly higher mental, motor, and language scores as compared to the ECMO and CT groups. Groups did not differ on measures of behavior, social competence, exploratory play skills, or parental attitudes. Specifically for the ECMO group, there was a trend toward language being more problematic than other areas of development. In general, the data demonstrate that severe respiratory complications, regardless of type of treatment, place children at increased risk for neurodevelopmental difficulties.     

Cognitive deficits of executive functions and decision‐making in obsessive‐compulsive disorder

The nature of cognitive deficits in obsessive‐compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision‐making and response inhibition. The aim of this study was to investigate cognitive deficits in decision‐making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision‐making on a version of the Cambridge gambling task (CGT) and on the color‐word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision‐making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom‐dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.     

To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

PSYKOANALYTISKT ORIENTERAD PSYKOTERAPI

The increasing discourse of the concept of intersubjectivity in modern psychoanalysis has pushed the interest in the intrapsychic and its emphasis on drive and object into the background. Authors who wish to avoid a one-sided focus on intersubjectivity usually subscribe to a dual dimensional approach, taking both perspectives into account. In this article, the analytic situation is described not in two, but in three dimensions, the analytic function constituting a third dimension necessary for the interplay between the other two dimensions. Focusing on the analyst's position, the author presents a model that consists of (1) the-analyst-as-subject, (2) the-analyst-as-function, and (3) the-analyst-as-object. The analytic function is understood to be invested with a particular form of desire and it is argued that the asymmetry between this desire of the analyst and the desire of the analysand is a central characteristic of the analytic situation.     

The present and absent object—on thinking and the capacity to symbolize

In this paper, Bion's different theories on the development of thinking will be introduced: on the one hand, his theory of thoughts as resulting from tolerance for the absence of the object, and on the other hand, dream thoughts and thoughts as resulting from the presence of the object, originally through the mother's containing function. The effects of failures in this development will be discussed; among other things, a hypertrophy of the apparatus of projective identification at the expense of thinking capacities. Briefly, a comparison will be made between a facilitating relation between container and contained and the oscillation between the paranoid-schizoid and depressive position, which Bion describes as a prerequisite for open symbolizing processes. Bion's theories and concepts will be supplemented by Winnicott's theories on the “creative illusion” and the breast/the mother as a “subjective object” as a precondition for the symbolizing capacity that later develops in the “potential space”. Very briefly, a comparison is made between Winnicott's term “the subjective object” and Segal's term “symbolic equation”. Clinical vignettes are interpolated.