Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy

Excessive fear and avoidance in relatively safe situations can lead to a narrowing of one's behavioral repertoire and less engagement with valued aspects of living. Ultimately, these processes can reach clinical levels, as seen in anxiety, trauma, and obsessive–compulsive disorders. Research on the basic behavioral processes underlying successful treatment with exposure therapy is growing, yet little is known about the mechanisms contributing to clinical relapse. Until recently, these mechanisms have largely been conceptualized in terms of Pavlovian return of fear, with relatively little research into operant processes. In the current paper, we briefly review translational research in anxiety disorders and the connections between fear and avoidance, focusing on recent work in the acquisition, extinction, and relapse of avoidance behavior and the generalization of this learning through arbitrary symbolic relations. We then introduce one possible treatment approach to mitigating clinical relapse, acceptance and commitment therapy (ACT), and provide a conceptual analysis for why ACT may be especially well-situated to address this issue. Finally, we end with potential directions for future research on treatment and relapse of anxiety disorders.     

夜间进食综合征的研究进展

夜间进食综合征是一种表现为早晨没有食欲、晚饭后过量进食或夜间醒来进食的饮食障碍,并且与睡眠问题相关。在国内外文献进行分析研究的基础上,本文先后介绍了夜食症的概念内涵、发病的生理神经机制及主要的干预措施和治疗手段,并对现有研究的不足进行总结,提出了未来研究的方向,旨在为研究者在此领域的进一步探索提供参考。     

Organisational interventions to improve employees' health and wellbeing: A realist synthesis

Although organisational interventions have shown promising results in improving employees' health and wellbeing, reviews of the effectiveness of such interventions conclude results are inconsistent. Realist synthesis is considered an appropriate method of literature review to improve the consistency of empirical evidence by developing generalisable statements of ‘what works for whom in which circumstances’. In this article, to identify and synthesise existing evidence from the empirical studies of organisational interventions, we conducted a realist synthesis according to the RAMESES publication standards. We reviewed 28 articles. Six realist programme theories were developed that explain how different mechanisms of organisational interventions may bring about different outcomes in different contexts. These realist programme theories are based on the process mechanisms of implementation adherence, communication, employees' participation, senior management support, middle management support and external consultants/researchers support. This realist synthesis enhances the understanding of how organisational interventions may improve employees' health and wellbeing, in which contexts, and for which group of employees. As such, it makes an important potential contribution to designing, implementing and evaluating future organisational interventions.     

The same but different: an empirical investigation of the reducibility principle

According to classical utility theory the valuation of any lottery should depend only on its outcomes and their respective probabilities, and should not be affected by the nature, complexity and structure of the chance mechanism. Previous research has documented systematic violations of this principle. For example, most subjects prefer lotteries in which the payoffs are contingent on the joint occurrence of multiple (high probability) events to simple lotteries, and lotteries in which the earlier stages offer higher probabilities than the later stages. We review the various violations of this principle and suggest a classification into two major types associated with misunderstanding of chance mechanisms and attitude towards the chance mechanism and process. In the present study 40 subjects were presented with 30 pairs of binary gambles. In any given pair the lotteries had identical outcomes and equal ‘reduced’ probabilities (and thus equal expected values). However, the chance mechanisms varied along a variety of factors such as the size of the sample space, the number of stages, temporal ordering, order of probabilities, their transparency and time constraints. Half the subjects saw lotteries involving gains and the other half considered only losses. After choosing one lottery in each pair, the subjects were asked to explain and justify their choices. The findings revealed systematic violations of the reducibility principle: subjects displayed a preference for lotteries with larger sample spaces, and for lotteries that allow quicker resolutions in the earlier stages. A clear distinction between some patterns of preferences in the gains and loss domains was revealed. In gambles involving gains subjects preferred to have the highest probability on the first stage (and the lowest probability on the last stage), but displayed the opposite preferences for losses. A content analysis of the subjects' stated reasons for their choices identified eight major categories. The most frequently invoked were hope, fun, simplicity, stress and time. Copyright © 2001 John Wiley & Sons, Ltd.     

事件性前瞻记忆的加工机制：来自ERP的证据

采用事件相关电位技术,对前瞻记忆的加工机制——主要是执行前的加工机制进行研究。控制条件为单纯的背景任务,实验条件为背景任务含前瞻记忆任务,对两种条件下非靶线索的行为数据进行比较,结果表明实验条件下被试的反应时显著长于控制条件,可能说明两种条件的认知过程存在差异,这种差异在ERPs上主要体现为刺激呈现200ms以后,两种条件的波形和脑地形图存在显著差异。结果支持预备注意加工和记忆加工理论,也部分支持多重加工理论     

内-外倾人格对情绪调节的影响及神经机制

内—外倾人格(即外倾性)是与情绪活动密切相关的人格特质：该特质不但影响人类的适应能力与主观幸福感，还与焦虑、冲动等情绪—行为障碍的产生有密切关联。在以往研究中，外倾性与情绪健康的关系集中体现为内—外倾人格对情绪事件易感性的影响，如外倾人格得分的增高伴随着对奖赏刺激更强的积极情绪反应水平。然而，上述联系也有可能是由于外倾性不同的人群具有不同的情绪调节特点导致。因此，可通过系统操纵外倾性人格因素与情绪调节方式，从外倾性人格特质对情绪调节方式及调节效果影响的角度，深入探讨外倾性和人类情绪与健康的关系。拟综合使用行为调查与生理测量、EEG/ERP 与 fMRI 手段，开展如下三个层面的研究工作：1)情绪调节问卷的编制及内、外倾人群情绪调节策略的比较研究；2)外倾性对情绪调节的影响及其脑机制研究，探讨认知情绪调节的生理变化、时间进程及神经基础与内—外倾人格的关系；3)情绪稳定性不同的内、外倾人群其情绪调节的特点及其脑机制研究。通过上述系列研究，深化对情绪与人格关系的认识，从而为心理健康的维护，情绪障碍的治疗及相关疗法的开发应用奠定理论基础。     

Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness‐based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of “mechanisms of change.” Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client‐therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.     

The Interplay of Cross‐Situational Word Learning and Sentence‐Level Constraints

A variety of mechanisms contribute to word learning. Learners can track co‐occurring words and referents across situations in a bottom‐up manner (cross‐situational word learning, CSWL). Equally, they can exploit sentential contexts, relying on top–down information such as verb–argument relations and world knowledge, offering immediate constraints on meaning (word learning based on sentence‐level constraints, SLCL). When combined, CSWL and SLCL potentially modulate each other's influence, revealing how word learners deal with multiple mechanisms simultaneously: Do they use all mechanisms? Prefer one? Is their strategy context dependent? Three experiments conducted with adult learners reveal that learners prioritize SLCL over CSWL. CSWL is applied in addition to SLCL only if SLCL is not perfectly disambiguating, thereby complementing or competing with it. These studies demonstrate the importance of investigating word‐learning mechanisms simultaneously, revealing important characteristics of their interaction in more naturalistic learning environments.