Visual-Verbal Self/Other-Referential Processing Task: Direct vs. indirect assessment, valence, and experiential correlates

This study evaluated a new methodology for assessing valenced Self-Referential Processing (SRP) in comparison with Other-Referential Processing (ORP). Participants viewed pictures of themselves during certain trials and same-gender strangers during others, intermixed between valenced words. Participants internally-rehearsed the words “I am” or “He/she is” when presented with the respective pictures and read the valenced words, thereby associating the self/other with positivity/negativity on different trials. Participants self-monitored their affective response, and their degree of attention and/or rate of internal speech/reading speed was measured indirectly via button-press response time (RT). Results in 91 young adults demonstrated a self-positivity bias in survey ratings, stronger affective responses during SRP than ORP, slower RT during SRP than ORP, and slower RT during positive than negative valence. Difference scores between SRP of negative- vs. positive-valence trials, and between SRP vs. ORP of negative-valence trials, were correlated among survey ratings, affective responses, and RT. Finally, content analyses of phenomenological reports showed that task conditions differentially provoked a number of socioemotional experiences during both SRP and ORP (e.g., jealousy-envy, sympathy-pity, good will/pride). We discuss potential applications of the task in the study of personality and individual differences.     

Perceived causal relations: novel methodology for assessing client attributions about causal associations between variables including symptoms and functional impairment

Researchers have argued that the investigation of causal interrelationships between symptoms may help explain the high comorbidity rate between certain psychiatric disorders. Clients' own attributions concerning the causal interrelationships linking the co-occurrence of their symptoms represent data that may inform their clinical case conceptualization, treatment, and psychological theory regarding the etiology of comorbid disorders. The present study developed and evaluated a novel psychological assessment methodology for measuring Perceived Causal Relations (PCR) and examined its psychometric properties as applied to the question of whether posttraumatic stress and anxiety symptoms represent causal risk factors for depressive symptoms in 225 undergraduates. Participants attributed their symptoms of anxiety and posttraumatic reexperiencing as significant causes of their depressive symptoms. Exploratory analyses identified a listing of symptoms reliably attributed as significant causes of other symptoms and functional impairment, as well as a listing of symptoms reliably attributed as significant effects (outcomes) of other symptoms and functional impairment. The PCR method has promise as an idiographic approach to assessing the causes and consequences of comorbid psychiatric symptoms and associated functional impairment. Research is required to assess the relevance and replicate these findings in distinct psychiatric groups experiencing various symptomatic presentations. Future research may also examine PCR ratings associating other individual differences, for example, between measures of history (e.g., life events), life choices, and personality.     

Recognition and Interpretation of Facial Expressions in Dysphoric Women

Two studies are presented that evaluate emotion recognition accuracy and interpretative processing of facial expressions in relation to depressive symptoms in women. Dysphoric women more often attributed themselves as the cause of negative expressions, more often made negative interpretations of others’ thoughts, and had more negative thoughts about themselves when viewing facial expressions. However, dysphoric women were not less accurate or rapid in recognizing facial expressions. An integrative model, the “levels of self-processing view,” is discussed as a synthesis of the results across studies. Limitations of the current studies and future research directions are discussed.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

Evaluation of the evidence for the trauma and fantasy models of dissociation

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.