Group CBT for early psychosis--are there still benefits one year later?

Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.     

The role of inferences in children's comprehension of pronouns

Several researchers have suggested that children have difficulty in drawing inferences to understand prose and, although inferences have been shown to be important in the reference decisions of adults there have been very few studies that have specifically investigated children's use of them in reference assignments. The results of the three sentence comprehension studies reported here suggest that some children are able to draw the relevant inferences to assign reference. But many children appear to use an order-of-mention strategy which biases them towards the first-mentioned noun phrase. This strategy seems to be adopted even when children are aware that the resulting pronoun assignment conflicts with their inferences. Children in the third study appear to be able to use local selectional information to reject a noun phrase chosen by their order-of-mention strategy but, at least at the youngest ages (4.5 years), children do not use the information provided by the whole sentence. These results are seen as yet another example of the lack of comprehension monitoring in young children.     

Inference and children's comprehension of pronouns

Two experiments are reported that investigate the ability of 5 year olds to determine the reference of anaphoric pronouns. The first study shows that children have problems coping with more than one pronoun in a sentence and if they have to draw an inference to define the reference of a pronoun. The second study shows that the difficulty in assigning reference is not due to children merely forgetting the premise information but is due to the difficulty of carrying out the inference. There is an indication in the second study that some of the children may be using a syntactically oriented rule (that the pronoun should be assigned to a noun phrase that has a parallel function in the previous sentence), and that they are not drawing the appropriate inferences.     

Information processing and aspects of visual attention in children with the DSM-III-R diagnosis “pervasive developmental disorder not otherwise specified” (PDDNOS): II. sustained attention

A group of 15 nonhyperactive children of normal intelligence with the DSM-III-R diagnosis “pervasive developmental disorder not otherwise specified” (PDDNOS) performed a sustained attention task. Adopting a cognitive-energetical linear stage model of human information processing, we investigated whether task performances deteriorated due to a diminishing level of arousal, activation, or by the active ‘effortful’ mode of information processing. In comparison to an age-matched group of normal children, the patients showed no sharper decrease in perceptual sensitivity (d'). D' is assumed to be a measure of arousal. However, the children with PDDNOS exhibited large fluctuations in their response bias beta (β), which is assumed to be a measure of activation. During the first part of the task, they shifted between under- and overestimating negative responses. In the latter part of the task this pattern altered to significantly overestimating the number of negative responses. This indicates that the patients were not able to appropriately tune to the task-inherent response probability. Moreover, as compared to the control children, the patients showed a significantly sharper decrease in hit rate with time on task, despite the fact that feedback was given on the errors. The findings are interpreted as an increasing loss of the ability to control the response bias due to difficulties in maintaining the voluntary effortful mode of processing information with prolonged time on task.     

Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale?

Schizophrenia is a severe and disabling disorder with considerable psychological, social and economic costs. Over the last 15 years there has been a significant development in the use of cognitive behaviour therapy for psychosis (CBTp) in the treatment of schizophrenia, with 20 randomised controlled trials having been published. The majority of this work has been with alleviating medication resistant symptoms in chronic patients, but preliminary work has also been carried out with speeding recovery in acute schizophrenia and in relapse prevention and early intervention. A review of these studies indicates modest effect sizes, with the strongest evidence available for chronic patients. There is evidence that the effect size of the trials is significantly and negatively correlated to their methodological quality. We conclude cautiously that overall there is good evidence for the efficacy and effectiveness of CBTp in the treatment of schizophrenia.     

Modification of performance on the Span of Apprehension Task in a group of young people with early onset psychosis

The aim of the study was to examine the effect of contingent monetary reinforcement and enhanced instructions on Span of Apprehension (SPAN) performance in a group of young people with early onset psychosis. Twenty-five participants (mean age 16.7) received a 3- and 12-letter version of the SPAN task six times: baseline, three x intervention, post-test, and 10-day follow-up. No significant effects of time were found in the 3-letter condition, indicating a ceiling effect for accuracy. In the 12-letter condition detection rates improved significantly reaching a maximum at the third intervention (p < 0.001). Performance showed a temporary decline at post-test, but performance returned to the maximum level at the 10-day follow-up. The study suggests that SPAN performance can be improved in young people with early onset psychosis using relatively simple interventions and that performance gains are relatively durable.     

Research priorities for the COVID-19 pandemic and beyond: A call to action for psychological science

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that has caused the coronavirus disease 2019 (COVID-19) pandemic represents the greatest international biopsychosocial emergency the world has faced for a century, and psychological science has an integral role to offer in helping societies recover. The aim of this paper is to set out the shorter- and longer-term priorities for research in psychological science that will (a) frame the breadth and scope of potential contributions from across the discipline; (b) enable researchers to focus their resources on gaps in knowledge; and (c) help funders and policymakers make informed decisions about future research priorities in order to best meet the needs of societies as they emerge from the acute phase of the pandemic. The research priorities were informed by an expert panel convened by the British Psychological Society that reflects the breadth of the discipline; a wider advisory panel with international input; and a survey of 539 psychological scientists conducted early in May 2020. The most pressing need is to research the negative biopsychosocial impacts of the COVID-19 pandemic to facilitate immediate and longer-term recovery, not only in relation to mental health, but also in relation to behaviour change and adherence, work, education, children and families, physical health and the brain, and social cohesion and connectedness. We call on psychological scientists to work collaboratively with other scientists and stakeholders, establish consortia, and develop innovative research methods while maintaining high-quality, open, and rigorous research standards.