Internet-delivered assessment and manipulation of anxiety-linked attentional bias: validation of a free-access attentional probe software package

It recently has been established within the laboratory that the attentional probe methodology not only can sensitively assess the threat attentional bias associated with anxiety vulnerability, but also can be configured to yield training tasks capable of modifying emotional vulnerability by manipulating such attentional selectivity. In order to appraise and exploit the potential practical applications of such procedures, it is desirable that clinical investigators without specialist equipment should become able to deliver such tasks within field settings. The present research program involved development of a fully customizable attentional probe software package, that delivers assessment and training versions of the probe task across the Internet. Two experimental studies served to validate the assessment and training efficacy of resulting probe task variants, completed remotely by GAD sufferers and nonclinical populations using their own computers. We advise fellow researchers how to freely download this software package for use within their own investigations.

Toward a Process-Based Framework for Classifying Personality Tests: Comment on Meyer and Kurtz (2006)

Meyer and Kurtz (2006) argued that the longstanding psychological test labels "objective" and "projective" have outlived their usefulness, and invited further work focusing on alternative terms for these measures. This Comment describes a framework for classifying personality tests based on the psychological processes that occur as people respond to test stimuli. Because an attribution process is involved in responding to both types of measures, those instruments formerly called "objective" tests are labeled self-attribution tests, and those formerly classified as "projective" tests are labeled stimulus-attribution tests. The possibility of extending the process-based framework beyond personality, to psychological tests in general, is also discussed. Clinical and empirical implications of a process-based framework are considered.

A review of web-assisted interventions for diabetes management: maximizing the potential for improving health outcomes

Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes.This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.

Psychophysiological and behavioural characteristics of individuals comorbid for antisocial personality disorder and schizophrenia-spectrum personality disorder

BACKGROUND

Few studies have examined people with comorbid schizophrenia-spectrum personality disorder and antisocial personality disorder, a subgroup who may differ psychophysiologically and behaviourally from those with either condition alone.

AIMS

To test whether individuals with both types of personality disorder are particularly characterised by reduced orienting and arousal and by increased criminal offending.

METHOD

In a community adult sample, self-reported crime and skin conductance orienting were collected on four diagnostic groups: schizophrenia-spectrum personality disorder only; antisocial personality disorder only; comorbidity of the two disorders; and a control group.

RESULTS

The comorbid group showed significantly higher levels of criminal behaviour than the other three groups. They also showed reduced skin conductance orienting to neutral tones compared with the other groups, and significantly reduced arousal and orienting to significant stimuli compared with the control group.

CONCLUSIONS

Reduced orienting may reflect a neurocognitive attentional risk factor for both antisocial and schizotypal personality disorders that indirectly reflects a common neural substrate to these disorders.

Linking antisocial behavior, substance use, and personality: an integrative quantitative model of the adult externalizing spectrum

Antisocial behavior, substance use, and impulsive and aggressive personality traits often co-occur, forming a coherent spectrum of personality and psychopathology. In the current research, the authors developed a novel quantitative model of this spectrum. Over 3 waves of iterative data collection, 1,787 adult participants selected to represent a range across the externalizing spectrum provided extensive data about specific externalizing behaviors. Statistical methods such as item response theory and semiparametric factor analysis were used to model these data. The model and assessment instrument that emerged from the research shows how externalizing phenomena are organized hierarchically and cover a wide range of individual differences. The authors discuss the utility of this model for framing research on the correlates and the etiology of externalizing phenomena.

Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

BACKGROUND

Illicit drug use in pregnancy is a complex social and public health problem. It is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial in this population; however, to our knowledge, no systematic review on the subject has been undertaken.

OBJECTIVES

To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programs on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance.?

SEARCH STRATEGY

We searched the Cochrane Drugs and Alcohol Group's trial register (May 2006), the Cochrane Central Register of Trials (Central- The Cochrane Library, Issue 3, 2005); MEDLINE (1.1996-8.2006); EMBASE (1.1996-8.2006); CINAHL (1.1982-8.2006), and reference lists of articles.

SELECTION CRITERIA

Randomised studies comparing any psychosocial intervention versus pharmacological interventions or placebo or non-intervention or another psychosocial intervention for treating illicit drug use in pregnancy.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data.

MAIN RESULTS

Nine trials involving 546 pregnant women were included. Five studies considered contingency management (CM), and four studies considered manual based interventions such as motivational interviewing (MI). The main finding was that contingency management led to better study retention. There was only minimal effect of CM on illicit drug abstinence. In contrast, motivational interviewing led towards poorer study retention, although this did not approach statistical significance. For both, no difference in birth or neonatal outcomes was found, but this was an outcome rarely captured in the studies.

AUTHORS' CONCLUSIONS

The present evidence suggests that CM strategies are effective in improving retention of pregnant women in illicit drug treatment programs as well as in transiently reducing illicit drug use. There is insufficient evidence to support the use of MI. Overall the available evidence has low numbers and, therefore, it is impossible to accurately assess the effect of psychosocial interventions on obstetrical and neonatal outcomes. It is important to develop a better evidence base to evaluate psychosocial modalities of treatment in this important population.

Interactions of child maltreatment and serotonin transporter and monoamine oxidase A polymorphisms: Depressive symptomatology among adolescents from low socioeconomic status backgrounds

Child maltreatment and polymorphisms of the serotonin transporter (5-HTT) and monoamine oxidase A (MAOA) genes were examined in relation to depressive symptomatology. Adolescents (Mage = 16.7 years) from low socioeconomic backgrounds with a history of child maltreatment (n= 207) or no such history (n= 132) were interviewed and provided buccal cells for genetic analysis. Gene × environment interactions were observed. Heightened depressive symptoms were found only among extensively maltreated youth with lowMAOAactivity. Among comparably maltreated youth with highMAOAactivity, self-coping strategies related to lower symptoms. Sexual abuse and the5-HTT short/shortgenotype predicted higher depression, anxiety, and somatic symptoms. This Gene × Environment interaction was further moderated byMAOAactivity level. The results highlight the protective functions of genetic polymorphisms and coping strategies in high risk youth and offer direction for understanding resilience and its promotion from a multiple levels of analysis perspective.

Threat interpretation bias as a vulnerability factor in childhood anxiety disorders

The present study examined threat interpretation biases in children 7-12 years of age with separation, social and generalised anxiety disorders (N=15), non-anxious offspring at risk due to parental anxiety (N=16) and non-anxious controls of non-anxious parents (N=14). Children provided interpretations of ambiguous situations to assess cognitive, emotional and behavioural responses. In comparison with non-anxious control children and at-risk children who did not differ from each other, anxious children reported stronger negative emotion and less ability to influence ambiguous situations. These results suggest that threat interpretation bias may be a cognitive factor associated with ongoing childhood anxiety but not a vulnerability factor associated with parental anxiety.

The skin conductance orienting response to semantic stimuli: Significance can be independent of arousal

The characteristics of stimuli that elicit skin conductance responses (SCRs) have been conceptualized in varied ways, with strong emphasis on the significance or arousing quality of stimuli. Our goal was to determine whether "significance" can be shown to have an effect on SCRs independent of "arousal," using words as stimuli. Ratings of words indicated that significance is partially independent of arousal. In Study 1, SCRs from 43 participants during presentation of 20 significant, nonarousing words with a negative valence that were either depression related or potentially self-referent and 20 nonsignificant words matched on valence and arousal showed a main effect of significance. In Study 2 (N=44), significant, nonarousing words were sampled more broadly to examine the effects of self-reference and valence. Significance, rather than just negativity or self-reference, elicited SCRs independently of arousal. SCRs to significant words may reflect cognitive and attentional processes that, in turn, might prove useful for the assessment of the cognitive aspects of anxiety.

Neuronal nicotinic receptors: A perspective on two decades of drug discovery research

Neuronal nicotinic acetylcholine receptors (nAChRs) have been a target for drug discovery efforts, primarily for CNS indications, for the past two decades. While nicotine and related natural products have been used for smoking cessation in various formulations (e.g., gum, spray, patches), it was only in 2006 with the launch of varenicline (Chantix) by Pfizer for smoking cessation that a new chemical entity (NCE) originating from a rational medicinal chemistry effort targeting neuronal AChRs was approved. The current overview outlines the chronology of drug discovery efforts in nAChRs from the cloning of the receptor family in the 1980s, to initial research efforts at SIBIA, R.J. Reynolds and Abbott, to the current industry-wide interest in nAChR agonists as novel therapeutics for pain, schizophrenia and Alzheimer's Disease. Key events in the evolution of the nAChR field were the development of high throughput electrophysiological screening tools that provided the means to enable lead optimization efforts in medicinal chemistry and the discovery by John Daly at the NIH of the frog alkaloid, epibatidine, that provided the framework for the discovery of ABT-594, an alpha4beta2 agonist that is 200 times more potent than morphine as an analgesic. Over the next decade, it is anticipated that additional NCEs including antagonists and allosteric modulators (both positive and negative), interacting with various nAChR subtypes, will be advanced to the clinic in areas of high unmet medical need, e.g., pain, neurodegeneration, to provide novel medications with improved efficacy.

Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes

OBJECTIVE

This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25.

METHOD

Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to form a best estimate of exposure to CSA and CPA. The relationship between CSA, CPA, and self-reported educational outcomes to 25 years was examined using logistic regression models that took into account social background, parental factors, and individual factors.

RESULTS

Increasing exposure to CSA and CPA was significantly associated with failing to achieve secondary school qualifications (CSA: B=.53, SE=.13, p<.0001; CPA: B=.62, SE=.12, p<.0001), gaining a Higher School Certificate (CSA: B=-.48, SE=.13, p<.001; CPA: B=-.78, SE=.14, p<.001), attending university (CSA: B=-.29, SE=.13, p<.05; CPA: B=-.45, SE=.13, p<.001), and gaining a university degree (CSA: B=-.54, SE=.18, p<.005; CPA: B=-.64, SE=.17, p<.001). Adjustment for confounding social, parental, and individual factors explained most of these associations. After control for confounding factors, omnibus tests of the associations between CSA and outcomes and CPA and outcomes failed to reach statistical significance (CSA: Wald chi(2) (4)=7.72, p=.10; CPA: Wald chi(2) (4)=8.26, p=.08).

CONCLUSIONS

The effects of exposure to CSA and CPA on later educational achievement outcomes are largely explained by the social, family, and individual context within which exposure to abuse takes place.

Adherence to the principles of Motivational Interviewing, clients' characteristics and behavior outcome in a smoking cessation and relapse prevention trial in women postpartum

OBJECTIVES

1. Quantitative description of the adherence to the principles of Motivational Interviewing (MI) in smoking counseling sessions, 2. Examination of the relation between clients' characteristics and the adherence to the principles of MI, and between adherence to the principles of MI and future smoking status.

METHODS

A sample of n=163 sessions conducted during a randomized controlled trial in testing the effectiveness of a population-based smoking intervention in women postpartum was investigated. Demographic and behavior-related variables were included in a logistic regression to predict adherence to MI. Adherence was measured using the Motivational Interviewing Treatment Integrity (MITI) scale.

RESULTS

Of the sessions, 49.4% showed good adherence to MI. The OR of receiving a good MI session was 3.1 for non-smokers in comparison to daily smokers. No other demographic or behavioral variable gained statistical significance. The relation between adherence and intervention outcome after 6 months was statistically significant (chi(2)=6.459, p<0.05).

CONCLUSIONS

This intervention study shows a satisfactory degree of adherence to and the effectiveness of MI. MI-adherence seems more likely in sessions concerned with smoking relapse prevention compared to smoking cessation sessions.

Selective reinforcement learning deficits in schizophrenia support predictions from computational models of striatal-cortical dysfunction

BACKGROUND

Rewards and punishments may make distinct contributions to learning via separate striatal-cortical pathways. We investigated whether fronto-striatal dysfunction in schizophrenia (SZ) is characterized by selective impairment in either reward- (Go) or punishment-driven (NoGo) learning.

METHODS

We administered two versions of a probabilistic selection task to 40 schizophrenia patients and 31 control subjects, using difficult to verbalize stimuli (experiment 1) and nameable objects (experiment 2). In an acquisition phase, participants learned to choose between three different stimulus pairs (AB, CD, EF) presented in random order, based on probabilistic feedback (80%, 70%, 60%). We used analyses of variance (ANOVAs) to assess the effects of group and reinforcement probability on two measures of contingency learning. To characterize the preference of subjects for choosing the most rewarded stimulus and avoiding the most punished stimulus, we subsequently tested participants with novel pairs of stimuli involving either A or B, providing no feedback.

RESULTS

Control subjects demonstrated superior performance during the first 40 acquisition trials in each of the 80% and 70% conditions versus the 60% condition; patients showed similarly impaired (<60%) performance in all three conditions. In novel test pairs, patients showed decreased preference for the most rewarded stimulus (A; t = 2.674; p = .01). Patients were unimpaired at avoiding the most negative stimulus (B; t = .737).

CONCLUSIONS

The results of these experiments provide additional evidence for the presence of deficits in reinforcement learning in SZ, suggesting that reward-driven learning may be more profoundly impaired than punishment-driven learning.

Why dissociation and schizotypy overlap: the joint influence of fantasy proneness, cognitive failures, and childhood trauma

A number of studies have noted that dissociative symptoms (e.g., feelings of derealization, depersonalization, memory complaints, absorption) overlap with the tendency to report psychotic-like experiences (i.e., schizotypy). The question arises as to what may account for the shared variance between dissociation and schizotypy. The present study investigated whether fantasy proneness, cognitive failures, and childhood trauma may jointly explain the dissociation-schizotypy link. To this end, we administered the Dissociative Experiences Scale, the Schizotypal Personality Scale, the Creative Experiences Questionnaire, the Cognitive Failures Questionnaire, and the Childhood Trauma Questionnaire to a sample of undergraduates (N = 185). Fantasy proneness, cognitive failures, and childhood trauma together explained substantial part (58%) of the dissociation-schizotypy link. The present study succeeded in explaining a considerate part of the shared variance between dissociation and schizotypy.

Psychiatric comorbidity among children with gender identity disorder

OBJECTIVE

To investigate the prevalence and type of comorbidity in children with gender identity disorder (GID).

METHOD

The Diagnostic Interview Schedule for Children-Parent version was used to assess psychopathology according to the DSM in two groups of children. The first group consisted of 120 Dutch children (age range 4-11 years) who were referred to a gender identity clinic between 1998 and 2004 (GID group) and the second group consisted of 47 Dutch children who were referred to an attention-deficit/hyperactivity disorder (ADHD) clinic between 1998 and 2004 (ADHD group; 100% response rate for both groups).

RESULTS

Fifty-two percent of the children diagnosed with GID had one or more diagnoses other than GID. As expected, more internalizing (37%) than externalizing (23%) psychopathology was present in both boys and girls. Furthermore, the odds ratios of having internalizing or externalizing comorbidity were 1.28 and 1.39 times higher, respectively, in the clinical comparison group (ADHD group) than in the GID group. Finally, 31% of the children with GID suffered from an anxiety disorder.

CONCLUSIONS

The results of this categorical diagnostic study show that children with GID are at risk for developing co-occurring problems. Because 69% of the children do not have an anxiety disorder, a full-blown anxiety disorder does not seem to be a necessary condition for the development of GID. Clinicians working with children with GID should be aware of the risk for co-occurring psychiatric problems and must realize that externalizing comorbidity, if present, can make a child with GID more vulnerable to social ostracism.

The use of motivational interviewing in weight loss

Within the past two decades, motivational interviewing has emerged as a useful strategy to help individuals develop motivation to change health behavior and sustain those efforts. This article reviews the preliminary but burgeoning literature that supports the effectiveness of motivational interviewing strategies in promoting positive changes in a variety of health behaviors, including dietary change, activity increases, and regimen adherence. A variety of adaptations of the motivational interviewing process are discussed as relevant to making this treatment strategy increasingly applicable to a variety of health care settings.

Understanding the impact of prior depression on stress generation: examining the roles of current depressive symptoms and interpersonal behaviours

Stress generation is a process in which individuals contribute to stressful life events. While research has supported an association between current depression and stress generation, it has been noted that individuals with prior depression tend to contribute to stressors even when they are no longer experiencing a depressive episode. The aim of the study is to elucidate the pathways through which prior major depression predicts interpersonal stress generation in women. Specifically, we examined current subsyndromal depressive symptoms and problematic interpersonal behaviours as potential mediators. Fifty-one college women were followed prospectively for 6 weeks. Participants were interviewed to assess current and past depression as well as stressful life events they experienced over the 6-week period. The findings suggest that prior major depression continues to have an impact even after the episode has ended, as the disorder continues to contribute to stress generation through residual depressive symptoms.

Diagnostic labeling in juvenile court: how do descriptions of psychopathy and conduct disorder influence judges?

This study examined the influence of diagnostic criteria and diagnostic labels for psychopathy or conduct disorder on judicial decisions. A national sample of judges (N = 326) rendered hypothetical dispositions based on 1 of 12 mock psychological evaluations. The evaluations varied the presence of 2 sets of diagnostic criteria (antisocial behavioral history and psychopathic personality traits) and 3 diagnostic labels (conduct disorder, psychopathy, no diagnosis) to distinguish diagnostic criterion effects from diagnostic labeling effects. Results revealed substantial effects (Cohen's d = .33- 1.27 on 6 of 9 variables) for a history of antisocial behavior. Psychopathic personality features also appeared influential, albeit on fewer variables. There were no negative effects associated with conduct disorder or psychopathy labels. Results suggest that the criteria underlying labels, more than labels themselves, exert influence in juvenile justice contexts.

Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.

Stress and health: psychological, behavioral, and biological determinants

Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual's biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.

Evidence-based assessment

Evidence-based assessment (EBA) emphasizes the use of research and theory to inform the selection of assessment targets, the methods and measures used in the assessment, and the assessment process itself. Our review focuses on efforts to develop and promote EBA within clinical psychology. We begin by highlighting some weaknesses in current assessment practices and then present recent efforts to develop EBA guidelines for commonly encountered clinical conditions. Next, we address the need to attend to several critical factors in developing such guidelines, including defining psychometric adequacy, ensuring appropriate attention is paid to the influence of comorbidity and diversity, and disseminating accurate and up-to-date information on EBAs. Examples are provided of how data on incremental validity and clinical utility can inform EBA. Given the central role that assessment should play in evidence-based practice, there is a pressing need for clinically relevant research that can inform EBAs.

Coping resources, coping processes, and mental health

Coping, defined as action-oriented and intrapsychic efforts to manage the demands created by stressful events, is coming to be recognized both for its significant impact on stress-related mental and physical health outcomes and for its intervention potential. We review coping resources that aid in this process, including individual differences in optimism, mastery, self-esteem, and social support, and examine appraisal and coping processes, especially those marked by approach or avoidance. We address the origins of coping resources and processes in genes, early life experience, and gene-environment interactions, and address neural underpinnings of coping that may shed light on evaluating coping interventions. We conclude by outlining possible intervention strategies for improving coping processes.

Doctoral training in clinical psychology

Competing models of doctoral training in clinical psychology are described and compared within their historical contexts. Trends in the field are examined critically with a focus on the impact of managed care on doctoral training and clinical practice. Implications for the future of doctoral training are considered, and a blueprint for the future of doctoral training in clinical psychology is presented.

Personality and risk of physical illness

Several personality characteristics have been linked in multiple well-designed prospective studies to subsequent physical health outcomes, such as longevity and the development and course of cardiovascular disease. The evidence is strongest for negative affectivity/neuroticism, anger/hostility and related traits, and optimism. Models of mechanisms underlying these associations have emphasized physiological effects of stress, exposure to stressors, and health behavior. Preliminary evidence supports the viability of some mechanisms, but formal mediational tests are lacking. In addition to addressing limitations and inconsistencies in this literature, future research should address developmental aspects of these psychosocial risk factors, contextual moderators of their health effects, and intervention applications in the prevention and management of disease. In these efforts, greater incorporation of concepts and methods in the structural, social-cognitive, and interpersonal perspectives in the field of personality are needed.

Explaining mental health treatment disparities: ethnic and cultural differences in family involvement

In a large, representative sample of persons receiving public mental health treatment, we examined whether ethnic minority consumers were more likely than white consumers to live with their families and to receive family support. We then evaluated whether differences observed in family involvement explained treatment disparities observed in outpatient and inpatient mental health services. Results indicated that Asian American and Latino consumers, especially, were considerably more likely than white consumers to live with family members and to receive family support. Ethnocultural differences in living with family did explain treatment intensity disparities whether or not consumers described themselves as dependent on family support. The results support the hypothesis that cultural differences in family involvement and support play a role in explaining mental health treatment disparities.

Rethinking the paradigms that inform behavioral treatment research for substance use disorders

AIMS

Over the last three decades, the randomized controlled trial or 'psychotherapy technology' approach has been the dominant model of inquiry in research on addiction treatment. This period has yielded impressive discoveries, but recent failures to confirm core research hypotheses such as occurred in Project MATCH and the Cocaine Collaborative Treatment Study have raised questions about future research directions. The paper identifies several testable assumptions of the psychotherapy technology model.

METHODS

A review is conducted on four substance use disorder behavioral interventions--motivational interviewing, cognitive-behavioral treatment, behavioral couples treatment and 12-Step-oriented treatment--to determine whether these assumptions are supported by research findings.

RESULTS

Overall, the review suggests weak support for the technology model of psychotherapy research. Lack of support is interpreted as indicating flaws in several model assumptions about how to conceptualize and measure patient responsivity and the interaction of non-specific and specific therapeutic factors. The paper offers alternative strategies for addressing these issues drawn from the general psychotherapy process literature and provides illustrative examples of how these could be used to spur innovation in addiction treatment research.

CONCLUSIONS

The addiction treatment research field is coming up against the limitations of the psychotherapy technology model as the dominant paradigm guiding treatment research. It is important for addiction treatment researchers to explore alternative conceptualizations and methodologies in order to understand more clearly how treatment works.

Functional neuroimaging and the law: trends and directions for future scholarship

Under the umbrella of the burgeoning neurotransdisciplines, scholars are using the principles and research methodologies of their primary and secondary fields to examine developments in neuroimaging, neuromodulation and psychopharmacology. The path for advanced scholarship at the intersection of law and neuroscience may clear if work across the disciplines is collected and reviewed and outstanding and debated issues are identified and clarified. In this article, I organize, examine and refine a narrow class of the burgeoning neurotransdiscipline scholarship; that is, scholarship at the interface of law and functional magnetic resonance imaging (fMRI).

Parental expressed emotion and adolescent self-injury

OBJECTIVE

This study examined the relationship between parental expressed emotion (EE) and adolescent self-injurious thoughts and behaviors (SITB), as well as potential mediators and moderators of this relationship.

METHOD

Thirty-six adolescents ages 12 to 17 years recruited from the community (2004-2005) provided data. Parents of the adolescents completed the Five-Minute Speech Sample, a performance-based measure of EE, and adolescents completed interviews and rating scales assessing SITB, mental disorders, and related constructs.

RESULTS

Analyses revealed that high parental EE was associated with each type of SITB assessed: suicide ideation, suicide plans, suicide attempts, and non-suicidal self-injury. Analyses also revealed that one specific component of EE (i.e., parental criticism) was strongly associated with SITB, whereas the other (i.e., emotional overinvolvement) was not and that the relationship between EE and SITB was not explained by the presence of mental disorders. Finally, a moderation model was supported in which the relationship between parental criticism and SITB was especially strong among adolescents with a self-critical cognitive style.

CONCLUSIONS

This study indicates that parental criticism is significantly associated with SITB and suggests one specific pathway through which the family may influence adolescent SITB. Future research is needed to replicate these findings and examine the direction of these relationships.

Cognitive neuroscience-based approaches to measuring and improving treatment effects on cognition in schizophrenia: the CNTRICS initiative

The goal of this article is to discuss ways to further improve the search for potentially procognitive agents that could be used to enhance cognition and functional outcome in schizophrenia. In particular, we focus on the potential advantages to this process of using a contemporary, cognitive neuroscience-based approach to measuring cognitive function in clinical trials of procognitive agents in schizophrenia. These tools include computer-administered tasks that measure specific cognitive systems (such as attention, working memory, long-term memory, cognitive control) as well as the component cognitive processes that comprise these more overarching systems. The advantages of using these tools include the ability to identify and use homologous animal and human models in the drug discovery and testing process and the ability to incorporate noninvasive functional imaging measures into clinical trial contexts at several different phases of the drug development process. However, despite the clear potential advantages to using such methods, a number of barriers exist to their translation from basic science tools to tools for drug discovery. We discuss the development and implementation of a new project, Cognitive Neuroscience Treatment to Improve Cognition in Schizophrenia, designed to identify and overcome these barriers to the translation of cognitive neuroscience measures and methods into regular use in the drug discovery and development process of cognition-enhancing agents for use in schizophrenia.

Anticipation of aversive stimuli activates extended amygdala in unipolar depression

According to cognitive theories, negative cognitions including negative attitudes towards the future are key factors associated with depressive disorder. We investigated the neural correlates of anticipation of emotional stimuli in patients with unipolar depression to reveal influences of future thinking on brain activity. We used functional magnetic resonance imaging (fMRI) to study 12 female patients with stable antidepressant medication and 12 healthy women. Subjects were presented with positive, negative and neutral pictures that were announced by a congruent cue. Subjects were instructed to expect and subsequently watch the pictures. After scanning, subjects filled the Emotion Regulation Questionnaire (ERQ) to assess the regulation strategies suppression and reappraisal. Compared to the healthy control group, during expectation of negative vs. neutral or positive stimuli the patients showed significantly more activation within the sublenticular extended dorsal amygdala (SLEA) bilaterally but did not differ from controls upon expecting positive stimuli. Hamilton depression scores of the patients correlated positively with activation of the left and right ventral amygdala during expectation of negative stimuli. Furthermore, we found a negative correlation of ventral amygdala activation in the patients with reappraisal scores comprising the ability to limit emotional responding by re-interpreting emotion-eliciting situations. We interpret enhanced activation in the amygdala/SLEA as a possible consequence of altered future thinking in patients suffering from depression. Supporting cognitive theories, this finding does represent evidence that altered cognitions as potentially involved in expectation result in differences in brain activity.

Five-Factor Model Assessment of Personality Disorder

The Five-factor model (FFM) provides a viable dimensional model of personality disorder assessment. Advantages of the FFM include the provision of a precise yet comprehensive description of both normal and abnormal personality functioning, the avoidance of the many limitations and problems inherent to the categorical diagnostic system, and the incorporation of basic science research on general personality structure and functioning into clinicians' description and understanding of personality disorders. We discuss three alternative instruments for the assessment of personality disorder from the perspective of the FFM. We also provide a method for diagnosing personality disorders and illustrate its application through a case study.

Does expressive writing reduce stress and improve health for family caregivers of older adults?

PURPOSE

We examined whether written emotional disclosure reduces stress and improves health outcomes for family caregivers of physically frail and cognitively impaired older adults, as it has been shown to do for certain student and clinical populations.

DESIGN AND METHODS

Primary caregivers of older adults attending a day program were randomly assigned to expressive-writing (n = 14), time-management (n = 13), or history-writing (n = 13) conditions. Participants wrote for 20 minutes on four occasions over a 2-week period, and they completed self-report measures of caregiver burden and health prior to the intervention, immediately afterward, and at 1-month follow-up.

RESULTS

Contrary to expectations, expressive-writing and history-writing participants performed similarly across outcomes. Only caregiver participants in the time-management condition experienced significant mental and physical health improvements after writing.

IMPLICATIONS

The results of this study add to a growing body of research demonstrating equivocal effects of expressive writing with clinical samples, and they suggest the potential benefit of written time management for stressed caregivers.

Developmental differences in the effects of repeated interviews and interviewer bias on young children's event memory and false reports

The present study investigated developmental differences in the effects of repeated interviews and interviewer bias on children's memory and suggestibility. Three- and 5-year-olds were singly or repeatedly interviewed about a play event by a highly biased or control interviewer. Children interviewed once by the biased interviewer after a long delay made the most errors. Children interviewed repeatedly, regardless of interviewer bias, were more accurate and less likely to falsely claim that they played with a man. In free recall, among children questioned once after a long delay by the biased interviewer, 5-year-olds were more likely than were 3-year-olds to claim falsely that they played with a man. However, in response to direct questions, 3-year-olds were more easily manipulated into implying that they played with him. Findings suggest that interviewer bias is particularly problematic when children's memory has weakened. In contrast, repeated interviews that occur a short time after a to-be-remembered event do not necessarily increase children's errors, even when interviews include misleading questions and interviewer bias. Implications for developmental differences in memory and suggestibility are discussed.

Viewing Resistance as Ambivalence: Integrative Strategies for Working With Resistant Ambivalence

Resistance to change is a problem that has long evaded easy solutions. In this article, the authors suggest the value of understanding and working with some forms of resistance as ambivalence. They describe resistant ambivalence in the context of an integrative and multivoiced understanding. A person who is ambivalent possesses a voice that moves toward change and a voice that struggles against change. The authors sought therapy methods that were consistent with the multivoiced integrative understanding of ambivalence and that could be useful in its resolution. Motivational interviewing and the two-chair method are described in this article, along with illustrative case material. These methods share a common spirit and therapist style that is accepting of the client's worldview and creates a strong partnership between the therapist and client. These methods can be used in conjunction with other therapy approaches and have a research base supporting their use.

Therapeutic Neuropsychological Assessment: A Humanistic Model and Case Example

One of the challenges the field of clinical neuropsychology faces is to develop an assessment process that is relevant to the needs of patients and referral sources and responsive to those needs. One method for meeting this need is for psychologists and neuropsychologists to extend their services to develop clinical interventions that serve to enhance patients' cognitive and emotional well-being. Feedback to patients from the results of neuropsychological tests is an intervention that is considered an important part of the assessment process, and there is evidence that direct feedback has positive therapeutic effects for patients. Although many authors have provided suggestions and principles for conducting neuropsychological test feedback, there is no agreed-on conceptual framework for doing so. The following article presents a humanistic model for providing feedback from the results of neuropsychological tests and a case example of its application with a young woman suffering from a brain tumor.

Phenomenological Characteristics of Attentional Biases Towards Threat: A Critical Review

Although research has consistently revealed the presence of a general attentional bias towards threat, empirical and theoretical ambiguity exists in determining whether attentional biases are comprised of facilitated attention to threat, difficulty in disengagement from threat, or both, as well as whether attentional biases reflect automatic or strategic processes. This paper reviews empirical investigations across 4 common assessment tasks: the Stroop (masked and unmasked), dot probe, visual search, and the Posner tasks. Although the review finds inconsistencies both within and between assessment tasks, the evidence suggests that attentional biases towards threat are comprised of each of the phenomenological characteristics addressed in this paper. Contemporary theoretical models of attentional biases in anxiety are summarized and critically reviewed in light of the current evidence. Suggestions for future research are addressed, including a need to investigate the psychometric properties of the assessment tasks, to utilize consistent theoretically driven operationalizations of attentional biases, and to provide a temporal description of the characteristics of attentional biases towards threat.

Increased perceived stress is associated with blunted hedonic capacity: potential implications for depression research

Preclinical studies suggest that stress exerts depressogenic effects by impairing hedonic capacity; in humans, however, the precise mechanisms linking stress and depression are largely unknown. As an initial step towards better understanding the association between stress and anhedonia, the present study tested, in two independent samples, whether individuals reporting elevated stress exhibit decreased hedonic capacity. The Perceived Stress Scale (PSS) measured the degree to which participants appraised their daily life as unpredictable, uncontrollable, and overwhelming. Hedonic capacity was objectively assessed using a signal-detection task based on a differential reinforcement schedule. Decreased reward responsiveness (i.e., the participants' propensity to modulate behavior as a function of reward) was used as an operational measure of hedonic capacity. In both Study 1 (n=88) and Study 2 (n=80), participants with high PSS scores displayed blunted reward responsiveness and reported elevated anhedonic symptoms. Additionally, PSS scores predicted reduced reward responsiveness even after controlling for general distress and anxiety symptoms. These findings are consistent with preclinical data highlighting links between stress and anhedonia, and offer promising insights into potential mechanisms linking stress to depression.

Issues in designing and implementing a Spanish-language multi-site clinical trial

To address at least in part health disparities in Hispanic populations, the NIDA Clinical Trials Network implemented the first multi-site randomized clinical trial of substance abuse treatment conducted entirely in Spanish. This trial was intended to evaluate the effectiveness of Motivational Enhancement Therapy in a diverse population of Hispanics. In the conduct of this trial, several barriers to the successful implementation of a Spanish-language multi-site trial had to be addressed, including the appropriate translation of assessment instruments, shortage of appropriately trained Spanish-speaking clinical staff, and barriers to recruitment and retention of this population. To encourage similar research, strategies are described that were developed by the study team to meet these challenges.