Exaggerated Attention Blink Response in Prisoners with Externalizing

The joy of being frightened: Fear experience in psychopathy

OBJECTIVE

Psychopathic traits are associated with abnormalities in fear processing. While traditional theories focus on a lack of fear, Hosker-Field et al. (2016) provided a new perspective. They suggested that individuals with elevated psychopathic traits may experience threatening situations with appreciation or positivity, resulting in reduced negative fear responses and heightened positive responses (fear enjoyment hypothesis, FEH).

METHOD

Our study aimed to refine Hosker-Field et al.'s (2016) study design, addressing methodological limitations and improving the inconsistent operationalization of fear experience in the literature. In an online sample of 353 participants from the general population, we examined the relationship between the FEH and relevant psychopathic traits, specifically those derived from the PCL-R framework (i.e., SRP 4 Factor 1), and from a more trait-based approach to psychopathy with assumed links to fearlessness (i.e., TriPM Boldness).

RESULTS

By employing linear mixed effect models, we extended Hosker-Field et al.'s correlational analysis and provided further evidence for the FEH, particularly in relation to psychopathic traits measured using the PCL-R framework. The results regarding Boldness, however, are somewhat inconclusive.

CONCLUSION

The present study enhances existing research on fear deficits in psychopathy by assessing the subjective experience of individuals facing threat.

Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample

BACKGROUND

The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings.

METHODS

Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximum-security forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses.

RESULTS

The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting α and ω values ≥ 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity.

CONCLUSION

Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.

Highly Structured Treatment Programs for Addicted Offenders: Comparing the Effects of the Reasoning & Rehabilitation Program and DBT-F

BACKGROUND

When treating addicted offenders in a forensic psychiatric setting, a primary concern is to decrease antisocial cognitions and behaviors. The cognitive style of offenders is often characterized by impulsiveness, egocentricity, irrational thinking, and rigidity. We examined the relative efficacy of Reasoning and Rehabilitation Program (R&R) and Dialectical Behavioral Therapy- Forensic (DBT-F) on the domains of underlying psychological constructs (e.g., mental flexibility, planning, and problem-solving).

MATERIALS AND METHODS

The R&R and DBT-F were introduced in a forensic-psychiatric hospital for offenders with substance addictions in Germany. We compared pre- and post-tests to measure the cognitive skills of addicted offenders having undergone R&R (N = 47), DBT-F (N = 34), or Treatment as Usual (TAU; N = 28). Participants' skills (cognitive flexibility, ability to inhibit cognitive interference, cognitive performance/mental speed, divergent and convergent reasoning/problem solving) were assessed using neuropsychological instruments. Analyses of variance were conducted to investigate whether there were significant improvements within groups and whether these differences were significant between groups. To examine the predictive power of treatment-program on outcomes, and diagnosis of personality disorder, a hierarchical regression model was used.

RESULTS

Both programs were associated with improvements in nearly all of the measured constructs. The only construct on which the R&R and DBT-F groups differed significantly was word fluency, with those receiving R&R improving more than those receiving DBT-F. A regression model showed no predictive power for age, IQ, or diagnosis of personality disorder. Treatment group explained 13.8% of variance in cognitive flexibility but did not predict variance in other outcomes.

CONCLUSION

Surprisingly, we did not find superiority for one intervention over TAU or differential effects between the two programs. Future research should use larger samples and additional outcomes, including recidivism, to identify possible effects of treatment programs. Additionally, qualitative methods might inform us about these programs are implemented as well as which outcomes may be relevant.

Neural correlates of emotion reappraisal in individuals with externalizing psychopathology

Externalizing psychopathology (EXT) is characterized by regulatory deficits of behavior, cognition, and negative emotion. Previous research on EXT suggests that cognitive and affective dysregulation are highly related, such that strong affective states constrain a reduced-capacity cognitive system. Reappraisal is an effective emotional control strategy involving complex interactions between cognitive and affective brain functions and may therefore offer novel insight into the specific neural mechanisms of affective dysregulation among individuals with EXT. To evaluate these possibilities, we tested individuals with low or high EXT in a reappraisal paradigm. Neuroimaging results indicated that EXT was associated with hypo-activation in the amygdala and superior parietal lobule during both maintenance and reappraisal as well as poor modulation of the lateral occipital cortex during negative emotion reappraisal. These results suggest a general disruption of perceptual-attentional resource allocation such that high EXT individuals are characterized by poor modulation of perceptual-attentional resources during reappraisal. Subsequently, emotion reappraisal may be a useful but not adequate tool to control negative affect in EXT.

Selective Mapping of Psychopathy and Externalizing to Dissociable Circuits for Inhibitory Self-Control

Antisociality is commonly conceptualized as a unitary construct, but there is considerable evidence for multidimensionality. In particular, two partially dissociable symptom clusters - psychopathy and externalizing - have divergent associations to clinical and forensic outcomes and are linked to unique patterns executive dysfunction. Here, we used fMRI in a sample of incarcerated offenders to map these dimensions of antisocial behavior to brain circuits underlying two aspects of inhibitory self-control: interference suppression and response inhibition. We found that psychopathy and externalizing are characterized by unique and task-selective patterns of dysfunction. While higher levels of psychopathy predicted increased activity within a distributed fronto-parietal network for interference suppression, externalizing did not predict brain activity during attentional control. By contrast, each dimension had opposite associations to fronto-parietal activity during response inhibition. These findings provide neurobiological evidence supporting the fractionation of antisocial behavior, and identify dissociable mechanisms through which different facets predispose dysfunction and impairment.

Altering the Cognitive-Affective Dysfunctions of Psychopathic and Externalizing Offender Subtypes with Cognitive Remediation

Cognitive remediation is a treatment approach with the potential to translate basic science into more specific, mechanism-based interventions by targeting particular cognitive skills. The present study translated understanding of two well-defined cognitive-emotion dysfunctions into novel deficit-matched interventions and evaluated whether cognitive remediation would demonstrate specific and generalizable change. Two antisocial-subtypes, individuals with psychopathy and externalizing traits, are characterized by cognitive-affective problems that predispose them to engage in significant substance abuse and criminal behavior, culminating in incarceration. Whereas individuals with psychopathy fail to consider important contextual information, individuals with externalizing traits lack the capacity to regulate affective reactions. Training designed to remedy these subtype-specific deficits led to improvement on both trained and non-trained tasks. Such findings offer promise for changing neural and behavioral patterns, even for what many consider to be the most recalcitrant treatment population, and presage a new era of translating cognitive-affective science into increasingly specific and effective interventions.

Psychopathic and externalizing offenders display dissociable dysfunctions when responding to facial affect

Despite similarity in their disinhibited behaviors, the cognitive-affective mechanisms that characterize psychopathy and externalizing are relatively distinct. One theoretical perspective suggests that psychopathy is associated with an early attention bottleneck that precludes the processing of contextual information, leading to a rigid goal-directed focus. Alternatively, externalizing may be associated with an overallocation of processing resources to motivationally salient information, which disrupts the use of cognitive control. In this study, male prisoners assessed on psychopathic and externalizing traits performed a new gaze detection task involving affective faces. As predicted, psychopathy but not externalizing was associated with superior performance on the gaze-detection task when the necessity of using contextual affect to regulate goal-directed behavior was minimized. Conversely, externalizing but not psychopathy was associated with increased errors on trials that required participants to use affective expressions, specifically fear, as a cue to inhibit dominant responses. These results have theoretical and applied significance for both psychopathic and externalizing forms of disinhibition. Recognition and utilization of facial affect are important for socialization and interpersonal interactions; therefore, any cognitive-affective processes that interrupt the fluency with which this information is processed may be important for understanding the underpinnings of disinhibition.

Feature-based attention and conflict monitoring in criminal offenders: interactive relations of psychopathy with anxiety and externalizing

As predicted by the response modulation model, psychopathic offenders are insensitive to potentially important inhibitory information when it is peripheral to their primary focus of attention. To date, the clearest tests of this hypothesis have manipulated spatial attention to cue the location of goal-relevant versus inhibitory information. However, the theory predicts a more general abnormality in selective attention. In the current study, male prisoners performed a conflict-monitoring task, which included a feature-based manipulation (i.e., color) that biased selective attention toward goal-relevant stimuli and away from inhibitory distracters on some trials but not others. Paralleling results for spatial cuing, feature-based cuing resulted in less distracter interference, particularly for participants with primary psychopathy (i.e., low anxiety). This study also investigated the moderating effect of externalizing on psychopathy. Participants high in psychopathy but low in externalizing performed similarly to primary psychopathic individuals. These results demonstrate that the abnormal selective attention associated with primary psychopathy is not limited to spatial attention but, instead, applies to diverse methods for establishing attentional focus. Furthermore, they demonstrate a novel method of investigating psychopathic subtypes using continuous analyses.

The impact of cognitive control, incentives, and working memory load on the P3 responses of externalizing prisoners

The P3 amplitude reduction is one of the most common correlates of externalizing. However, few studies have used experimental manipulations designed to challenge different cognitive functions in order to clarify the processes that impact this reduction. To examine factors moderating P3 amplitude in trait externalizing, we administered an n-back task that manipulated cognitive control demands, working memory load, and incentives to a sample of male offenders. Offenders with high trait externalizing scores did not display a global reduction in P3 amplitude. Rather, the negative association between trait externalizing and P3 amplitude was specific to trials involving inhibition of a dominant response during infrequent stimuli, in the context of low working memory load, and incentives for performance. In addition, we discuss the potential implications of these findings for externalizing-related psychopathologies. The results complement and expand previous work on the process-level dysfunction contributing to externalizing-related deficits in P3.