Looking beyond the negatives: A time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive-behavior therapy for panic disorder

Time period analysis was used in an international sample of clients ( N = 106) to demonstrate that cognitive - behavioral therapy (CBT) for panic disorder is associated with specific changes in both negative and positive cognitions during the treatment period. In the first 6 weeks of the treatment phase, working alliance failed to predict changes in panic severity, whereas changes in panic self-efficacy and catastrophic misinterpretation of bodily sensations predicted rapid symptom relief. In the last 6 weeks of treatment, higher doses of CBT were associated with further changes in positive and negative cognitions. The findings can be interpreted as suggesting that the role of the working alliance in CBT for panic disorder is to facilitate cognitive change.

Cognitive mediation of panic severity: The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy

This study examined the differential role of negative and positive cognitions in mediating treatment outcome in CBT for Panic Disorder through comparison of a Standard CBT (n = 36) versus a Waitlist Condition (n = 24). Regression analyses indicated that, relative to the Waitlist Condition, patients in the Standard CBT condition reported significantly greater shifts both towards higher panic self-efficacy and lower catastrophic misinterpretation of bodily sensations during treatment, as well as a significantly lower level of panic severity at posttreatment. Changes in catastrophic misinterpretation of bodily sensations and panic self-efficacy contributed significantly more to prediction of panic severity than did assignment to either Standard CB T or a Waitlist Condition. Results are discussed in terms of the importance of including both negative and positive cognitions in demonstrating cognitive mediation.

Addition of cue exposure to cognitive-behaviour therapy for alcohol misuse: a randomized trial with dysphoric drinkers

Aim To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction ( emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. Design Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. Setting Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. Participants People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. Intervention Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. Measurements Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. Results Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. Conclusions These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.

Position information but not force information is used in adapting to changes in environmental dynamics

This study investigated how movement error is evaluated and used to change feedforward commands following a change in the environmental dynamics. In particular, we addressed the question of whether only position-error information is used or whether information about the force-field direction can also be used for rapid adaptation to changes in the environmental dynamics. Subjects learned to move in a position-dependent force field (PF) with a parabolic profile and the dynamics of a negative spring, which produced lateral force to the left of the target hand path. They adapted very rapidly, dramatically reducing lateral error after a single trial. Several times during training, the strength of the PF was unexpectedly doubled (PF2) for two trials. This again created a large leftward deviation, which was greatly reduced on the second PF2 trial, and an aftereffect when the force field subsequently returned to its original strength. The aftereffect was abolished if the second PF2 trial was replaced by an oppositely directed velocity-dependent force field (VF). During subsequent training in the VF, immediately after having adapted to the PF, subjects applied a force that assisted the force field for similar to 15 trials, indicating that they did not use information about the force-field direction. We concluded that the CNS uses only the position error for updating the internal model of the environmental dynamics and modifying feedforward commands. Although this strategy is not necessarily optimal, it may be the most reliable strategy for iterative improvement in performance.

Systematic changes in the duration and precision of interception in response to variation of amplitude and effector size

The results of two experiments are reported that examined how performance in a simple interceptive action (hitting a moving target) was influenced by the speed of the target, the size of the intercepting effector and the distance moved to make the interception. In Experiment 1, target speed and the width of the intercepting manipulandum (bat) were varied. The hypothesis that people make briefer movements, when the temporal accuracy and precision demands of the task are high, predicts that bat width and target speed will divisively interact in their effect on movement time (MT) and that shorter MTs will be associated with a smaller temporal variable error (VE). An alternative hypothesis that people initiate movement when the rate of expansion (ROE) of the target's image reaches a specific, fixed criterion value predicts that bat width will have no effect on MT. The results supported the first hypothesis: a statistically reliable interaction of the predicted form was obtained and the temporal VE was smaller for briefer movements. In Experiment 2, distance to move and target speed were varied. MT increased in direct proportion to distance and there was a divisive interaction between distance and speed; as in Experiment 1, temporal VE was smaller for briefer movements. The pattern of results could not be explained by the strategy of initiating movement at a fixed value of the ROE or at a fixed value of any other perceptual variable potentially available for initiating movement. It is argued that the results support pre-programming of MT with movement initiated when the target's time to arrival at the interception location reaches a criterion value that is matched to the pre-programmed MT. The data supported completely open-loop control when MT was less than between 200 and 240 ms with corrective sub-movements increasingly frequent for movements of longer duration.

An examination of the antecedents of readiness for fine-tuning and corporate transformation changes

This study examined employee readiness for fine-tuning changes and for corporate transformation changes. It was proposed that employees would report different degrees of readiness for these two types of change and that different variables would be associated with readiness for the two types of change. Results of regression analyses indicated that trust in peers and logistics and system support displayed strong positive relationships with readiness for fine-tuning changes, while trust in senior leaders and self-efficacy displayed strong positive relationships with readiness for corporate transformation changes. The implications of this study focus on the appropriateness of traditional change management strategies in light of findings that multiple change readiness attitudes exist within an organization.

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive-behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA)

Introduction Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. Aim To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. Methods Literature review and consensus of expert opinion. Results and conclusion MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.

A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham elderly thyroid study

Context: Subclinical hypothyroidism (SCH) and cognitive dysfunction are both common in the elderly and have been linked. It is important to determine whether T4 replacement therapy in SCH confers cognitive benefit. Objective: Our objective was to determine whether administration of T4 replacement to achieve biochemical euthyroidism in subjects with SCH improves cognitive function. Design and Setting: We conducted a double-blind placebo-controlled randomized controlled trial in the context of United Kingdom primary care. Patients: Ninety-four subjects aged 65 yr and over (57 females, 37 males) with SCH were recruited from a population of 147 identified by screening. Intervention: T4 or placebo was given at an initial dosage of one tablet of either placebo or 25 µg T4 per day for 12 months. Thyroid function tests were performed at 8-weekly intervals with dosage adjusted in one-tablet increments to achieve TSH within the reference range for subjects in treatment arm. Fifty-two subjects received T4 (31 females, 21 males; mean age 73.5 yr, range 65–94 yr); 42 subjects received placebo (26 females, 16 males; mean age 74.2 yr, 66–84 yr). Main Outcome Measures: Mini-Mental State Examination, Middlesex Elderly Assessment of Mental State (covering orientation, learning, memory, numeracy, perception, attention, and language skills), and Trail-Making A and B were administered. Results: Eighty-two percent and 84% in the T4 group achieved euthyroidism at 6- and 12-month intervals, respectively. Cognitive function scores at baseline and 6 and 12 months were as follows: Mini-Mental State Examination T4 group, 28.26, 28.9, and 28.28, and placebo group, 28.17, 27.82, and 28.25 [not significant (NS)]; Middlesex Elderly Assessment of Mental State T4 group, 11.72, 11.67, and 11.78, and placebo group, 11.21, 11.47, and 11.44 (NS); Trail-Making A T4 group, 45.72, 47.65, and 44.52, and placebo group, 50.29, 49.00, and 46.97 (NS); and Trail-Making B T4 group, 110.57, 106.61, and 96.67, and placebo group, 131.46, 119.13, and 108.38 (NS). Linear mixed-model analysis demonstrated no significant changes in any of the measures of cognitive function over time and no between-group difference in cognitive scores at 6 and 12 months. Conclusions: This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.

Changes in information processing in children and their implications for marketing strategy

This thesis examines children's consumer choice behaviour using an information processing perspective, with the fundamental goal of applying academic research to practical marketing and commercial problems. Proceeding a preface, which describes the academic and commercial terms of reference within which this interdisciplinary study is couched, the thesis comprises four discernible parts. Initially, the rationale inherent in adopting an information processing perspective is justified and the diverse array of topics which have bearing on children's consumer processing and behaviour are aggregated. The second part uses this perspective as a springboard to appraise the little explored role of memory, and especially memory structure, as a central cognitive component in children's consumer choice processing. The main research theme explores the ease with which 10 and 11 year olds retrieve contemporary consumer information from subjectively defined memory organisations. Adopting a sort-recall paradigm, hierarchical retrieval processing is stimulated and it is contended that when two items, known to be stored proximally in the memory organisation are not recalled adjacently, this discrepancy is indicative of retrieval processing ease. Results illustrate the marked influence of task conditions and orientation of memory structure on retrieval; these conclusions are accounted for in terms of input and integration failure. The third section develops the foregoing interpellations in the marketing context. A straightforward methodology for structuring marketing situations is postulated, a basis for segmenting children's markets using processing characteristics is adopted, and criteria for communicating brand support information to children are discussed. A taxonomy of market-induced processing conditions is developed. Finally, a case study with topical commercial significance is described. The development, launch and marketing of a new product in the confectionery market is outlined, the aetiology of its subsequent demise identified and expounded, and prescriptive guidelines are put forward to help avert future repetition of marketing misjudgements.

Towards a unified understanding of event-related changes in the EEG:the Firefly model of synchronization through cross-frequency phase modulation

Although event-related potentials (ERPs) are widely used to study sensory, perceptual and cognitive processes, it remains unknown whether they are phase-locked signals superimposed upon the ongoing electroencephalogram (EEG) or result from phase-alignment of the EEG. Previous attempts to discriminate between these hypotheses have been unsuccessful but here a new test is presented based on the prediction that ERPs generated by phase-alignment will be associated with event-related changes in frequency whereas evoked-ERPs will not. Using empirical mode decomposition (EMD), which allows measurement of narrow-band changes in the EEG without predefining frequency bands, evidence was found for transient frequency slowing in recognition memory ERPs but not in simulated data derived from the evoked model. Furthermore, the timing of phase-alignment was frequency dependent with the earliest alignment occurring at high frequencies. Based on these findings, the Firefly model was developed, which proposes that both evoked and induced power changes derive from frequency-dependent phase-alignment of the ongoing EEG. Simulated data derived from the Firefly model provided a close match with empirical data and the model was able to account for i) the shape and timing of ERPs at different scalp sites, ii) the event-related desynchronization in alpha and synchronization in theta, and iii) changes in the power density spectrum from the pre-stimulus baseline to the post-stimulus period. The Firefly Model, therefore, provides not only a unifying account of event-related changes in the EEG but also a possible mechanism for cross-frequency information processing.

Strategic groups, cognitive groups and environmental change in the UK pharmaceutical industry

This chapter explores the relationship between changes in strategy and environmental pressures within the UK Pharmaceutical Industry during a ten- year period. Two stable strategic time periods (SSTPs) were identified each of five years duration. Within each time period seven strategic groups were found but 11 out of 29 firms (37.9%) changed strategic groups membership during the period studied. The break between these two SSTPs was found to coincide with a sharp increase in the substitution of branded pharmaceuticals by cheaper parallel imports. A significant relationship was found between firms that changed groups and both their continent of origin and nationality. Firms whose home markets are more vulnerable to substitution were more likely to switch strategic groups. © 2011 Nova Science Publishers, Inc. All rights reserved.

Nutritional influences on cognitive function:mechanisms of susceptibility

The impact of nutritional variation, within populations not overtly malnourished, on cognitive function and arousal is considered. The emphasis is on susceptibility to acute effects of meals and glucose loads, and chronic effects of dieting, on mental performance, and effects of cholesterol and vitamin levels on cognitive impairment. New developments in understanding dietary influences on neurohormonal systems, and their implications for cognition and affect, allow reinterpretation of both earlier and recent findings. Evidence for a detrimental effect of omitting a meal on cognitive performance remains equivocal: from the outset, idiosyncrasy has prevailed. Yet, for young and nutritionally vulnerable children, breakfast is more likely to benefit than hinder performance. For nutrient composition, despite inconsistencies, some cautious predictions can be made. Acutely, carbohydrate-rich–protein-poor meals can be sedating and anxiolytic; by comparison, protein-rich meals may be arousing, improving reaction time but also increasing unfocused vigilance. Fat-rich meals can lead to a decline in alertness, especially where they differ from habitual fat intake. These acute effects may vary with time of day and nutritional status. Chronically, protein-rich diets have been associated with decreased positive and increased negative affect relative to carbohydrate-rich diets. Probable mechanisms include diet-induced changes in monoamine, especially serotoninergic neurotransmitter activity, and functioning of the hypothalamic pituitary adrenal axis. Effects are interpreted in the context of individual traits and susceptibility to challenging, even stressful, tests of performance. Preoccupation with dieting may impair cognition by interfering with working memory capacity, independently of nutritional status. The change in cognitive performance after administration of glucose, and other foods, may depend on the level of sympathetic activation, glucocorticoid secretion, and pancreatic β-cell function, rather than simple fuelling of neural activity. Thus, outcomes can be predicted by vulnerability in coping with stressful challenges, interacting with nutritional history and neuroendocrine status. Functioning of such systems may be susceptible to dietary influences on neural membrane fluidity, and vitamin-dependent cerebrovascular health, with cognitive vulnerability increasing with age.