Predicting outcomes following cognitive behavior therapy in child anxiety disorders: the influence of genetic, demographic and clinical information

Background. Within a therapeutic gene by environment (GxE) framework, we recently demonstrated that variation in the Serotonin Transporter Promoter Polymorphism; 5HTTLPR and marker rs6330 in Nerve Growth Factor gene; NGF is associated with poorer outcomes following cognitive behaviour therapy (CBT) for child anxiety disorders. The aim of this study was to explore one potential means of extending the translational reach of G×E data in a way that may be clinically informative. We describe a ‘risk-index’ approach combining genetic, demographic and clinical data and test its ability to predict diagnostic outcome following CBT in anxious children. Method. DNA and clinical data were collected from 384 children with a primary anxiety disorder undergoing CBT. We tested our risk model in five cross-validation training sets. Results. In predicting treatment outcome, six variables had a minimum mean beta value of 0.5: 5HTTLPR, NGF rs6330, gender, primary anxiety severity, comorbid mood disorder and comorbid externalising disorder. A risk index (range 0-8) constructed from these variables had moderate predictive ability (AUC = .62-.69) in this study. Children scoring high on this index (5-8) were approximately three times as likely to retain their primary anxiety disorder at follow-up as compared to those children scoring 2 or less. Conclusion. Significant genetic, demographic and clinical predictors of outcome following CBT for anxiety-disordered children were identified. Combining these predictors within a risk-index could be used to identify which children are less likely to be diagnosis free following CBT alone or thus require longer or enhanced treatment. The ‘risk-index’ approach represents one means of harnessing the translational potential of G×E data.

Process analysis of trauma-focused cognitive behavioural therapy for individuals with schizophrenia

Objective. Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session ‘process’ of working alliance and emotional processing of trauma memories for individuals with schizophrenia. Design. The study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N = 26). Method. Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported. Results. Working alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring. Conclusion. This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive–emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered.

Enhanced effects of combined cognitive bias modification and computerised cognitive behaviour therapy on social anxiety

This study examines whether combined cognitive bias modification for interpretative biases (CBM-I) and computerised cognitive behaviour therapy (C-CBT) can produce enhanced positive effects on interpretation biases and social anxiety. Forty socially anxious students were randomly assigned into two conditions, an intervention group (positive CBM-I + C-CBT) or an active control (neutral CBM-I + C-CBT). At pre-test, participants completed measures of social anxiety, interpretative bias, cognitive distortions, and social and work adjustment. They were exposed to 6 × 30 min sessions of web-based interventions including three sessions of either positive or neutral CBM-I and three sessions of C-CBT, one session per day. At post-test and two-week follow-up, participants completed the baseline measures. A combined positive CBM-I + C-CBT produced less negative interpretations of ambiguous situations than neutral CBM-I + C-CBT. The results also showed that both positive CBM-I + C-CBT and neutral CBM-I + C-CBT reduced social anxiety and cognitive distortions as well as improving work and social adjustment. However, greater effect sizes were observed in the positive CBM-I + C-CBT condition than the control. This indicates that adding positive CBM-I to C-CBT enhanced the training effects on social anxiety, cognitive distortions, and social and work adjustment compared to the neutral CBM-I + C-CBT condition.

Is cognitive bias modification training truly beneficial for adolescents?

Background Cognitive Bias Modification (CBM) has been shown to change interpretation biases commonly associated with anxiety and depression and may help ameliorate symptoms of these disorders. However, its evidence base for adolescents is scarce. Previous results have been hard to interpret because of methodological issues. In particular, many studies have used negative bias training as the control condition. This would tend to inflate any apparent benefits of CBM compared to a neutral control. Most studies also only examined the effects of a single training session and lacked follow-up assessment or ecologically valid outcome measures. Method Seventy-four adolescents, aged 16–18 years, were randomised to two sessions of CBM training or neutral control. Interpretation bias and mood were assessed three times: at baseline, immediately post-training and 1 week post-training. A controlled experimental stressor was also used, and responses to everyday stressors were recorded for 1 week after training to assess responses to psychological challenges. Feedback for the training programme was collected. Results The CBM group reported a greater reduction in negative affect than control participants. However, other hypothesised advantages of CBM were not demonstrated. Regardless of training group, participants reported increased positive interpretations, decreased negative interpretations, reduced depressive symptoms and no change in trait anxiety. The two groups did not differ in their stress reactivity. After controlling for group differences in training performance, all the mood effects disappeared. Conclusions When tested under stringent experimental conditions the effects of CBM in healthy adolescents appear to be minimal. Future studies should concentrate on participants with elevated cognitive biases and/or mood symptoms who may be more sensitive to CBM.

Cognitive vulnerability to postnatal depressive symptomatology

Understanding the factors involved in the development of postpartum depressive disorders has important implications for the detection of women at risk, and the development of theory‐driven preventative treatments. In the current study, recent innovations in the assessment of idiographic cognitive functioning among adult, non‐pregnant samples were administered to a sample of healthy primiparous women to investigate their predictive utility in the onset of low mood following childbirth. Cognitive biases using autobiographical material, and the degree of self‐devaluation during brief episodes of naturally occurring low mood were assessed in 94 concurrently well women in the third trimester of their first pregnancy. The degree of depressive symptomatology at 2 and 8 weeks postpartum was assessed subsequently. Antenatal self‐devaluative tendencies and a lack of specificity in autobiographical retrieval were not associated with low mood in the initial weeks following delivery, when biological factors are believed to play an important role, but did predict depressive symptoms more distally at 8 weeks after childbirth. This relationship was demonstrated after controlling for educational level, variations in antenatal dysphoria, previous emotional difficulties, neuroticism and the woman's own experience of mothering. The theoretical and clinical implications of the findings are discussed.

Cognitive appraisals in young people with obsessive-compulsive disorder

Background: A number of cognitive appraisals have been identified as important in the manifestation of obsessive-compulsive disorder (OCD) in adults. There have, however, been few attempts to explore these cognitive appraisals in clinical groups of young people. Method: This study compared young people aged between 11 and 18 years with OCD (N ¼ 28), young people with other types of anxiety disorders (N ¼ 28) and a non-clinical group (N ¼ 62) on three questionnaire measures of cognitive appraisals. These were inflated responsibility (Responsibility Attitude Scale; Salkovskis et al., 2000), thought–action fusion – likelihood other (Thought–Action Fusion Scale; Shafran, Thordarson & Rachman, 1996) and perfectionism (Multidimensional Perfectionism Scale; Frost, Marten, Luhart & Rosenblate, 1990). Results: The young people with OCD had significantly higher scores on inflated responsibility, thought–action fusion – (likelihood other), and one aspect of perfectionism, concern over mistakes, than the other groups. In addition, inflated responsibility independently predicted OCD symptom severity. Conclusions: The results generally support a downward extension of the cognitive appraisals held by adults with OCD to young people with the disorder. Some of the results, however, raise issues about potential developmental shifts in cognitive appraisals. The findings are discussed in relation to implications for the cognitive model of OCD and cognitive behavioural therapy for young people with OCD. Keywords: Cognitive models, inflated responsibility, obsessive-compulsive disorder, perfectionism, thought–action fusion. Abbreviations: ADIS-C: Anxiety Disorders Interview Schedule for Children; ADIS-P: Anxiety Disorders Interview Schedule for Parents; E/RP: Exposure/Response Prevention; LOI-CV: Leyton Obsessional Inventory – Child Version; MPS: Multidimensional Perfectionism Scale; OCD: Obsessive-Compulsive Disorder; RAS: Responsibility Attitude Scale; TAF-LO: Thought–Action Fusion – (Likelihood Other).

L3 acquisition: a focus on cognitive approaches

Interest in third language (L3) acquisition has increased exponentially in recent years, due to its potential to inform long-lasting debates in theoretical linguistics, language acquisition and psycholinguistics. Researchers investigating child and adult L3 acquisition have, from the very beginning, considered the many different cognitive factors that constrain and condition the initial state and development of newly acquired languages, and their models have duly evolved to incorporate insights from the most recent findings in psycholinguistics, neurolinguistics and cognitive psychology. The articles in this Special Issue of Bilingualism: Language and Cognition, in dealing with issues such as age of acquisition, attrition, relearning, cognitive economy or the reliance on different memory systems –to name a few–, provide an accurate portrayal of current inquiry in the field, and are a particularly fine example of how instrumental research in language acquisition and other cognitive domains can be to one another.

Influence of education and depressive symptoms on cognitive function in the elderly

Objective: The purpose of the present study was to investigate the influence that education and depression have on the performance of elderly people in neuropsychological tests. Methods: The study was conducted at the Institute of Psychiatry, University of Sao Paulo School of Medicine, Hospital das Clinicas. All of the individuals evaluated were aged 60 or older. The study sample consisted of 59 outpatients with depressive disorders and 51 healthy controls. We stratified the sample by level of education: low = 1-4 years of schooling; high = 5 or more years of schooling. Evaluations consisted of psychiatric assessment, cognitive assessment, laboratory tests and cerebral magnetic resonance imaging. Results: We found that level of education influenced all the measures of cognitive domains investigated (intellectual efficiency, processing speed, attention, executive function and memory) except the Digit Span Forward and Fuld Object Memory Evaluation (immediate and delayed recall), whereas depressive symptoms influenced some measures of memory, attention, executive function and processing speed. Although the combination of a low level of education and depression had a significant negative influence on Stroop Test part B, Trail Making Test part B and Logical Memory (immediate recall), we found no other significant effects of the interaction between level of education and depression. Conclusion: The results of this study underscore the importance of considering the level of education in the analysis of cognitive performance in depressed elderly patients, as well as the relevance of developing new cognitive function tests in which level of education has a reduced impact on the results.

Gait and risk of falls associated with frontal cognitive functions at different stages of Alzheimer's disease

The decline in frontal cognitive functions contributes to alterations of gait and increases the risk of falls in patients with dementia, a category which included Alzheimer's disease (AD). The objective of the present study was to compare the gait parameters and the risk of falls among patients at different stages of AD, and to relate these variables with cognitive functions. This is a cross-sectional study with 23 patients with mild and moderate AD. The Clinical Dementia Rating was used to classify the dementia severity. The kinematic parameters of gait (cadence, stride length, and stride speed) were analyzed under two conditions: (a) single task (free gait) and (b) dual task (walking and counting down). The risk of falls was evaluated using the Timed Up-and-Go test. The frontal cognitive functions were evaluated using the Frontal Assessment Battery (FAB), the Clock Drawing Test (CDT) and the Symbol Search Subtest. The patients who were at the moderate stage suffered reduced performance in their stride length and stride speed in the single task and had made more counting errors in the dual task and still had a higher fall risk. Both the mild and the moderate patients exhibited significant decreases in stride length, stride speed and cadence in the dual task. Was detected a significant correlation between CDT, FAB, and stride speed in the dual task condition. We also found a significant correlation between subtest Similarities, FAB and cadence in the dual task condition. The dual task produced changes in the kinematic parameters of gait for the mild and moderate AD patients and the gait alterations are related to frontal cognitive functions, particularly executive functions.

Brazilian adaptation of the Woodcock-Johnson III cognitive tests

An adaptation of the standard battery of Woodcock-Johnson III Tests of Cognitive Abilities (WJ-III) for Brazilian children and youth was investigated. The sample was composed of 1094 students (54 percent girls), ages 7-17, living in Sao Paulo state (91 percent). Items from Brazilian school books as well as from the WJ-III Spanish version (Bateria-R) were added to comprehension-knowledge tests. Brazilian words were adapted to the auditory tests according to syllabic division and stressed syllables. Items were examined through IRT and age differences through analysis of variance. Results indicated the need to remove items from all WJ-III subtests with the exception of the visual learning test. Analysis of Variance indicated significant age differences (p <= 0.001) for all tests. Thus, the importance of a Brazilian adaptation for the WJ-III was confirmed.

Homogamy preferences for cognitive sex-typicality in women

Homogamy has been suggested as crucial for human mate preferences and mate choice. People are attracted to and choose romantic partners that are similar to them in socio-demographic, physical, and psychological traits. However, only a few studies have shown homogamy in preferences for evolved sex-typical traits. Here, we have investigated male and female preferences for the level of cognitive masculinity-femininity (MF). We tested whether self-reported MF positively correlates with preferences for MF. One hundred men and one hundred women from Brazil filled in questionnaires on their own level of cognitive MF and preferred level of cognitive MF in their ideal partner. Half of the respondents were asked to indicate their preferences for long-term, and the other half for short-term relationships. We found a positive correlation between self-ascribed and preferred level of cognitive MF in women (P = 0.002), but no significant correlation in men (P = 0.309). There was no significant effect of the temporal context of the relationship, but there was a positive correlation between self-ascribed and preferred level of cognitive MF only in women answering about long-term partner. By subtracting the preferred from the selfascribed level of cognitive MF, we created a self-similarity index. We found that women desire potential mates more self-similar and more masculine than men (P < 0.001) and that in men there is greater variation in the self-similarity index than in women. Our results thus add to previous evidence on the role of homogamy in human mating, by showing preferences for self-similarity also in cognitive MF for women, especially for long-term partner preferences. Future studies should cross-culturally test whether the higher self-similar preference found in women is universal.

Cognitive Training and Educational Intervention for Individuals with Hypertension: Effects on Cognition

Objectives: To evaluate the possibility of combining cognitive training to an educational intervention composed by eight sessions about hypertension for a better management of the disease among the elderly. Methods: 64 older adults who reported having hypertension, divided into experimental group (EG, n=35) and control group (CG, n=29) participated in the study. Control participants received training after the post-test. The protocol contained socio-demographic and clinical data, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Rivermead Behavioral Memory Test (RBMT), Verbal Fluency Animal Category (VF) and Short Cognitive Test (SKT). Results: The EG showed better cognitive performance when compared with the CG, at post-test. Conclusion: Cognitive gains may occur after psychoeducational interventions for older adults with hypertension.

Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: A practical clinical trial

Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores >= 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n = 70) or fluoxetine (n = 88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p = 0.875). Patients presented a mean of 2.7 psychiatric comorbidities. and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p = 0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p = 0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population. (C) 2011 Elsevier Ltd. All rights reserved.