When less is more: How fewer diagnostic criteria can indicate greater severity.

For diagnosing many mental disorders, the current Diagnostic and Statistical Manual of Mental Disorders (DSM) system weights each diagnostic criterion equally—each criterion counts the same toward meeting the diagnostic threshold. Research on the diagnostic efficiency of criteria, however, reveals that some diagnostic criteria are more useful than others for identifying their associated mental disorders. That some criteria are more useful than others suggests that the criteria may indicate different levels of severity, but this has yet to be empirically tested. Using data from a large epidemiological study (N = 41,227) and two-parameter logistic item response theory models, the level of latent severity associated with each diagnostic criterion for a particular DSM mental disorder was estimated. Maximum likelihood estimates for all possible response patterns to the criteria were then calculated, and results indicated that items and combinations of items identified varying levels of severity. Furthermore, different response patterns associated with the same raw score identified a range (or band) of latent severity. In many instances, these bands overlapped, revealing that some response patterns with fewer endorsed criteria had higher estimated latent severity than did response patterns with more endorsed criteria. Specifically, many response patterns associated with a raw score of 3 (below threshold for the analyzed disorder) indicated greater latent severity than did response patterns associated with a raw score of 4 (at threshold). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When more is less: A counterintuitive effect of distractor frequency in the picture-word interference paradigm.

Pictures were shown with superimposed word distractors of high and low frequency. Low-frequency distractors produced greater interference on picture naming than did high-frequency distractors. This distractor frequency effect was not affected by manipulations that facilitated or hindered distractor recognition. Interference was reduced for distractors that were read aloud several times prior to being shown in the picture-naming task. Together these findings suggest that the distractor frequency effect has its locus at some stage of lexical access for production. Other findings further constrain hypotheses about which level of speech production is involved in the effect. The distractor frequency effect has implications for models of lexical processing in speaking as well as for accounts of picture-word interference and the frequency effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive behavior therapy for diagnostically heterogeneous groups: A benchmarking study.

Researchers have recently suggested that the commonalities across the emotional disorders outweigh the differences, and thus similar treatment principles could be applied in unified interventions. In this study, the authors used a benchmarking strategy to investigate the transportability of cognitive-behavioral therapy (CBT) for anxiety and depression to mixed-diagnosis groups. Patients (N = 143) attended 10 2-hour sessions of group CBT plus a 1-month follow-up. Changes in anxiety and depression were indexed by effect sizes, reliable change, and clinically significant change and then benchmarked to previous efficacy and effectiveness studies. Symptoms of depression and anxiety significantly improved, and mixed-diagnosis groups compared favorably with diagnosis-specific CBT, suggesting that unified treatments are an effective, efficient, and practical method of treatment delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraindividual variability is related to cognitive change in older adults: Evidence for within-person coupling.

In this study, the authors addressed the longitudinal nature of intraindividual variability over 3 years. A sample of 304 community-dwelling older adults, initially between the ages of 64 and 92 years, completed 4 waves of annual testing on a battery of accuracy- and latency-based tests covering a wide range of cognitive complexity. Increases in response-time inconsistency on moderately and highly complex tasks were associated with increasing age, but there were significant individual differences in change across the entire sample. The time-varying covariation between cognition and inconsistency was significant across the 1-year intervals and remained stable across both time and age. On occasions when intraindividual variability was high, participants' cognitive performance was correspondingly low. The strength of the coupling relationship was greater for more fluid cognitive domains such as memory, reasoning, and processing speed than for more crystallized domains such as verbal ability. Variability based on moderately and highly complex tasks provided the strongest prediction. These results suggest that intraindividual variability is highly sensitive to even subtle changes in cognitive ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory–II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retesting in selection: A meta-analysis of coaching and practice effects for tests of cognitive ability.

Previous studies have indicated that as many as 25% to 50% of applicants in organizational and educational settings are retested with measures of cognitive ability. Researchers have shown that practice effects are found across measurement occasions such that scores improve when these applicants retest. In this study, the authors used meta-analysis to summarize the results of 50 studies of practice effects for tests of cognitive ability. Results from 107 samples and 134,436 participants revealed an adjusted overall effect size of .26. Moderator analyses indicated that effects were larger when practice was accompanied by test coaching and when identical forms were used. Additional research is needed to understand the impact of retesting on the validity inferences drawn from test scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive therapy for depression in a community mental health center: A benchmarking study.

The current study examined the feasibility and effectiveness of transporting an empirically supported treatment for depression, cognitive therapy (CT), to a community mental health center setting. CT was delivered to 192 adult outpatients with major depression, and a benchmarking strategy compared results with those of 2 randomized controlled trials (RCTs). The 3 samples were largely similar in terms of initial severity of depression, and CT was as effective in reducing depressive symptoms in the current sample as in the RCTs. More favorable outcome was associated with less severe initial depression, more therapy sessions, more years of education, and absence of a comorbid personality disorder. This study demonstrates that an empirically supported treatment can be transported effectively to a clinical setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting outcome in computerized cognitive behavioral therapy for depression in primary care: A randomized trial.

Objective: To explore pretreatment and short-term improvement variables as potential moderators and predictors of 12-month follow-up outcome of unsupported online computerized cognitive behavioral therapy (CCBT), usual care, and CCBT combined with usual care for depression. Method: Three hundred and three depressed patients were randomly allocated to (a) unsupported online CCBT, (b) treatment as usual (TAU), or (c) CCBT and TAU combined (CCBT&TAU). Potential predictors and moderators were demographic, clinical, cognitive, and short-term improvement variables. Outcomes were the Beck Depression Inventory–II score at 12 months of follow-up and reliable change. Results: Those with higher levels of extreme (positive) responding had a better outcome in CCBT compared with TAU, whereas those having a parental psychiatric history or a major depressive disorder diagnosis had a better outcome in CCBT&TAU compared with TAU. Predictors regardless of treatment type included current employment, low pretreatment illness severity, and short-term improvement on clinical variables. Conclusions: Optimistic patients, holding approach-oriented coping strategies, might benefit most from CCBT, whereas CCBT&TAU might be the most suitable option for those with more severe vulnerability characteristics. Those with the least impairment improve the most, regardless of treatment type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common method biases in behavioral research: A critical review of the literature and recommended remedies.

Interest in the problem of method biases has a long history in the behavioral sciences. Despite this, a comprehensive summary of the potential sources of method biases and how to control for them does not exist. Therefore, the purpose of this article is to examine the extent to which method biases influence behavioral research results, identify potential sources of method biases, discuss the cognitive processes through which method biases influence responses to measures, evaluate the many different procedural and statistical techniques that can be used to control method biases, and provide recommendations for how to select appropriate procedural and statistical remedies for different types of research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy.

Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance and commitment therapy for smoking cessation: A preliminary study of its effectiveness in comparison with cognitive behavioral therapy.

This controlled preliminary trial determined the feasibility and initial effectiveness of a promising behavioral intervention for smoking: Acceptance and Commitment Therapy (ACT). In a quasi-experimental design, the ACT intervention condition used metaphors and experiential exercises focused on personal values to motivate quitting smoking and enhancing the willingness to experience internal cues to smoke (e.g., urges) and abstinence-related internal distress. The comparison condition was cognitive behavioral therapy (CBT)—the current standard in behavioral intervention for smoking cessation. Each treatment was delivered in seven weekly 90-min sessions in a group format to 81 (43 in ACT; 38 in CBT) adult smokers. Results show that the ACT treatment was as feasible as the CBT treatment. They also demonstrate promising evidence of ACT’s effectiveness: 30.2% intent-to-treat biochemically-supported 30-day point prevalence at twelve month follow-up, compared with 13.2% in the CBT condition (odds ratio = 5.13; p = .02). Replication in a well-powered, randomized, controlled trial is now needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing cognitive behavioral therapy for chronic fatigue syndrome in a mental health center: A benchmarking evaluation.

Objective: This study evaluated the success of implementing cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) in a representative clinical practice setting and compared the patient outcomes with those of previously published randomized controlled trials (RCTs) of CBT for CFS. Method: The implementation interventions were the following: spreading information about the new treatment setting to general practitioners and CFS patients; training mental health center (MHC) therapists in CBT for CFS; and organizing changes in the MHC patient workflow. Patient outcomes were documented with validated self-report measures of fatigue and physical functioning before and after treatment. The comparison of the treatment results with RCT results was done following the benchmark strategy. Results: One-hundred forty-three CFS patients were referred to the MHC, of whom 112 started treatment. The implementation was largely successful, but a weak point was the fact that 32% of all referred patients dropped out shortly after or even before starting treatment. Treatment effect sizes were in the range of those found in the benchmark studies. Conclusions: CBT for CFS can successfully be implemented in an MHC. Treatment results were acceptable, but the relatively large early dropout of patients needs attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p     

Prototype personality diagnosis in clinical practice: A viable alternative for DSM–5 and ICD–11.

Several studies suggest that a prototype-matching approach yields diagnoses of comparable validity to the more complex diagnostic algorithms outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Furthermore, clinicians prefer prototype diagnosis of personality disorders to the current categorical diagnostic system or alternative dimensional methods. An important extension of this work was to investigate the degree to which clinicians are able to make prototype diagnoses reliably. The aim of this study was to assess the interrater reliability of a prototype-matching approach to personality diagnosis in clinical practice. Using prototypes derived empirically in prior research, outpatient clinicians diagnosed patients' personality after an initial evaluation period. External evaluators independently diagnosed the same patients after watching videotapes of the same clinical hours. Interrater reliability for prototype diagnosis was high, with a median r = .72. Cross-correlations between disorders were low, with a median r = .01. Clinicians and clinically trained independent observers can assess complex personality constellations with high reliability using a simple prototype-matching procedure, even with prototypes that are relatively unfamiliar to them. In light of its demonstrated reliability, efficiency, and versatility, prototype diagnosis appears to be a viable system for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the 11th edition of the International Classification of Diseases, with exceptional utility for research and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of slight to moderate risk for birth hypoxia on acquisition of cognitive and language function in the preterm infant: A cross-sectional comparison with preterm-birth controls.

The cognitive and language performance of a group of 26 preterm-birth preschool and early school-age children with slight to moderate risk for perinatal hypoxia was compared with the performance of a preterm-birth comparison group of 26 children. Despite the relatively small discrepancy in degree of risk, the cognitive performance of the 2 groups diverged significantly. When data for children with known perinatal arterial pH were combined, a curvilinear (quadratic) regression model provided the best fit. Increasing acidosis was linearly related to decreases in cognitive skills, with the bend in the curve occurring well within the normal range of pH values. Hence, in the preterm infant, even minor risk for birth hypoxia may result in discernible deviation from the expected developmental trajectory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)