Evaluating circumlocution in naming as a predictor of communicative informativeness and efficiency in discourse.

Background: Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication. Aim: This study aimed to test whether, after controlling for naming accuracy, the addition of a measure of circumlocution into predictive models of discourse-level informativeness and efficiency would account for a significant amount more of the variance in these discourse-level outcomes. Methods & Procedures: Naming and discourse data from 43 people with poststroke aphasia were analyzed. Naming data were collected using 120 pictured items and discourse data were collected using two picture description prompts. Data scoring and coding yielded measures of naming accuracy, incorrect response type, communicative informativeness, and efficiency. We used robust hierarchical regression to evaluate study predictions. Outcomes & Results: After controlling for naming accuracy, the inclusion of circumlocution into predictive models accounted for a significant amount more of the variance in both informativeness and efficiency. The subsequent inclusion of other response types, such as real word and nonword errors, did not account for a significant amount more of the variance in either outcome. Conclusions: In addition to naming accuracy, the production of circumlocution during naming assessments may correspond with measures of informativeness and efficiency at the discourse-level. Reducing the burden of estimating patients' functional communication will increase our ability to estimate functional communication using tools that are easy to administer and interpret.

Baseline Conceptual-Semantic Impairment Predicts Longitudinal Treatment Effects for Anomia in Primary Progressive Aphasia and Alzheimer's Disease.

Background: An individual's diagnostic subtype may fail to predict the efficacy of a given type of treatment for anomia. Classification by conceptual-semantic impairment may be more informative. Aims: This study examined the effects of conceptual-semantic impairment and diagnostic subtype on anomia treatment effects in primary progressive aphasia (PPA) and Alzheimer's disease (AD). Methods & Procedures: At baseline, the picture and word versions of the Pyramids and Palm Trees and Kissing and Dancing tests were used to measure conceptual-semantic processing. Based on norming that was conducted with unimpaired older adults, participants were classified as being impaired on both the picture and word versions (i.e., modality-general conceptual-semantic impairment), the picture version (Objects or Actions) only (i.e., visual-conceptual impairment), the word version (Nouns or Verbs) only (i.e., lexical-semantic impairment), or neither the picture nor the word version (i.e., no impairment). Following baseline testing, a lexical treatment and a semantic treatment were administered to all participants. The treatment stimuli consisted of nouns and verbs that were consistently named correctly at baseline (Prophylaxis items) and/or nouns and verbs that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at three, seven, eleven, fourteen, eighteen, and twenty-one months. Outcomes & Results: Compared to baseline naming performance, lexical and semantic treatments both improved naming accuracy for treated Remediation nouns and verbs. For Prophylaxis items, lexical treatment was effective for both nouns and verbs, and semantic treatment was effective for verbs, but the pattern of results was different for nouns -- the effect of semantic treatment was initially nonsignificant or marginally significant, but it was significant beginning at 11 Months, suggesting that the effects of prophylactic semantic treatment may become more apparent as the disorder progresses. Furthermore, the interaction between baseline Conceptual-Semantic Impairment and the Treatment Condition (Lexical vs. Semantic) was significant for verb Prophylaxis items at 3 and 18 Months, and it was significant for noun Prophylaxis items at 14 and 18 Months. Conclusions: The pattern of results suggested that individuals who have modality-general conceptual-semantic impairment at baseline are more likely to benefit from lexical treatment, while individuals who have unimpaired conceptual-semantic processing at baseline are more likely to benefit from semantic treatment as the disorder progresses. In contrast to conceptual-semantic impairment, diagnostic subtype did not typically predict the treatment effects.

Listening to Yourself and Watching Your Tongue: Distinct Abilities and Brain Regions for Monitoring Semantic and Phonological Speech Errors.

Despite the many mistakes we make while speaking, people can effectively communicate because we monitor our speech errors. However, the cognitive abilities and brain structures that support speech error monitoring are unclear. There may be different abilities and brain regions that support monitoring phonological speech errors versus monitoring semantic speech errors. We investigated speech, language, and cognitive control abilities that relate to detecting phonological and semantic speech errors in 41 individuals with aphasia who underwent detailed cognitive testing. Then, we used support vector regression lesion symptom mapping to identify brain regions supporting detection of phonological versus semantic errors in a group of 76 individuals with aphasia. The results revealed that motor speech deficits as well as lesions to the ventral motor cortex were related to reduced detection of phonological errors relative to semantic errors. Detection of semantic errors selectively related to auditory word comprehension deficits. Across all error types, poor cognitive control related to reduced detection. We conclude that monitoring of phonological and semantic errors relies on distinct cognitive abilities and brain regions. Furthermore, we identified cognitive control as a shared cognitive basis for monitoring all types of speech errors. These findings refine and expand our understanding of the neurocognitive basis of speech error monitoring.

Aphasia severity is modulated by race and lesion size in chronic survivors: A retrospective study.

INTRODUCTION: In stroke survivors with aphasia (SWA), differences in behavioral language performance have been observed between Black and White Americans. These racial differences in aphasia outcomes may reflect biological stroke severity, disparities in access to care, potential assessment bias, or interactions between these factors and race. Understanding the origin of disparities in aphasia outcomes is critical to any efforts to promote health equity among SWA. In this study, we explore aphasia outcomes by examining the relationship between race, socioeconomic status, and neurological factors in SWA. METHOD: Eighty-five chronic left-hemisphere SWA (31 Black, 54 White) participated in the study. The primary aphasia outcome measure was the Western Aphasia Battery-Revised (WAB-R). Lesion size was measured based on manual lesion segmentations. FLAIR and T2 images were scored for severity of white matter disease. Independent sample t-tests were used to determine differences by race in education, age, income, aphasia severity, white matter disease, and lesion size. A linear regression model was used to explore factors that predicted aphasia severity on the WAB-R. RESULT: Level of education and estimated income differed by race in our sample. For predictors of aphasia severity, the regression model revealed a significant effect of lesion size on WAB Aphasia Quotient and an interaction of race x lesion size, such that Black and White participants with small lesions had similar WAB scores, but in individuals with larger lesions, Black participants had lower WAB scores than White participants. CONCLUSION: We suggest two explanations for the difference between Black and White SWA in the relationship between lesion size and aphasia severity. First, the impact of disparities in access to rehabilitation after stroke may be more evident when a stroke is larger and causes significant aphasia. Additionally, an assessment bias in aphasia outcome measures may be more evident with increasing severity of aphasia. Future studies should further discern the drivers of observed disparities in aphasia outcomes in order to identify opportunities to improve equity in aphasia care.

Distinguishing semantic control and phonological control and their role in aphasic deficits: A task switching investigation.

People use cognitive control across many contexts in daily life, yet it remains unclear how cognitive control is used in contexts involving language. Distinguishing language-specific cognitive control components may be critical to understanding aphasia, which can co-occur with cognitive control deficits. For example, deficits in control of semantic representations (i.e., semantic control), are thought to contribute to semantic deficits in aphasia. Conversely, little is known about control of phonological representations (i.e., phonological control) in aphasia. We developed a switching task to investigate semantic and phonological control in 32 left hemisphere stroke survivors with aphasia and 37 matched controls. We found that phonological and semantic control were related, but dissociate in the presence of switching demands. People with aphasia exhibited group-wise impairment at phonological control, although individual impairments were subtle except in one case. Several individuals with aphasia exhibited frank semantic control impairments, and these individuals had relative deficits on other semantic tasks. The present findings distinguish semantic control from phonological control, and confirm that semantic control impairments contribute to semantic deficits in aphasia.

Absence of Perilesional Neuroplastic Recruitment in Chronic Poststroke Aphasia.

BACKGROUND AND OBJECTIVES: A prominent theory proposes that neuroplastic recruitment of perilesional tissue supports aphasia recovery, especially when language-capable cortex is spared by smaller lesions. This theory has rarely been tested directly and findings have been inconclusive. We tested the perilesional plasticity hypothesis using 2 fMRI tasks in 2 groups of patients with previous aphasia diagnosis. METHODS: Two cohorts totaling 82 patients with chronic left-hemisphere stroke with previous aphasia diagnosis and 82 control participants underwent fMRI using either a naming task or a reliable semantic decision task. Individualized perilesional tissue was defined by dilating anatomical lesions and language regions were defined using meta-analyses. Mixed modeling examined differences in activity between groups. Relationships with lesion size and aphasia severity were examined. RESULTS: Patients exhibited reduced activity in perilesional language tissue relative to controls in both tasks. Although a few cortical regions exhibited greater activity irrespective of distance from the lesion, or only when distant from the lesion, no regions exhibited increased activity only when near the lesion. Larger lesions were associated with reduced language activity irrespective of distance from the lesion. Using the reliable fMRI task, reduced language activity was related to aphasia severity independent of lesion size. DISCUSSION: We found no evidence for neuroplastic recruitment of perilesional tissue in aphasia beyond its typical role in language. Rather, our findings are consistent with alternative hypotheses that changes in left-hemisphere activation during recovery relate to normalization of language network dysfunction and possibly recruitment of alternate cortical processors. These findings clarify left-hemisphere neuroplastic mechanisms supporting language recovery after stroke.

Two types of phonological reading impairment in stroke aphasia.

Alexia is common in the context of aphasia. It is widely agreed that damage to phonological and semantic systems not specific to reading causes co-morbid alexia and aphasia. Studies of alexia to date have only examined phonology and semantics as singular processes or axes of impairment, typically in the context of stereotyped alexia syndromes. However, phonology, in particular, is known to rely on subprocesses, including sensory-phonological processing, motor-phonological processing, and sensory-motor integration. Moreover, many people with stroke aphasia demonstrate mild or mixed patterns of reading impairment that do not fit neatly with one syndrome. This cross-sectional study tested whether the hallmark symptom of phonological reading impairment, the lexicality effect, emerges from damage to a specific subprocess of phonology in stroke patients not selected for alexia syndromes. Participants were 30 subjects with left-hemispheric stroke and 37 age- and education-matched controls. A logistic mixed-effects model tested whether post-stroke impairments in sensory phonology, motor phonology, or sensory-motor integration modulated the effect of item lexicality on patient accuracy in reading aloud. Support vector regression voxel-based lesion-symptom mapping localized brain regions necessary for reading and non-orthographic phonological processing. Additionally, a novel support vector regression structural connectome-symptom mapping method identified the contribution of both lesioned and spared but disconnected, brain regions to reading accuracy and non-orthographic phonological processing. Specifically, we derived whole-brain structural connectomes using constrained spherical deconvolution-based probabilistic tractography and identified lesioned connections based on comparisons between patients and controls. Logistic mixed-effects regression revealed that only greater motor-phonological impairment related to lower accuracy reading aloud pseudowords versus words. Impaired sensory-motor integration was related to lower overall accuracy in reading aloud. No relationship was identified between sensory-phonological impairment and reading accuracy. Voxel-based and structural connectome lesion-symptom mapping revealed that lesioned and disconnected left ventral precentral gyrus related to both greater motor-phonological impairment and lower sublexical reading accuracy. In contrast, lesioned and disconnected left temporoparietal cortex is related to both impaired sensory-motor integration and reduced overall reading accuracy. These results clarify that at least two dissociable phonological processes contribute to the pattern of reading impairment in aphasia. First, impaired sensory-motor integration, caused by lesions disrupting the left temporoparietal cortex and its structural connections, non-selectively reduces accuracy in reading aloud. Second, impaired motor-phonological processing, caused at least partially by lesions disrupting left ventral premotor cortex and structural connections, selectively reduces sublexical reading accuracy. These results motivate a revised cognitive model of reading aloud that incorporates a sensory-motor phonological circuit.

Intellectual awareness of naming abilities in people with chronic post-stroke aphasia.

Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.

Reinforcer pathology in cocaine use disorder: Temporal window determines cocaine valuation.

AIMS: The Experimental Medicine Approach offers a unique perspective to determine clinical behavior change by engaging a target underlying the cause of a disorder. The present work engaged a novel target of addiction, Reinforcer Pathology, in two studies to test changes in behavior among individuals with cocaine use disorder. METHODS: In Study 1, n = 44 participants engaged the temporal window with episodic future thinking (EFT), a positive prospection exercise. Changes in temporal view and cocaine valuation were tested using delay discounting and behavioral economic demand, respectively. Additionally, a computational model assessed the relative reliance on the near- and far-sighted systems during EFT. In Study 2, n = 71 engaged the temporal window with a negatively-valenced hurricane scenario to test the opposite effects on window length and cocaine valuation. RESULTS: Results demonstrated systematic and symmetrical engagement of the behavioral target. Study 1 robustly replicated previous work, wherein EFT lengthened the temporal window and decreased cocaine valuation. Moreover, EFT increased the weighting of the modeled far-sighted system, increasing the relative impact of long-term discounting decisions. Study 2 produced opposite outcomes, shortened temporal window and increased cocaine valuation. CONCLUSIONS: This approximately equal and opposite reaction to the manipulations supports reinforcer pathology theory and implicates the temporal window over which rewards are valued as a target to be pushed and pulled to produce clinically meaningful behavior change. Using the Experimental Medicine Approach as a guide, future work should identify new potential interventions to engage reinforcer pathology and use the clinically relevant outcomes as a litmus test for mechanism.

A reinforcer pathology model of health behaviors in individuals with obesity.

Objective: Research concerning trans-disease processes aims to ascertain an underlying mechanism of several seemingly dissonant behaviors, pathological conditions, or both. The theory of reinforcer pathology posits that excessive delay discounting and the maladaptive overvaluation of a particular commodity underlie a variety of dysfunctional health behavior ranging from substance abuse to overeating and financial responsibility. The present study extends recent health behavior research by examining the extent delay discounting and food valuation correlate with engagement in a latent factor model of health and financial behaviors among healthy-weight participants and participants with obesity using the Health Behaviors Questionnaire. Method: A total of 700 participants (n = 340, body mass index [BMI] < 30; n = 360, BMI > 30 kg/m2) were recruited using Amazon Mechanical Turk. Participants completed a monetary delay discounting assessment, the Health Behaviors Questionnaire, and 2 measures of food valuation: Behavioral economic demand and the Power of Food Scale (PFS). Results: Utilizing structural equation modeling, both delay discounting and food valuation significantly correlated with engagement in health and financial behavior for both groups. The comparison of latent factors between groups indicated that participants with obesity were less likely to engage in multiple health behaviors and that these differences can be partially attributed to differences in delay discounting and food valuation. Conclusion: These results replicate previous research and further support the role of delay discounting as a trans-disease process. Given these results, trans-disease interventions, such as episodic future thinking, designed to specifically target reinforcer pathology may have a profound effect on overall functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reinforcer Pathology: Implications for Substance Abuse Intervention.

The rate at which individuals discount future rewards (i.e., discounting rate) is strongly associated with their propensity for substance abuse as well as myriad other negative health behaviors. An excessive preference for immediately available rewards suggests a shortened time horizon in which immediate rewards are overvalued and future, potentially negative consequences are undervalued. This review outlines Reinforcer Pathology Theory (i.e., the interaction between excessive preference for immediately available rewards and the overvaluation of a particular commodity that offers brief, intense reinforcement), its neurobiological/behavioral underpinnings, and its implications for treating substance use disorders. In doing so, the current review provides an overview of a variety of ways in which interventions have been used to manipulate aspects of reinforcer pathology in an individual, including narrative theory, framing manipulations, and neuromodulation (e.g., working memory training, TMS) which may serve as promising avenues for the modulation of the temporal window and/or valuation of reinforcers.

Overcoming non-compliance with clinical trial registration and results reporting: One Institution's approach.

ClinicalTrials.gov is a web-based resource which provides the general public, healthcare professionals, patients, and caregivers access to privately and publicly supported clinical trials and trial results. The web site is maintained by the National Library of Medicine (NLM) at the National Institutes of Health (NIH) (ClinicalTrials.gov Background, 2018). The penalties for non-compliance with the legal obligations under FDAAA 801 (Food and Drug Administration Amendments Act of 2007) and the NIH requirements for registering and reporting results on studies within certain timeframes can result in large monetary fines and the withholding of federal funds (ClinicalTrials.gov FDAAA 801 and the Final Rule, 2019). Years following, in 2016, the Final Rule expanded upon the requirement with additional data elements for both registration and result submission records in accordance of FDAAA 801 (ClinicalTrials.gov FDAAA 801 and the Final Rule, 2019). The Medical University of South Carolina (MUSC), along with the institution's Office of Clinical Research and Regulatory Knowledge & Support group, identified issues affecting their own compliance rate with FDAAA 801 and the NIH and implemented several processes to overcome these challenges. In short, these processes included hiring a designated full-time ClinicalTrials.gov coordinator, implementing a workflow that identifies trials early in the IRB approval process requiring registration (without effecting study start up timelines), assisting researchers when navigating the registration and results reporting process through one-on-one consultations, Lunch and Learns, and disseminating new training tools as they become available. Over the next 12 months the results of this approach demonstrated a marked increase to 98% overall compliance with these federal regulations which may provide valuable guidance for other institutions working toward improved compliance rates.

Grammatical Ability Predicts Relative Action Naming Impairment in Primary Progressive Aphasia.

BACKGROUND: Findings from several studies have indicated that participants with nfvPPA and participants with svPPA exhibit different patterns on action and object naming tasks, while other recent studies have found that neither participants with nfvPPA nor participants with svPPA show a significant difference in accuracy between object naming and action naming. AIMS: The goal of this study was to test the hypothesis that relative action naming impairment is associated with grammatical ability in PPA, rather than a specific subtype of PPA. METHODS & PROCEDURES: Thirty-four participants with PPA completed the Boston Naming Test, the Action Naming subtest of the Boston Diagnostic Aphasia Examination, and the Northwestern Anagram Test, which was used to measure grammatical ability. Z-scores for the two naming tasks were calculated based on normative data from unimpaired controls. For each participant with PPA, the relative action naming impairment was calculated by subtracting the object naming z-score from the action naming z-score. Linear regression analysis was then used to evaluate the role of grammatical ability as a predictor of relative action naming impairment, while controlling for age, education, cognitive ability (as measured by the Montreal Cognitive Assessment), and semantic ability (as measured by the Pyramids and Palm Trees test). The interaction between grammatical ability and each control variable was also examined. OUTCOMES & RESULTS: The main effect of grammatical ability was a significant predictor of relative action naming impairment, while none of the control variables was a significant predictor. However, the interaction between grammatical ability and semantic ability was also significant. CONCLUSIONS: Individuals who have both grammatical impairment and semantic impairment have the largest relative action naming impairment. These individuals may benefit from a treatment that focuses on the retrieval of verbs and their arguments.

Reinforcer pathology: Narrative of hurricane-associated loss increases delay discounting, demand, and consumption of highly palatable snacks in the obese.

Reinforcer pathology is derived from the integration of two measures: (a) self-control (i.e., delay discounting), and (b) reward valuation (i.e., behavioral economic demand). Narrative theory asserts that vividly imagining oneself in a hypothetical, yet realistic, scenario can acutely alter decision making, valuation of reinforcers such as food, and how much food is consumed. The present study measured changes in reinforcer pathology for highly palatable snacks following either a negative or neutral scenario in obese individuals. Participants (N = 48), with a body mass index of 30 or greater, rated their liking of 7 calorie-dense snack items and completed discounting and purchase demand tasks for their top-rated snack. Participants then read a randomly assigned hypothetical scenario (i.e., a devastating hurricane [negative] or minor storm [neutral]), completed the tasks again, and were given ad libitum access to their top 3 ranked snack foods. Results indicated that delay discounting, demand for participants' top-rated snack food, and negative affect all increased in the hurricane group compared with the minor storm group. The hurricane group also consumed more calories, even when hunger was standardized with a preload meal bar. Consistent with reinforcer pathology, these results suggest that vivid consideration of a devastating scenario constricts the temporal window and increases demand for hedonic snack foods among obese individuals. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Practicing prospection promotes patience: Repeated episodic future thinking cumulatively reduces delay discounting.

BACKGROUND: Delay discounting, or the preference for smaller, sooner over larger, later rewards, has been associated with alcohol use disorder and problem drinking. Episodic future thinking has been suggested as an intervention to address steep delay discounting. In the present study, we examined the effect of up to six consecutive sessions of episodic future thinking. METHODS: Repeated, within-subject data were collected from current and recent problem drinkers (n = 50) over six sessions. Linear mixed-effect models were used to estimate effects of repeated sessions and manipulations. Participants completed episodic future thinking interviews at up to six sessions, in which they generated personalized future events. Participants also engaged with cues of scarcity. At each session, participants completed three delay discounting tasks under: a no-cue baseline condition, a future cue condition, and a scarcity cue condition. RESULTS: Delay discounting in the no cue condition did not change over time. Discounting rates were reduced in the future cue condition, and these effects grew larger with repeated sessions. In the scarcity condition, discounting rates were slightly higher, with no effect of repeated sessions. CONCLUSIONS: Episodic future thinking reduced delay discounting rate while future cues were presented, and these effects grew larger with repeated sessions. This suggests that repeated episodic future thinking may cumulatively potentiate repair of excessive preference for immediate reward.

The Subjective Experience of Inner Speech in Aphasia Is a Meaningful Reflection of Lexical Retrieval.

Purpose Individuals with aphasia often report that they feel able to say words in their heads, regardless of speech output ability. Here, we examine whether these subjective reports of successful "inner speech" (IS) are meaningful and test the hypothesis that they reflect lexical retrieval. Method Participants were 53 individuals with chronic aphasia. During silent picture naming, participants reported whether or not they could say the name of each item inside their heads. Using the same items, they also completed 3 picture-based tasks that required phonological retrieval and 3 matched auditory tasks that did not. We compared participants' performance on these tasks for items they reported being able to say internally versus those they reported being unable to say internally. Then, we examined the relationship of psycholinguistic word features to self-reported IS and spoken naming accuracy. Results Twenty-six participants reported successful IS on nearly all items, so they could not be included in the item-level analyses. These individuals performed correspondingly better than the remaining participants on tasks requiring phonological retrieval, but not on most other language measures. In the remaining group ( n = 27), IS reports related item-wise to performance on tasks requiring phonological retrieval, but not to matched control tasks. Additionally, IS reports were related to 3 word characteristics associated with lexical retrieval, but not to articulatory complexity; spoken naming accuracy related to all 4 word characteristics. Six participants demonstrated evidence of unreliable IS reporting; compared with the group, they also detected fewer errors in their spoken responses and showed more severe language impairments overall. Conclusions Self-reported IS is meaningful in many individuals with aphasia and reflects lexical phonological retrieval. These findings have potential implications for treatment planning in aphasia and for our understanding of IS in the general population.

The phenotype of recovery III: Delay discounting predicts abstinence self-efficacy among individuals in recovery from substance use disorders.

Abstinence self-efficacy (ASE) and delay discounting predict treatment outcomes and risk of relapse. Associations between delay discounting and ASE among individuals in recovery from substance use have not been investigated. Data from 216 individuals in recovery from substance abuse recruited from The International Quit & Recovery Registry, an ongoing online data collection program used to understand addiction and how people succeed in recovery, were included in the analysis. Discounting rates were assessed using an adjusting-delay task, and ASE was assessed using the Relapse Situation Efficacy Questionnaire (RSEQ). Delay discounting was a significant predictor of ASE, even after controlling for age, gender, race, ethnicity, annual income, education level, marital status, and primary addiction. Context-specific factors of relapse included Negative Affect, Positive Affect, Restrictive Situations (to drug use), Idle Time, Social-Food Situations, Low Arousal, and Craving. A principal component analysis of RSEQ factors in the current sample revealed that self-efficacy scores were primarily unidimensional and not situation specific. The current study expands the generality of delay discounting and indicates that discounting rates predict ASE among individuals in recovery from substance use disorders. This finding supports the recent characterizations of delay discounting as a candidate behavioral marker of addiction and may serve as a basis to better identify and target subgroups that need unique or more intensive interventions to address higher risks of relapse and increase their likelihood of abstinence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Self-reported inner speech relates to phonological retrieval ability in people with aphasia.

Many individuals with aphasia report the ability to say words in their heads despite spoken naming difficulty. Here, we examined individual differences in the experience of inner speech (IS) in participants with aphasia to test the hypotheses that self-reported IS reflects intact phonological retrieval and that articulatory output processing is not essential to IS. Participants (N = 53) reported their ability to name items correctly internally during a silent picture-naming task. We compared this measure of self-reported IS to spoken picture naming and a battery of tasks measuring the underlying processes required for naming (i.e., phonological retrieval and output processing). Results from three separate analyses of these measures indicate that self-reported IS relates to phonological retrieval and that speech output processes are not a necessary component of IS. We suggest that self-reported IS may be a clinically valuable measure that could assist in clinical decision-making regarding anomia diagnosis and treatment.

Willing to Work But Not to Wait: Individuals with Greater Alcohol Use Disorder Show Increased Delay Discounting Across Commodities and Less Effort Discounting for Alcohol.

BACKGROUND: Delay discounting refers to the devaluation of a reward given increasing delays to delivery. Similarly, effort discounting refers to the devaluation of a reward given increasing effort required to obtain it. Individuals with substance use disorder show higher rates of delay discounting, exacerbating short-term positive reinforcement at the expense of long-term consequences. This study explores how effort discounting compares to delay discounting behavior among alcohol users as well as how these preferences change between monetary and alcohol rewards. METHODS: A total of 100 participants completed an online survey through Amazon Mechanical Turk. Participant alcohol use was evaluated using DSM-5 and the Alcohol Use Disorders Identification Test criteria. All participants completed 4 randomized discounting tasks involving delay or effort discounting, in which the reward was money or alcohol. A follow-up experiment (n = 423) added the alcohol purchase task to assess alcohol valuation. RESULTS: Individuals with greater alcohol use disorder (AUD) severity discounted future money and alcohol significantly more than those with less AUD. However, individuals meeting more DSM-5 criteria were only willing to perform more effort for alcohol. The follow-up experiment replicated these findings and demonstrated that individuals with greater AUD also showed an increased valuation of alcohol and alcohol value-mediated effort discounting. CONCLUSIONS: These results suggest that individuals with greater AUD were less willing to wait for money or alcohol. While all participants were willing to work for money regardless of AUD severity, individuals with greater AUD showed increased valuation of alcohol drinks and were willing to exert more effort to obtain alcohol. Together, these results paint a picture of individuals with increased AUD as both more impulsive and willing to work to obtain alcohol, contributing to our understanding of decision making among individuals who abuse substances.

Using an Experimental Medicine Approach to Identify Novel Determinants of Addiction.

Our understanding and effectiveness in treating addiction is not fully adequate. Therefore, perhaps developing a pragmatic theory for identifying novel determinants and potential interventions is needed. The experimental medicine approach, derived from Claude Bernard, proposes a methodology for inductive theory development and suggests interventions directed at targets closely aligned with the underlying mechanisms of the disorder. The steps of theory development under this approach are intended to (1) identify an intervention target; (2) develop assays to verify target measurement; (3) engage the target via experiment or intervention; and (4) test the degree to which target engagement produces other therapeutically useful changes in the disorder. In this article, we review these steps in detail using an example from our work. That is, shortened temporal windows (target) is frequently observed among those who are addicted. Delay discounting is an assay used to measure that target. We and others have demonstrated manipulation of the target, delay discounting, is associated with changing the drug valuation among those with addiction. We conclude with a culmination of the experimental medicine approach by proposing a recently developed hypothesis of substance use disorder, Reinforcer Pathology 2.0.