A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences.

BACKGROUND: Clients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences. METHOD: The Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2-week interval in between. RESULTS: The positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test-retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well-being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three-factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self-)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences. CONCLUSIONS: In the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.

Can false denials turn fact into fiction? The effect of false denials on memory for self-performed actions.

We examined the mnemonic effects of falsely denying a self-performed action. Specifically, participants (N = 30) performed, imagined, or received no instruction about 24 action statements (e.g., "cross your arms"). Next, their memory for whether they had performed, imagined, or did nothing (i.e., received no instructions) with these actions was tested. Subsequently, participants were instructed to repeatedly deny an action they had performed (false denial) and to repeatedly claim to have performed an action they had only imagined (false admission). In a final sorting memory task, 54% (n = 16) of participants erroneously indicated, after false admissions, that they had performed the imagined action. None of the participants indicated that they had only imagined an action after false denials, showing that it might be difficult to forget a performed action, even after repeatedly denying it. The current experiment sets the stage for future research to investigate why it seems to be difficult to forget performed actions.

Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework.

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identifyempirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation.

No self-serving bias in therapists' evaluations of clients' premature treatment termination: An approximate replication of Murdock et al. (2010).

In an often-cited study, Murdock et al. (2010) found that therapists are more likely to attribute premature treatment termination to client characteristics than to themselves, a finding that the authors interpreted in terms of a self-serving bias (SSB). We replicated and extended the study of Murdock et al. (2010, study 2). Psychologists and psychotherapists (N = 91) read two case vignettes about premature treatment terminations of clients that, in a between-subjects set-up, were either described as own clients or other therapists' clients. Next, participants used three attribution subscales (blaming therapist, client and situation) to evaluate potential causes for the premature terminations. This way, we tested whether participants would manifest SSB. We also investigated whether therapists' scores on self-confidence and need for closure were linked to SSB tendencies. Unlike Murdock et al. (2010), we found no overall SSB. However, a stronger need for closure was related to more SSB tendencies (i.e., less endorsement of 'blame therapist' attributions) in the own-client condition (r = -.35, p < .05, r2 = .12), but not in the other-therapist's-client condition (r = .17, p = .27). Our results suggest that SSB is not a ubiquitous phenomenon when therapists evaluate premature termination problems and that their willingness to attend to their own role depends to some extent on their need for closure.

Memory and eye movement desensitization and reprocessing therapy: a potentially risky combination in the courtroom.

Does Eye Movement and Desensitization and Reprocessing (EMDR) therapy affect the accuracy of memories? This recurrent issue in recent memory research bears relevance to expert witness work in the courtroom. In this review, we will argue that several crucial aspects of EMDR may be detrimental to memory. First, research has shown that eye movements undermine the quality and quantity of memory. Specifically, eye movements have been shown to decrease the vividness and emotionality of autobiographical experiences and amplify spontaneous false memory levels. Second, a sizeable proportion of EMDR practitioners endorse the controversial idea of repressed memories and discuss the topic of repressed memory in therapy. Third, in the Dutch EMDR protocol, patients are instructed to select the target image by using flawed metaphors of memory (e.g., memory works as a video). Such instructions may create demand characteristics to the effect that people over-interpret imagery during therapy as veridical memories. Collectively, the corpus of research suggests that several components of EMDR therapy (i.e., performing eye movements, therapist beliefs and therapeutic instructions) may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.

Associations between supernormality ('faking good'), narcissism and depression: An exploratory study in a clinical sample.

We explored underreporting of mental health symptoms and its correlates in adults receiving psychological treatment. We administered the Supernormality Scale (SS), the Minnesota Multiple Personality Inventory-2 (Restructured Form, MMPI-2-RF), the Narcissistic Personality Inventory (NPI) and the Beck Depression Inventory-II (BDI-2) to 147 patients at the start of their treatment. Supernormality (i.e., denial of common symptoms) was positively associated with MMPI-2(-RF) faking good parameters supporting the construct validity of the SS. Narcissism was negatively related to self-reported depression symptoms, but this association failed to reach significance (r = -.15, p = .07). This suggests that patients high on grandiose/overt narcissism might tend to deny common symptoms. The link between supernormality and depression symptoms as measured by the BDI-2 was substantial and negative (r = -.72). Our data suggest that supernormality is associated with constricted self-reports of depression. Given the clinical relevance of symptom underreporting, our preliminary findings require a large-scale replication.

Verifiability on the run: an experimental study on the verifiability approach to malingered symptoms.

Several studies on the verifiability approach found that truth-tellers report more verifiable details than liars. Therefore, we wanted to test whether such a difference would emerge in the context of malingered symptoms. We obtained statements from undergraduates (N = 53) who had been allocated to three different conditions: truth-tellers, coached malingerers and naïve malingerers. Truth-tellers carried out an intensive physical exercise and after a short interval wrote a report about their experience and elicited symptoms. The two malingering groups had to fabricate a story about the physical activity and its symptoms. Truth-tellers did not generate more verifiable details than malingerers. However, malingerers reported more non-verifiable details than truth-tellers. Coached and naïve malingerers did not differ in this respect. Relative to truth-tellers, naïve malingerers reported more symptoms-related non-verifiable details, while coached malingerers reported more exercise-related non-verifiable details. Focusing on non-verifiable details may inform the detection of malingered symptoms.

The effects of co-witness discussion on confidence and precision in eyewitness memory reports.

We examined the influence of co-witness discussion on the metacognitive regulation of memory reports. Participants (N = 92) watched a crime video. Later, a confederate confidently agreed with (gave confirming feedback), disagreed with (gave disconfirming feedback), or gave no feedback (control) regarding participants' answers to questions about the video. Participants who received disconfirming feedback reported fewer fine-grain details than participants in the confirming and control conditions on a subsequent, individual recall test for a different question set. Unexpectedly, this decrease in fine-grain reporting was not accompanied by a decrease in participants' confidence in the accuracy of their fine-grain responses. These results indicate that receiving social comparative feedback about one's memory performance can affect rememberers' metamemorial control decisions, and potentially decrease the level of detail they volunteer in later memory reports. Further research is needed to assess whether these results replicate under different experimental conditions, and to explore the effects of social influences on metamemory.

Alexithymia as a potential source of symptom over-reporting: An exploratory study in forensic patients and non-forensic participants.

The traditional interpretation of symptom over-reporting is that it indicates malingering. We explored a different perspective, namely that over-reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS-20) and symptom over-reporting (SIMS), but also sleep quality (SLEEP-50) to forensic psychiatric outpatients (n = 40) and non-forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non-forensic participants. In the total sample as well as in subsamples, over-reporting correlated positively and significantly with alexithymia, with rs being in the 0.50-0.65 range. Sleep problems were also related to over-reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over-reporting over and above sleep problems. Although our study is cross-sectional in nature, its results indicate that alexithymia as a potential source of over-reporting merits systematic research.

Undermining belief in false memories leads to less efficient problem-solving behaviour.

Memories of events for which the belief in the occurrence of those events is undermined, but recollection is retained, are called nonbelieved memories (NBMs). The present experiments examined the effects of NBMs on subsequent problem-solving behaviour. In Experiment 1, we challenged participants' beliefs in their memories and examined whether NBMs affected subsequent solution rates on insight-based problems. True and false memories were elicited using the Deese/Roediger-McDermott (DRM) paradigm. Then participants' belief in true and false memories was challenged by telling them the item had not been presented. We found that when the challenge led to undermining belief in false memories, fewer problems were solved than when belief was not challenged. In Experiment 2, a similar procedure was used except that some participants solved the problems one week rather than immediately after the feedback. Again, our results showed that undermining belief in false memories resulted in lower problem solution rates. These findings suggest that for false memories, belief is an important agent in whether memories serve as effective primes for immediate and delayed problem-solving.

Biased Symptom Reporting and Antisocial Behaviour in Forensic Samples: A Weak Link.

In two studies (one with 57 forensic inpatients and one with 45 prisoners) the connection between biased symptom reporting and antisocial behaviour is explored. The findings are as follows: 1) the association between symptom over-reporting and antisocial features is a) present in self-report measures, but not in behavioural measures, and b) stronger in the punitive setting than in the therapeutic setting; and 2) participants who over-report symptoms a) are prone to attribute blame for their offence to mental disorders, and b) tend to report heightened levels of antisocial features, but the reverse is not true. The data provide little support for the inclusion of antisocial behaviour (i.e. antisocial personality disorder) as a signal of symptom over-reporting (i.e. malingering) in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5). The empirical literature on symptom over-reporting and antisocial/psychopathic behaviour is discussed and it is argued that the utility of antisocial behaviour as an indicator of biased symptom reporting is unacceptably low.

These two are different. Yes, they're the same: Choice blindness for facial identity.

We examined the manipulability of face identity judgements by combining a sorting task for unfamiliar faces with a standard test of choice blindness. In Experiment 1, 50 participants completed a sorting task and then justified grouping specific pairs of photos together or apart. On manipulated trials, the presented pairings were different from those the participants had actually produced. Detection rates for these identity manipulations were strikingly low (∼21%). Moreover, participants readily provided justifications for identity decisions that they had not made, typically referring to specific facial features. Experiment 2 was conducted along similar lines and confirmed that lower task difficulty and higher confidence in one's face identity judgements increase detection rates. We conclude that observers can easily be led to believe that they made identity judgements they did not make. As well as underscoring the fragility of unfamiliar face matching, our findings have implications for identity judgements in legal settings.

On the alleged memory-undermining effects of daydreaming.

In three experiments, we examined the memory-undermining effects of daydreaming for (un)related stimuli. In Experiments 1 and 2, we tested whether daydreaming fosters forgetting of semantically interrelated material and hence, catalyzes false memory production. In Experiment 3, we examined the memory effects of different daydreaming instructions. In Experiment 1, daydreaming did not undermine correct recall of semantically interrelated words, nor did it affect false memories. In Experiment 2, we again failed to find that daydreaming exerted memory-undermining effects a. In Experiment 3, no memory effects were obtained using different daydreaming instructions. Together, our studies fail to show appreciable memory-undermining effects of daydreaming.

What if you went to the police and accused your uncle of abuse? Misunderstandings concerning the benefits of memory distortion: A commentary on Fernández (2015).

In a recent paper, Fernández (2015) argues that memory distortion can have beneficial outcomes. Although we agree with this, we find his reasoning and examples flawed to such degree that they will lead to misunderstandings rather than clarification in the field of memory (distortion). In his paper, Fernández uses the terms belief and memory incorrectly, creating a conceptual blur. Also, Fernández tries to make the case that under certain circumstances, false memories of abuse are beneficial. We argue against this idea as the reasoning behind this claim is based on controversial assumptions such as repression. Although it is true that memory distortions can be beneficial, the examples sketched by Fernández are not in line with recent documentation in this area.

Inconsistent retrospective self-reports of childhood sexual abuse and their correlates in the general population.

PURPOSE: Epidemiological research on childhood sexual abuse (CSA) and its consequences in adult life mainly relies on retrospective reports. This study explores their consistency and the correlates of inconsistent CSA self-reports in a random population sample. METHOD: A stratified subsample of 2,462 subjects (selected from a large-scale (N = 34,267) representative sample of Dutch adults aged 40 and beyond) participated in a two-phase online questionnaire survey on extra-familial CSA which was conducted on a four- to six-week interval. Subjects reporting CSA were overrepresented. Participants with consistent and inconsistent responses were compared with regard to demographics, family background, abuse severity, and clinical characteristics. Potential correlates of inconsistency were identified using logistic regression analysis. An additional questionnaire (Phase III) administered to inconsistent respondents explored possible reasons for their inconsistency. RESULTS: Of the 1,992 respondents who had reported extra-familial CSA during Phase I, 707 (35.5%) denied this in Phase II. Of the 2,462 respondents in Phase II, 727 (29.5%; 9.2% when considering sample stratification) gave a discrepant answer to the extra-familial sexual abuse item compared to their answers given in Phase I. Reports of less severe abuse, intra-familial CSA, and early parental separation predicted inconsistency. Reasons provided for inconsistency varied from misunderstanding (e.g., reporting intra-familial CSA rather than extra-familial CSA) to emotional motives (e.g., embarrassment, being overwhelmed) or practical considerations (e.g., lack of privacy while filling out the questionnaire). CONCLUSIONS: Inconsistent self-reports of extra-familial sexual abuse occur on a substantial scale and are associated with less severe forms of abuse (lack of salience) or classification difficulties (perpetrator being a family member or not). Consistency tests and probing for clarifications or corrections should be routinely conducted in order to increase the quality of CSA epidemiological research.

[Social security disability assessments: validity tests are useful]. / Verzekeringsgeneeskundige oordeelsvorming.

Social security disability assessors are required to objectively quantify disability with regards to potential ability to work. Difficulties arise when assessments need to be performed in the absence of objective medical data relying solely on self-report regarding subjective health complaints. In such cases, validity tests provide a useful tool during an assessment. This case report illustrates this through the outcomes of 3 disability assessments.

The prevalence of feigning and concealment of Covid-19 infections in an international sample.

We asked 463 participants from 21 countries whether they had feigned and/or concealed having a coronavirus infection during the pandemic period. 384 respondents (83%) reported having experienced a coronavirus infection. They were, on average, younger and reported more chronic health issues than participants who said they had never been infected. 65 (14%) admitted to having feigned the infection. Prevalence doubled (28%) when asked if they knew anyone who had feigned a coronavirus infection. Main motives for feigning were to stay at home and to obtain sick leave. As to having concealed a coronavirus infection, 56 (12%) responded affirmatively, but when asked about others, the prevalence reached 51% (n = 210). The most common reasons for concealment were to avoid letting others know and to not miss an event. Thus, both feigning and concealing infections can occur on a nontrivial scale, directly affecting prevalence rates in studies that rely on self-reported data collected from social platforms.

Repressed Memories (of Sexual Abuse Against Minors) and Statutes of Limitations in Europe: Status Quo and Possible Alternatives.

One of the most heated debates in psychological science concerns the concept of repressed memory. We discuss how the debate on repressed memories continues to surface in legal settings, sometimes even to suggest avenues of legal reform. In the past years, several European countries have extended or abolished the statute of limitations for the prosecution of sexual crimes. Such statutes force legal actions (e.g., prosecution of sexual abuse) to be applied within a certain period of time. One of the reasons for the changes in statutes of limitations concerns the idea of repressed memory. We argue that from a psychological standpoint, these law reforms can be detrimental, particularly when they are done to endorse unfounded psychological theories. The validity of testimonies is compromised many years after the alleged facts, and abolishing the statute of limitations increases the chance that even more (false) recovered memories of abuse might enter the courtroom. We propose solutions to these changes such as establishing an independent expert committee evaluating claims of sexual abuse.

Individual differences in spatial configuration learning predict the occurrence of intrusive memories.

The dual-representation model of posttraumatic stress disorder (PTSD; Brewin, Gregory, Lipton, & Burgess, Psychological Review, 117, 210-232 2010) argues that intrusions occur when people fail to construct context-based representations during adverse experiences. The present study tested a specific prediction flowing from this model. In particular, we investigated whether the efficiency of temporal-lobe-based spatial configuration learning would account for individual differences in intrusive experiences and physiological reactivity in the laboratory. Participants (N = 82) completed the contextual cuing paradigm, which assesses spatial configuration learning that is believed to depend on associative encoding in the parahippocampus. They were then shown a trauma film. Afterward, startle responses were quantified during presentation of trauma reminder pictures versus unrelated neutral and emotional pictures. PTSD symptoms were recorded in the week following participation. Better configuration learning performance was associated with fewer perceptual intrusions, r = -.33, p < .01, but was unrelated to physiological responses to trauma reminder images (ps > .46) and had no direct effect on intrusion-related distress and overall PTSD symptoms, rs > -.12, ps > .29. However, configuration learning performance tended to be associated with reduced physiological responses to unrelated negative images, r = -.20, p = .07. Thus, while spatial configuration learning appears to be unrelated to affective responding to trauma reminders, our overall findings support the idea that the context-based memory system helps to reduce intrusions.

Dissociative symptoms and sleep parameters--an all-night polysomnography study in patients with insomnia.

BACKGROUND: Dissociative disorders encompass a range of symptoms varying from severe absent-mindedness and memory problems to confusion about one's own identity. Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle. METHODS: In the current study, we explored this issue in patients suffering from insomnia (N=46). We investigated whether these patients have raised levels of dissociative symptoms and whether these are related to objective sleep parameters. Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained. In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics. RESULTS: Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality. Longer REM sleep periods and less time spent awake during the night were predictive of dissociation. CONCLUSIONS: This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters. These findings are important because they may inspire sleep-related treatment methods for dissociative disorders.