Do changes in beliefs and behaviours moderate improvement in insomnia after acquired brain injury?

Key mechanisms of change in cognitive behavioural therapy for insomnia in the general population encompass changing sleep-related beliefs and behaviours. In a population with acquired brain injury, cognitive behavioural therapy for insomnia is effective as well, but little is known about the mechanisms of change. The aim of this study was to evaluate how changing sleep-related beliefs and behaviours were associated with improvement in insomnia following blended cognitive behavioural therapy for insomnia in a population with acquired brain injury. A secondary analysis was performed on data of a randomized-controlled trial, including 24 participants that received blended cognitive behavioural therapy for insomnia, and 24 participants that received treatment as usual. Results showed that following blended cognitive behavioural therapy for insomnia, significantly more participants improved on dysfunctional beliefs and sleep-related behaviours and this was associated to improvement in insomnia severity. For sleep-related behaviours, the association between improvement on behaviour and improvement on insomnia was significantly moderated by blended cognitive behavioural therapy for insomnia. However, the relation between dysfunctional beliefs and insomnia was not moderated by type of treatment. Similar results were found for acquired brain injury-adapted versions of the questionnaires in which up to half of the items were excluded as they could be regarded as not dysfunctional for people with acquired brain injury. These results show that improvement on insomnia severity is related to improvement in dysfunctional beliefs and behaviours, and cognitive behavioural therapy for insomnia efficacy may be moderated by the improvement in behaviours in particular. A focus on these behaviours can enhance treatment efficacy, but caution is needed regarding the behaviours that may reflect adequate coping with the consequences of the acquired brain injury.

Effectiveness of Day Treatment Group Schema Therapy for Personality Disorders: A Multiple Baseline Single-Case Study.

BACKGROUND: Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking. AIMS: This study aimed to investigate the effectiveness of day treatment GST for patients with PDs. METHODS AND PROCEDURES: Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures. OUTCOMES AND RESULTS: A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes. CONCLUSIONS AND IMPLICATIONS: This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.

Brief individual experiential schema therapy in adult outpatients with cluster C personality disorders: Does it work?

This study investigated the effectiveness of brief individual experiential schema therapy (ST) in 12 adult outpatients with cluster C personality disorders (PD) using randomised multiple baseline design. Waitlist period was followed by five explorative sessions, 18 experiential ST sessions, two treatment follow-up (FU) booster sessions and a 6-month FU assessment. Overall well-being (ORS), behavioural treatment goals and negative core beliefs were assessed 60-91 times, global symptomatic distress (BSI) six times. PD severity (SCID-5-PD) was pre-post-analysed. Randomisation and non-parametric tests showed large significant effects (d = 1.08-2.38, r = .53-.66) on all outcomes at treatment-FU and 6-month FU assessment. This is the first study providing preliminary evidence of effectiveness of brief individual experiential ST for patients with cluster C PD, tentatively challenging the common tenet that long treatment duration is required. Due to limitations, replication is recommended.

Intelligence and Treatment Outcome of Mentalization-Based Treatment in Borderline Personality Disorder.

BACKGROUND: Mentalization-based treatment (MBT) is an evidence based treatment for patients diagnosed with borderline personality disorder (BPD). Although MBT is effective, on average, for individuals with BPD, there are large individual differences in treatment outcomes. Research on predictors of the treatment effect of MBT, such as intelligence, is needed to determine which treatment is most effective for which 'category' of BPD patients, providing more knowledge about optimal indications. OBJECTIVE: The study aimed to investigate whether intelligence is associated with MBT outcomes in patients with BPD and exploratively studying the difference between two variants of MBT. METHODS AND PROCEDURES: A pre-post intervention design was used to examine the effects of MBT on BPD severity. Personal and social recovery were measured as secondary outcome measures. The association between intelligence and the degree of recovery was examined. RESULTS: No significant correlation was found between intelligence level and treatment efficacy. In addition, a negative correlation between IQ and personal and social recovery was found, indicating that, as IQ increased, the level of recovery decreased. Secondary subanalyses showed the treatment effect of MBT was large and significant in reducing BPD symptoms (Cohen's d = 1.5) and that there was no significant difference between the 2-day MBT and 3-day MBT programmes in terms of a decrease in BPD severity. However, a significant medium positive correlational relationship was found between intelligence and a decrease in BPD severity level for the 3-day MBT, which was not found for the 2-day MBT programme. This indicates that in the 3-day MBT programme, the higher the IQ, the higher the decrease in BPD severity level. CONCLUSIONS AND IMPLICATIONS: This study is the first to examine the association between intelligence and the outcome of MBT in BPD patients. It shows that patients with a wide range of intelligence (72-124) can equally benefit from MBT and that effectiveness of MBT was not influenced negatively by lower intelligence. Secondary subanalyses showed that this was particularly evident when the intervention was delivered within the context of a 2-day MBT programme. Nevertheless, further randomized studies are required to ascertain the relationship between IQ and treatment effectiveness, as well as other predictors of MBT outcomes.

Short-term memory development: differences in serial position curves between age groups and latent classes.

In studies on the development of cognitive processes, children are often grouped based on their ages before analyzing the data. After the analysis, the differences between age groups are interpreted as developmental differences. We argue that this approach is problematic because the variance in cognitive performance within an age group is considered to be measurement error. However, if a part of this variance is systematic, it can provide very useful information about the cognitive processes used by some children of a certain age but not others. In the current study, we presented 210 children aged 5 to 12 years with serial order short-term memory tasks. First we analyze our data according to the approach using age groups, and then we apply latent class analysis to form latent classes of children based on their performance instead of their ages. We display the results of the age groups and the latent classes in terms of serial position curves, and we discuss the differences in results. Our findings show that there are considerable differences in performance between the age groups and the latent classes. We interpret our findings as indicating that the latent class analysis yielded a much more meaningful way of grouping children in terms of cognitive processes than the a priori grouping of children based on their ages.

Eye movements reveal differences in children's referential processing during narrative comprehension.

Children differ in their ability to build referentially coherent discourse representations. Using a visual world paradigm, we investigated how these differences might emerge during the online processing of spoken discourse. We recorded eye movements of 69 children (6-11 years of age) as they listened to a 7-min story and concurrently viewed a display containing line drawings of the protagonists. Throughout the story, the protagonists were referenced by either a name (e.g., rabbit) or an anaphoric pronoun (e.g., he). Results showed that the probability of on-target fixations increased after children heard a proper name, but not after they heard an anaphoric pronoun. However, differences in the probability of on-target fixation at word onset indicate that the referents of anaphoric pronouns were anticipated by good comprehenders, but less so by poor comprehenders. These findings suggest that comprehension outcomes are related to the online processing of discourse-level cues that regulate the accessibility of entities.

Who is at risk? Applying the biopsychosocial model to explain non-violent and violent delinquency in youth.

Research has highlighted the relevance of biological measures in explaining antisocial behavior, but the inclusion of such measures in clinical practice is lagging behind. According to the integrative biopsychosocial model, biological measures should be studied together with psychological and social-environmental factors. In this data-driven study, we applied this comprehensive model to explain non-violent and violent delinquency of 876 at-risk youth (715 male, 9-27 years), by combining nine biological (autonomic-nervous-system; endocrinological), nine psychological, and seven social-environmental measures. Using latent-class-regression analysis we uncovered four distinct psychologically-driven biological clusters, which differed in non-violent and violent delinquency-risk, moderated by social-environmental variables: a biological-psychopathic traits; low problem; high problem; and biological-reactive group. Individual vulnerabilities to (non-)violent delinquency depended on social-environmental context that differed between clusters. These findings highlight the importance of biological and psychological factors, in the context of social-environmental factors, in explaining (non)-violent delinquency.

A short-term testing effect in cross-language recognition.

Taking a memory test after an initial study phase produces better long-term retention than restudying the items, a phenomenon known as the testing effect. We propose that this effect emerges because testing strengthens semantic features of items' memory traces, whereas restudying strengthens surface features of items' memory traces. This novel account predicts that a testing effect should be observed even after a short retention interval when a language switch occurs between the learning phase and the final test phase. We assessed this prediction with Dutch-English bilinguals who learned Dutch Deese-Roediger-McDermott word lists through restudying or through testing (retrieval practice). Five minutes after this learning phase, they took a recognition test in Dutch (within-language condition) or in English (across-language condition). We observed a testing effect in the across-language condition, but not in the within-language condition. These findings corroborate our novel account of the testing effect.

The development of verbal and visual working memory processes: a latent variable approach.

Working memory (WM) processing in children has been studied with different approaches, focusing on either the organizational structure of WM processing during development (factor analytic) or the influence of different task conditions on WM processing (experimental). The current study combined both approaches, aiming to distinguish verbal and visual processing in order to investigate WM development. We investigated recall performance under different task conditions in a sample of 5- to 13-year-olds, applying latent class regression analysis. In this analysis, we examined latent classes (subgroups) within the sample that differed in terms of processing type. The interpretations of the latent classes were validated internally using characteristics of the latent classes and externally using recall performance of words and figures. The results showed that children of different developmental stages used the same type of processing under the same conditions. However, due to developmental differences, their overall performances differed, showing groups of children who were successful in verbal or visual processing and groups of children who were not. This study shows and discusses the importance of disentangling the influence of task conditions from the influence of WM development when interpreting recall performance in children.

Perceptual simulation in developing language comprehension.

We tested an embodied account of language proposing that comprehenders create perceptual simulations of the events they hear and read about. In Experiment 1, children (ages 7-13years) performed a picture verification task. Each picture was preceded by a prerecorded spoken sentence describing an entity whose shape or orientation matched or mismatched the depicted object. Responses were faster for matching pictures, suggesting that participants had formed perceptual-like situation models of the sentences. The advantage for matching pictures did not increase with age. Experiment 2 extended these findings to the domain of written language. Participants (ages 7-10years) of high and low word reading ability verified pictures after reading sentences aloud. The results suggest that even when reading is effortful, children construct a perceptual simulation of the described events. We propose that perceptual simulation plays a more central role in developing language comprehension than was previously thought.

EMDR therapy for PTSD symptoms in patients with mild intellectual disability or borderline intellectual functioning and comorbid psychotic disorder: A case series.

BACKGROUND: Little is known about the effectiveness of EMDR therapy for PTSD symptoms in persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50-85) and psychosis. AIMS: To examine effectiveness, feasibility, and safety of eye movement desensitization and reprocessing (EMDR) therapy in six patients with MID-BIF, PTSD and psychotic disorder. METHODS AND PROCEDURES: Data were collected in a multiple baseline across-subjects design. Before, during and after treatment, weekly assessments on PTSD symptoms and adverse events were carried out. PTSD classification was assessed, and severity of hallucinations, delusions, and general psychopathology were measured at pretreatment, posttreatment and three-month follow-up. OUTCOMES AND RESULTS: There were no dropouts and five of the six participants completed treatment early. They showed a decrease in PTSD symptom severity and did no longer meet DSM-5 PTSD criteria at posttreatment. Results were maintained at follow-up. Symptoms did not exacerbate as indicated by a significant decrease in general psychopathology (in five participants) and an improvement in general functioning. In five participants severity of psychotic symptoms decreased. CONCLUSIONS AND IMPLICATIONS: EMDR therapy is safe and feasible and the results suggest that it can be an effective treatment for PTSD in patients with triple mental health problems in a tertiary mental health treatment setting.

Power of a randomization test in a single case multiple baseline AB design.

A randomization test can be used to statistically test hypotheses in multiple baseline designs to complement the commonly used visual inspection analysis. A crossed factor simulation study was performed to investigate the power of a randomization test in an multiple baseline design. The results show that the degree of autocorrelation of the observations, the number of participants, the effect size, the overlap of possible start moments of the intervention between participants, the ratio of the number of measurements in the baseline- and intervention phase, a gradually emerging effect, and the number of measurements had strong main effects on the power. The two-way interactions between number of participants and effect size, and between the number of measurements and the number of start moments of the intervention also had a large effect. An online tool was developed to calculate the power of a multiple baseline design given several design characteristics.

The effects of verbal disgust- and threat-related information about novel animals on disgust and fear beliefs and avoidance in children.

Disgust is a basic emotion that is thought to play a role in the etiology of certain types of specific phobias, like animal phobias. Two experiments were conducted in which 9- to 14-year-old children were exposed to disgust-related, cleanliness-related, and threat-related information about unknown animals. It was investigated to what extent these types of information influenced children's fear beliefs, feelings of disgust, and avoidance behavior in relation to the animals. Most important, results suggested a bidirectional relationship between disgust and fear. That is, disgust-related information was found to promote fear beliefs, and conversely threat-related information enhanced feelings of disgust. Repercussions of these findings for the role of disgust in the development and maintenance of anxiety pathology are discussed.

Participant Nonnaiveté and the reproducibility of cognitive psychology.

Many argue that there is a reproducibility crisis in psychology. We investigated nine well-known effects from the cognitive psychology literature-three each from the domains of perception/action, memory, and language, respectively-and found that they are highly reproducible. Not only can they be reproduced in online environments, but they also can be reproduced with nonnaïve participants with no reduction of effect size. Apparently, some cognitive tasks are so constraining that they encapsulate behavior from external influences, such as testing situation and prior recent experience with the experiment to yield highly robust effects.

The testing effect for mediator final test cues and related final test cues in online and laboratory experiments.

BACKGROUND: The testing effect is the finding that information that is retrieved during learning is more often correctly retrieved on a final test than information that is restudied. According to the semantic mediator hypothesis the testing effect arises because retrieval practice of cue-target pairs (mother-child) activates semantically related mediators (father) more than restudying. Hence, the mediator-target (father-child) association should be stronger for retrieved than restudied pairs. Indeed, Carpenter (2011) found a larger testing effect when participants received mediators (father) than when they received target-related words (birth) as final test cues. METHODS: The present study started as an attempt to test an alternative account of Carpenter's results. However, it turned into a series of conceptual (Experiment 1) and direct (Experiment 2 and 3) replications conducted with online samples. The results of these online replications were compared with those of similar existing laboratory experiments through small-scale meta-analyses. RESULTS: The results showed that (1) the magnitude of the raw mediator testing effect advantage is comparable for online and laboratory experiments, (2) in both online and laboratory experiments the magnitude of the raw mediator testing effect advantage is smaller than in Carpenter's original experiment, and (3) the testing effect for related cues varies considerably between online experiments. CONCLUSIONS: The variability in the testing effect for related cues in online experiments could point toward moderators of the related cue short-term testing effect. The raw mediator testing effect advantage is smaller than in Carpenter's original experiment.

Understanding abstract expository texts.

BACKGROUND: This study dealt with the question whether abstract concepts and rules can be directly taught or can only be explained by using examples. The issue, known as Meno's Paradox, was addressed in the context of understanding expository texts. AIMS: We set out to show the indispensability of examples in the process of acquiring knowledge of concepts and rules. By blocking any possibility of linking concepts to examples we hoped to show the understanding of abstract concepts is impossible without a concrete context of interpretation. SAMPLES: In two experiments, secondary school students (17 years of age) and undergraduate university students were asked to study expository texts with no examples or with many examples. METHODS: In Experiment 1, two existing texts were manipulated by either adding examples or replacing specific concepts by more ambiguous concepts. In Experiment 2, two expository texts (one with rules, one with examples) on the law of large numbers were developed. Apart from that, a questionnaire to assess students' habit of concrete elaboration whilst studying expository texts was administered. RESULTS: Experiment 1 revealed that an expository text with ambiguous terms is difficult to understand. This evidence supported our claim that a concrete context of interpretation is indispensable. However, there was no difference in understanding of texts with many or few examples. An explanation might be that students were able to think of relevant examples themselves. Evidence for this active way of text comprehension was found in Experiment 2. An interaction between content (abstract, concrete) and learning style (high or low on concrete elaboration) showed up. Students high on concrete elaboration understood the abstract text better than students low on concrete elaboration. The reverse held for the concrete text. CONCLUSION: So, support was found for the indispensability of concrete examples, which should be available in the reader's memory or provided in the text.

Does intuition cause cooperation?

Recently, researchers claimed that people are intuitively inclined to cooperate with reflection causing them to behave selfishly. Empirical support for this claim came from experiments using a 4-player public goods game with a marginal return of 0.5 showing that people contributed more money to a common project when they had to decide quickly (i.e., a decision based on intuition) than when they were instructed to reflect and decide slowly. This intuitive-cooperation effect is of high scientific and practical importance because it argues against a central assumption of traditional economic and evolutionary models. The first experiment of present study was set up to examine the generality of the intuitive-cooperation effect and to further validate the experimental task producing the effect. In Experiment 1, we investigated Amazon Mechanical Turk (AMT) workers' contributions to a 4-player public goods game with a marginal return of 0.5 while we manipulated the knowledge about the other players' contribution to the public goods game (contribution known vs. contribution unknown), the identity of the other players (humans vs. computers randomly generating contributions) and the time constraint (time pressure/intuition vs. forced delay/reflection). However, the results of Experiment 1 failed to reveal an intuitive-cooperation effect. Furthermore, four subsequent direct replications attempts with AMT workers (Experiments 2a, 2b, 2c and Experiment 3, which was conducted with naïve/inexperienced participants) also failed to demonstrate intuitive-cooperation effects. Taken together, the results of the present study could not corroborate the idea that people are intuitively cooperative, hence suggesting that the theoretical relationship between intuition and cooperation should be further scrutinized.

Is spacing really the "friend of induction"?

Inductive learning takes place when people learn a new concept or category by observing a variety of exemplars. Kornell and Bjork (2008) asked participants to learn new painting styles either by presenting different paintings of the same artist consecutively (massed presentation) or by mixing paintings of different artists (spaced presentation). In their second experiment, Kornell and Bjork (2008) showed with a final style recognition test, that spacing resulted in better inductive learning than massing. Also, by using this style recognition test, they ruled out the possibility that spacing merely resulted in a better memory for the labels of the newly learned painting styles. The findings from Kornell and Bjork's (2008) second experiment are important because they show that the benefit of spaced learning generalizes to complex learning tasks and outcomes, and that it is not confined to rote memory learning. However, the findings from Kornell and Bjork's (2008) second experiment have never been replicated. In the present study we performed an exact and high-powered replication of Kornell and Bjork's (2008) second experiment with a Web-based sample. Such a replication contributes to establish the reliability of the original finding and hence to more conclusive evidence of the spacing effect in inductive learning. The findings from the present replication attempt revealed a medium-sized advantage of spacing over massing in inductive learning, which was comparable to the original effect in the experiment by Kornell and Bjork (2008). Also, the 95% confidence intervals (CI) of the effect sizes from both experiments overlapped considerably. Hence, the findings from the present replication experiment and the original experiment clearly reinforce each other.

Cognitive bias in action: evidence for a reciprocal relation between confirmation bias and fear in children.

BACKGROUND AND OBJECTIVES: Some cognitive models propose that information processing biases and fear are reciprocally related. This idea has never been formally tested. Therefore, this study investigated the existence of a vicious circle by which confirmation bias and fear exacerbate each other. METHODS: One-hundred-and-seventy-one school children (8-13 years) were first provided with threatening, ambiguous, or positive information about an unknown animal. Then they completed a computerized information search task during which they could collect additional (negative, positive, or neutral) information about the novel animal. Because fear levels were repeatedly assessed during the task, it was possible to examine the reciprocal relationship between confirmation bias and fear. RESULTS: A reciprocal relation of mutual reinforcement was found between confirmation bias and fear over the course of the experiment: increases in fear predicted subsequent increases in the search for negative information, and increases in the search for negative information further enhanced fear on a later point-in-time. In addition, the initial information given about the animals successfully induced diverging fear levels in the children, and determined their first inclination to search for additional information. LIMITATIONS: As this study employed a community sample of primary school children, future research should test whether these results can be generalized to clinically anxious youth. CONCLUSIONS: These findings provide first support for the notion that fearful individuals may become trapped in a vicious circle in which fear and a fear-related confirmation bias mutually strengthen each other, thereby maintaining the anxiety pathology.

Identifying children at risk of problematic development: latent clusters among childhood arrestees.

The presence of clusters characterized by distinct profiles of individual, family and peer characteristics among childhood arrestees was investigated and cluster membership stability after 2 years was determined. Identification of such clusters in this heterogeneous at-risk group can extend insight into the presence and severity of children's co-occurring problems and guide intervention and prevention efforts. Latent class analysis (LCA) was used to detect clusters among 308 childhood arrestees (mean age 10.7 years), based on dichotomous dynamic correlates of offending present at the time of first arrest. Correlates in the individual, peer and family domains were assessed at baseline and 2-year follow-up, using standardized instruments. This resulted in identification of a low problem group characterized by few problems across all domains (40.2 %), an externalizing intermediate problem group characterized by mainly externalizing problems on the individual and peer domains (39.4 %), and a pervasive high problem group characterized by numerous problems across all domains (20.4 %). Cluster membership was most stable for the low problem group (71.4 %), followed by the externalizing intermediate problem group (49.5 %). Transition was highest in the pervasive high problem group (63.0 %), with the majority of children progressing to the externalizing intermediate problem group. The identification of such distinct clusters among childhood arrestees, differing in the presence of co-occurring problems, stresses the importance of a first police arrest as an opportunity for early recognition of children in need of care. As problems present at the time of first arrest do not persist in every child, careful periodic monitoring is needed.