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A pilot study of exposure control of chronic auditory hallucinations in schizophrenia.

BACKGROUND: Many patients complain less of their auditory hallucinations per se than of lack of control of the experiences. There is reason to believe that a non-distraction (exposure) approach could help patients gain more control over persistent auditory hallucinations and teach them that their experience is a form of thinking and has no external source. This study is a pilot test of that idea. METHOD: Five DSM-III-R schizophrenic outpatients with medication-resistant auditory hallucinations improved with a mean of 31 hour-long sessions over 3 months of therapist-guided exposure to their hallucinations and situations likely to evoke them. RESULTS: Improvement was greatest in patients' anxiety and sense of control over their hallucinations, less in social use of leisure and hallucinating time. CONCLUSIONS: These mildly encouraging pilot results warrant a controlled study of exposure for drug-resistant chronic auditory hallucinations and other psychotic experiences which are associated with anxious avoidance.

Anxiety↗

The defensive function of persecutory delusions. Evidence from attribution tasks.

Abnormalities of 'social' reasoning were investigated in patients suffering from persecutory delusions and in matched depressed and normal controls using transparent (obvious) and opaque (unobvious) tests of attributional style. Whereas depressed and normal subjects yielded similar causal inferences for both attributional measures, the deluded subjects showed a marked shift in internality, attributing negative outcomes to external causes on the transparent Attributional Style Questionnaire but, on the more opaque Pragmatic Inference Task, attributing negative outcomes to internal causes and thus showing a cognitive style resembling that of the depressed group. This finding, interpreted in terms of explicit versus implicit judgements, supports the hypothesis that delusions function as a defence against underlying feelings of low self-esteem.

Adult↗

Trance logic in hypnosis and imagination.

In 2 experiments we investigated trance logic, or the tolerance of logical incongruity, in age regression and hallucination. Experiment 1 tested 21 hypnotizable and 19 unhypnotizable subjects in an application of the real-simulating model of hypnosis. Experiment 2 tested 26 high and 19 low imagery ability subjects in an adaptation of the model to the imagination context. Subjects' experiences were investigated through the experiential analysis technique. More real than simulating subjects displayed trance logic during age regression, but they did not differ on the major measures of trance logic during hallucination. This pattern of responding occurred in both the hypnosis and the imagination contexts. Subjects' comments suggested that completeness of and belief in age regression or hallucination may play some role in trance logic. The importance of understanding trance logic from the subject's point of view is discussed.

Adolescent↗

Suspiciousness, mental simulation, and norm theory.

Seven studies were conducted to replicate the work of Miller, Turnbull, and McFarland (1989), who tested predictions from norm theory (Kahneman & Miller, 1986). The first three studies with stimulus materials identical to those used by Miller et al. failed to confirm that the ease with which the event might be mentally simulated affected the degree of suspiciousness. In Studies 4, 5, and 6, the improbable events were made objectively more probable, but this did not produce significant results. In the 7th study, the objective probability and attitude toward the target were varied. Although there was a main effect for ease of mental simulation, this effect was produced by only 1 of the 3 vignettes.

Adult↗

Reality orientation therapy: a study investigating the value of this therapy in the rehabilitation of elderly people.

The Leeds Technique for Therapy with the Aged is described and evaluated. The purpose of the study was two-fold--to evaluate the therapy itself, and to examine it as a possible extra incentive for nurses working with the aged. Forty-six elderly patients were included in the study. Fourteen took part in a pilot study. Later, in a more carefully controlled investigation, the remaining 32 patients were divided into two groups, one of experimental subjects and one of control subjects. Improvement was assessed using the Clifton Assessment Schedule (CAS) and the Stockton Geriatric Rating Scale (SGRS). Twenty-five of the 30 experimental subjects improved and 10 were discharged. Eight of the 16 control subjects improved, but none was discharged.

Aged↗

Source monitoring.

A framework for understanding source monitoring and relevant empirical evidence is described, and several related phenomena are discussed: old-new recognition, indirect tests, eyewitness testimony, misattributed familiarity, cryptomnesia, and incorporation of fiction into fact. Disruptions in source monitoring (e.g., from confabulation, amnesia, and aging) and the brain regions that are involved are also considered, and source monitoring within a general memory architecture is discussed. It is argued that source monitoring is based on qualities of experience resulting from combinations of perceptual and reflective processes, usually requires relatively differentiated phenomenal experience, and involves attributions varying in deliberateness. These judgments evaluate information according to flexible criteria and are subject to error and disruption. Furthermore, diencephalic and temporal regions may play different roles in source monitoring than do frontal regions of the brain.

Attention↗

[Was Snow White a transsexual?].

The Rorschach Ink Blot test is considered to be an essential analytical instrument when studying the personalities of individuals presenting identity disorders, in particular, in the context of a sex change request. Nevertheless, there exist less than 20 studies of transsexualism utilising the Rorschach since the creation of this diagnostic category in 1953. This research has mostly concerned itself with relations between psychopathology and transsexualism. Practically non-existent are studies investigating the psychological conditions that permit, shape or induce sex change requests in individuals. Transsexuals request the removal of their genitals through mutilation surgery, which can be seen as subjects literally crying out to be castrated. This request is all the more surprising given that castration, in psychoanalytic terms, is considered to be the most severe punishment that an individual (woman or man) can be threatened with. Therefore, we asked ourselves which psychic conditions could motivate such as request. Based on any earlier study where answers (some explicit, others symbolic) given by sex-change applicants tested on the Rorschach were analysed, results seemed to suggest a counter-phobic attitude underlying sex-reassignment requests (28). According to these hypotheses, the fear of castration (banal as such) can only be overcome through the active search for castration itself. In opting for castration, the transsexual puts an end to the states of anxious waiting that are dominated by feelings of the incertitude and unpredictability of an eventual castration. Once obtained, the threat it constituted disappears, and with it so does the fear. Thus, by taking this active and voluntary step, the subject is no longer exposed to an imminent danger in a passive manner. This in itself creates a great feeling of relief, if not of actual pleasure in the subject (28). In this article, we postulated in a purely speculative manner, the existence of one or several modalities in the transsexual dynamics. Nevertheless, one can ask oneself about the possibility of a request based on a desire rather than on a defense, or even on the existence of a defensive process diametrically opposed to the counter-phobic attitude and which, instead of actively provoking the dreaded reality, would privilege its avoidance and the search of passivity. This latter hypothesis has the advantage of being rather easy to explore with the Rorschach because, according to Exner, the predominance of passive compared to active human movement responses (which he terms the Snow White Syndrome) indicates the propensity to escape into passive fantasies and the tendency to avoid the initiative for behaviour or decision-making, if other people can do it in the subject's place (12). Our results largely confirmed the hypothesis of the existence of an opposite mechanism, as a third of subjects (n = 26) presented Snow White Syndrome. According to Exner, these transsexuals are typically characterized by hiding into a world of make believe, avoiding all responsibility, as well as any decision-making. This passivity in our Snow White Syndrome group was all the more remarkable in that, on the whole, it infiltrated into all the movement responses and seemed to define a rigid style of thinking and mental elaboration, in addition to a suggestive content of passivity. However, this condition cannot be associated with a general lack of dynamism or energy. In fact, the treatment of information, which provides data concerning the motivation to treat a stimulus field of the stimulus--whether this concerns the capture (L) of the stimulus or the elaboration (DQ+) of the response--displayed a sufficient amount of motivation. Furthermore, internal resources (EA) were considerable and were brought into play whenever it was necessary to adopt a behaviour or make a decision. Furthermore, based on these Rorschach findings, we note that in transsexuals with Snow White Syndrome, there is a stereotyped tendency to shy away from difficulties by seeking refuge in realistic representations (but that lack in variety), which could be materialized by actions, but where the initiative is delegated to others. These transsexuals appear to shy away from the difficulties of life by seeking refuge into a world of fantasy, which they fill with the representations borrowed from reality (rather than fantasy) and consequently that are liable to be transposed, if necessary, back into reality. Therefore, one can better understand why they shun away from the deceiving reality that their physical sex represents, into the satisfying dream where they possess the genitals of the opposite sex, that is, a perfectly real organ, no longer the result of the subject's fantasy world.

Adult↗

Experiences of alien control in schizophrenia reflect a disorder in the central monitoring of action.

Twenty-three acute psychotic patients who were drug free at the time of testing performed a motor task designed to elicit many errors. Normal subjects and many of the psychotic patients were able to correct these errors in the absence of visual feedback. The ability to make such corrections depends on the subject knowing what response he has just made. Patients with experiences of alien control of their thoughts and actions who formed a subgroup of those classified as schizophrenic, were significantly less likely to make error corrections in the absence of visual feedback. This result is consistent with our previous suggestion (Frith, 1987) that these symptoms are a consequence of problems with the central monitoring of responses.

Affective Disorders, Psychotic↗

Cognitive therapy. A 30-year retrospective.

Several lines of investigation have evolved from the initial cognitive model of depression and other disorders. A large number of studies have tested the cognitive model using both clinical and laboratory-based strategies. In general, studies that most closely approximate the clinical conditions from which the theory was derived are supportive of the cognitive model of depression. Studies of anxiety and panic, although fewer, generally support the cognitive model of anxiety and panic. The application to the treatment of clinical problems has been promising and supports the concept of cognitive specificity. The cognitive therapy of depression has led to the utilization of specific cognitive strategies based on the specific conceptualizations of a given disorder to a wide variety of disorders. Study of abnormal reactions has also provided clues to the cognitive structure of normal reactions.

Anxiety Disorders↗

Young children's understanding of fact beliefs versus value beliefs.

Recent research on the development of children's knowledge about the mind has shown that young 3-year-olds have difficulty inferring that another person holds a false belief about a matter of verifiable fact, even when provided with considerable help. 4 studies tested the hypothesis that they would have less difficulty inferring that another person holds an odd, nonnormative belief about a matter of taste or value--one which, like the false fact belief, they themselves do not hold. On fact-belief tasks, an experimenter acted as if, or even explicitly stated that, she believed that the contents of a container were other than what the children knew to be the case. On value-belief tasks, she behaved as if she believed that a stimulus had a good or bad taste, smell, or appearance, whereas they thought it had the opposite. The results of all 4 studies confirmed the hypothesis.

Attention↗

Monitoring the source of memory in detoxified alcoholics.

The ability to monitor the source of remembered information and related reflective cognitive processes was examined in normal volunteers and detoxified alcoholics. Normal volunteers were very accurate judges of whether remembered events were presented as stimuli or were self-generated, even when memory was tested 2 days later. In contrast, a subgroup of otherwise cognitively unimpaired alcoholics demonstrated impairments in the ability to track the source of remembered knowledge and were also less able to inhibit intrusion errors in recalling information from memory. These findings provide preliminary evidence of an impairment in cognitive control functions in certain alcoholics. This conclusion is supported by associated findings indicating that, among alcoholics, performance on explicit memory tasks that required reflective cognitive operations were positively correlated with glucose utilization rates in left prefrontal, temporal, and posterior orbital frontal cortical regions.

Adult↗

Reasoning about the referent of a picture versus reasoning about the picture as the referent: an effect of visual realism.

Research on picture perception and picture-based problem solving has generally considered the information that enables one to "see" and think about a picture's subject matter. However, people often reason about a picture or representation as the referent itself. The question addressed here is whether pictorial features themselves help determine when one reasons about the referent of an image, as with an engrossing movie, and when one reasons about the image in its own right, as with abstract art. Two experiments tested the hypothesis that pictures with relatively high fidelity to their referents lead people to think about those referents, whereas pictures with relatively low fidelity lead people to think about the picture as a referent. Subjects determined whether marks on the bottom and top boards of an open hinge would meet if the hinge were closed. Accuracy and latency results indicated that subjects who saw realistic displays simulated the physical behavior of the hinge through analog imagery. In contrast, subjects who saw schematic displays tended to reason about static features of the display such as line lengths and angles. The results demonstrate that researchers must be cautious when generalizing from reasoning about diagrammatic materials to reasoning about the referents themselves.

Adult↗

Visual search in simple simulations of realistic scenes.

The effect distracting objects have on visual-search performance in real-life situations cannot readily be predicted from current search theories. The validity of an approach to close this gap was tested by comparing search performance for color slides of scenes in public buildings with performance for simplified computer-generated images derived from these slides. The target was always a blue rectangle in both the original slides of scenes and the computer simulations. The distractors were differently colored rectangles (not blue), and their number was varied systematically. Analysis showed a significant linear increase in search time with number of distractors, which challenges predictions of current search theories. An explanation for this contradiction is proposed. Also, search times for color slides were significantly longer than those for computer images; however, there was no significant interaction between type of stimulus and number of distractors. It is concluded that the simulated scenes yielded adequate predictions of the effect of distracting objects on search performance in real-life situations.

Adolescent↗

Theory of mind and rule use in individuals with Down's syndrome: a test of the uniqueness and specificity claims.

The relationship between Theory of Mind (ToM) and rule use was explored in adults with Down's Syndrome (DS) and in non-handicapped pre-schoolers. Twelve low-functioning individuals with DS (mean mental age = 5.1 years, mean chronological age = 22.7) performed worse than 12 MA-matched non-handicapped children (mean MA = 5.1 years) on several standard ToM tasks and on a color-shape card-sorting task in which subjects were required to switch between two incompatible sets of rules. On the ToM tasks, people with DS tended to focus on a single state of affairs (e.g. the present situation). Likewise, on the card sort, these subjects tended to use a single set of rules on all trials. Performance in the two types of task was positively correlated when MA was partialed out. The results are inconsistent with the slaim that ToM reflects a domain-specific psychological function and the notion that deficits in ToM are unique to individuals with autism.

Adult↗

Can autistic children distinguish lies from jokes? A second look at second-order belief attribution.

Previous studies show that autistic children fail tests of second-order belief attribution. They also fail tests of lying and deception. The present study used Leekam's (1988) joke-lie distinction task to test (a) understanding of second-order mental states (intention and belief) and (b) the ability to judge these acts as lies or jokes. Seventeen normal and 16 autistic children took part. Eight of the autistic children had previously passed a test of first-order false belief. Results showed that six autistic subjects (37.5%), all of whom are false belief "passers", gave consistently correct answers to second-order mental state questions. Neither normal nor autistic children found second-order intention easier than second-order belief. However, normal children found the ability to judge another person's mental state easier than labelling whether the person was lying or joking, supporting previous evidence. In contrast, there was no difference in these two judgements for autistic children. Overall these results qualify previous evidence by showing that autistic children can use second-order reasoning and can distinguish lies from jokes. Observational data on these children, however, suggest that their competence on the comprehension of these hypothetical situations was not matched by an ability to use lying and joking in real life. Methodological, language and diagnostic factors are discussed as providing possible explanations for the results.

Adolescent↗

Recognizing the un-real McCoy: priming and the modularity of face recognition.

Fodor (1983) has proposed that face perception is carried out by an informationally encapsulated module, whose operation is unaffected by context or expectancies. We tested the modularity hypothesis by examining whether discriminations between normal and distorted versions of famous faces can be primed, either by the name of an associated person (semantic context) or by a valid cue as to the identity of the target face (expectancy). A preliminary experiment showed that, in the absence of priming, discriminations between normal and distorted versions of a face were unaffected by whether the target faces were familiar or not, confirming that these judgments tap perceptual, not postperceptual (semantic), coding processes. In Experiment 1, accuracy was significantly higher when target face pairs were preceded by related name primes, as compared with unrelated ones. In Experiment 2, reaction times were significantly faster for targets preceded by a valid identity cue than for targets preceded by an invalid one. Neither effect could be explained as a speed-accuracy tradeoff. These results fail to support Fodor's conjecture that face processing is encapsulated.

Adult↗

Age trends in the use of social and temporal comparison for self-evaluation: examination of a novel developmental hypothesis.

Two studies tested the novel hypothesis that children use social comparison (SC) for self-appraisal at an earlier age than they do temporal comparison (TC). The effect of other's and of own prior outcome on performance and ability appraisal and on self-evaluative strategies was examined using simple tasks and outcome information. Results from 840 children at ages 4-8 confirmed that self-evaluative SC was similar over age. Even 4- to 5-year-olds rated themselves higher after doing better versus worse than another and explained their ratings in terms of explicit SC. Social failure undermined continuing motivation at all ages. In contrast, young children in TC conditions attended only to their last outcome, and comparisons between current and prior outcomes increased with age. Self-evaluative biases were marked at age 5-6 and for boys in SC conditions. Results clarify the role of cognitive and motivational factors in the development of SC and TC.

Age Factors↗

Intention and knowledge in preschoolers' conception of pretend.

Experiments 1 and 2 investigated 3- and 4-year-olds' understanding of the intended nature of pretend behaviors by testing their ability to distinguish between involuntary behaviors and the same behaviors emitted intentionally through acts of pretend. Four-year-olds' high rate of passing showed that (1) they understood intention as a mental cause of action and (2) they construed pretend behaviors mentalistically. Experiment 3 used the same contrastive procedure to examine Lillard's contention that 4-year-olds do not understand the knowledge conditions and hence the mental representational component of pretend actions. Whereas nearly all of the 5-year-olds understood that an agent who did not know of a specific animal could not be pretending to be that animal, 4-year-olds systematically associated ignorance with pretend. On the basis of the combined findings of the present experiments, and other research showing a mentalistic understanding of pretense by the age of 3 or 4, it was concluded that the specific reasoning requirements of Lillard's tasks resulted in an underestimation of children's appreciation of the mental features of pretend.

Age Factors↗