Integrating research with NHS clinical practice: Unwelcome intrusion or constructive triangulation?

When embarking on research into the effectiveness of psychoanalytic psychotherapy in the NHS or the application of psychoanalytic principles, researchers come up against a number of hurdles: many clinicians still see empirical research as antithetical or disruptive to the practice of psychoanalytic psychotherapy; psychoanalytic psychotherapy has previously fared poorly in evidence-based policy guidelines and this can discourage ambition, and there are technical problems of research design, measurement and standardization. Nevertheless, in a political climate which stresses service evaluation, measurable outcomes and empirical evidence, psychoanalytic psychotherapy must participate to survive. There may be gains from conducting research beyond simply meeting the requirement to provide evidence of effectiveness. Research may be viewed by some clinicians as an unwelcome intruder but it may have the potential to offer triangulation, the perspective of the 'third', and so strengthen the foundations of clinical practice and the development of psychoanalytic thought

Neural Processes Supporting Young and Older Adults' Emotional Memories

Young and older adults are more likely to remember emotional information than neutral information. The present functional magnetic resonance imaging study examined the neural processes supporting young (ages 18-35) and older (ages 62-79) adults' successful encoding of positive, negative, and neutral objects (e.g., a sundae, a grenade, a canoe). The results revealed general preservation of the emotional memory network across the age groups. Both groups recruited the amygdala and the orbito-frontal cortex during the successful encoding of positive and negative information. Both ages also showed valence-specific recruitment: right fusiform activity was greatest during the successful encoding of negative information, whereas left prefrontal and temporal activity was greatest during the successful encoding of positive information. These valence-specific processes are consistent with behavioral evidence that negative information is processed with perceptual detail, whereas positive information is processed at a conceptual or schematic level. The only age differences in emotional memory emerged during the successful encoding of positive items: Older adults showed more activity in the medial prefrontal cortex and along the cingulate gyrus than young adults. Because these regions often are associated with self-referential processing, these results suggest that older adults' mnemonic boost for positive information may stem from an increased tendency to process this information in relation to themselves.Psycholog

Episodic future thinking in generalized anxiety disorder

Research on future-oriented cognition in generalized anxiety disorder (GAD) has primarily focused on worry, while less is known about the role of episodic future thinking (EFT), an imagery-based cognitive process. To characterize EFT in this disorder, we used the experimental recombination procedure, in which 21 GAD and 19 healthy participants simulated positive, neutral and negative novel future events either once or repeatedly, and rated their phenomenological experience of EFT. Results showed that healthy controls spontaneously generated more detailed EFT over repeated simulations. Both groups found EFT easier to generate after repeated simulations, except when GAD participants simulated positive events. They also perceived higher plausibility of negative-not positive or neutral-future events than did controls. These results demonstrate a negativity bias in GAD individuals' episodic future cognition, and suggest their relative deficit in generating vivid EFT. We discuss implications for the theory and treatment of GAD.R01 MH060941 - NIMH NIH HHS; R01 MH078308 - NIMH NIH HHS; R01AG08441 - NIA NIH HHS; R01 AT007257 - NCCIH NIH HHS; R01MH60941 - NIMH NIH HHS; R01 AG008441 - NIA NIH HHS; R34 MH099311 - NIMH NIH HHS; R21MH102646 - NIMH NIH HHS; R01AT007257 - NCCIH NIH HHS; R21 MH102646 - NIMH NIH HHS; R34MH078308 - NIMH NIH HH

Prefrontal Activity and Diagnostic Monitoring of Memory Retrieval: fMRI of the Criterial Recollection Task

According to the distinctiveness heuristic, subjects rely more on detailed recollections (and less on familiarity) when memory is tested for pictures relative to words, leading to reduced false recognition. If so, then neural regions that have been implicated in effortful postretrieval monitoring (e.g., dorsolateral prefrontal cortex) might be recruited less heavily when trying to remember pictures. We tested this prediction with the criterial recollection task. Subjects studied black words, paired with either the same word in red font or a corresponding colored picture. Red words were repeated at study to equate recognition hits for red words and pictures. During fMRI scanning, alternating red word memory tests and picture memory tests were given, using only white words as test stimuli (say “yes” only if you recollect a corresponding red word or picture, respectively). These tests were designed so that subjects had to rely on memory for the criterial information. Replicating prior behavioral work, we found enhanced rejection of lures on the picture test compared to the red word test, indicating that subjects had used a distinctiveness heuristic. Critically, dorsolateral prefrontal activity was reduced when rejecting familiar lures on the picture test, relative to the red word test. These findings indicate that reducing false recognition via the distinctiveness heuristic is not heavily dependent on frontally mediated postretrieval monitoring processes.Psycholog

Aging, self-referencing, and medial prefrontal cortex

The lateral prefrontal cortex undergoes both structural and functional changes with healthy aging. In contrast, there is little structural change in the medial prefrontal cortex, but relatively little is known about the functional changes to this region with age. Using an event-related fMRI design, we investigated the response of medial prefrontal cortex during self-referencing in order to compare age groups on a task that young and elderly perform similarly and that is known to actively engage the region in young adults. Nineteen young (M age 23) and seventeen elderly (M age 72) judged whether adjectives described themselves, another person, or were presented in upper case. We assessed the overlap in activations between young and elderly for the self-reference effect (self vs. other person), and found that both groups engage medial prefrontal cortex and mid-cingulate during self-referencing. The only cerebral differences between the groups in self versus other personality assessment were found in somatosensory and motorrelated areas. In contrast, age-related modulations were found in the cerebral network recruited for emotional valence processing. Elderly (but not young) showed increased activity in the dorsal prefrontal cortex for positive relative to negative items, which could reflect an increase in controlled processing of positive information for elderly adults. Aging is associated with declines in cognitive performance in a number of domains. Recent neuroimaging data suggest that changes to the prefrontal cortex may contribute to impaired memory and cognition with age. Structurally, the prefrontal cortex shows pronounced shrinkage with age (Raz, 2000). Functionally, the engagement of frontal mnemonic processes appears to differ in young and elderly adults: Older adults show reduced activation of left inferior fronta

Effects of Emotion on Memory Specificity in Young and Older Adults

To examine how emotional content affects the amount of visual detail remembered, we had young and older adults study neutral, negative, and positive objects. At retrieval, they distinguished same (identical) from similar (same verbal label, different visual details) and new (nonstudied) objects. A same response to a same item indicated memory for visual details (specific recognition), whereas a same or similar response to a same or similar item signified memory for the general sort of object (general recognition). Both age groups showed enhanced specific recognition for negative (not positive) objects. Young adults' general recognition advantage also was restricted to negative objects, whereas older adults showed enhanced general recognition for positive and negative objects. Negative (not positive) content enhanced the visual specificity of memory in both ages, but positive content conferred a general memory advantage only for older adults.Psycholog

Retrieval Failure Contributes to Gist-Based False Recognition

People often falsely recognize items that are similar to previously encountered items. This robust memory error is referred to as gist-based false recognition. A widely held view is that this error occurs because the details fade rapidly from our memory. Contrary to this view, an initial experiment revealed that, following the same encoding conditions that produce high rates of gist-based false recognition, participants overwhelmingly chose the correct target rather than its related foil when given the option to do so. A second experiment showed that this result is due to increased access to stored details provided by reinstatement of the originally encoded photograph, rather than to increased attention to the details. Collectively, these results suggest that details needed for accurate recognition are, to a large extent, still stored in memory and that a critical factor determining whether false recognition will occur is whether these details can be accessed during retrieval.Psycholog

How Negative Emotion Enhances the Visual Specificity of a Memory

Some studies have suggested that emotion primarily increases memory for “gist,” and does not enhance memory for detail. There are, however, some instances in which negative objects (e.g., snake, grenade) are remembered with more visual detail than neutral objects (e.g., barometer, blender). In the present functional magnetic resonance imaging (fMRI) study, we examined the encoding processes that lead a person to remember the exact visual details of negative and neutral objects, and to remember which of two decisions were made about the objects (a size decision or an animacy decision). The enhancement in memory for a negative item's visual details appeared to result from enhanced visual processing: The right fusiform gyrus, a region known to be critical for processing exemplar-specific details, showed a greater extent and magnitude of activity during the successful encoding of negative objects. Activity in the right amygdala also corresponded with memory for visual detail, although it did not relate to memory for the task performed with the item. These data provide strong evidence that engagement of some amygdalar regions can correspond with enhanced memory for certain types of details, but does not ensure successful encoding of all contextual details.Psycholog

Interactions Between Visual Attention and Episodic Retrieval: Dissociable Contributions of Parietal Regions During Gist-Based False Recognition

The interaction between episodic retrieval and visual attention is relatively unexplored. Given that systems mediating attention and episodic memory appear to be segregated, and perhaps even in competition, it is unclear how visual attention is recruited during episodic retrieval. We investigated the recruitment of visual attention during the suppression of gist-based false recognition, the tendency to falsely recognize items that are similar to previously encountered items. Recruitment of visual attention was associated with activity in the dorsal attention network. The inferior parietal lobule, often implicated in episodic retrieval, tracked veridical retrieval of perceptual detail and showed reduced activity during the engagement of visual attention, consistent with a competitive relationship with the dorsal attention network. These findings suggest that the contribution of the parietal cortex to interactions between visual attention and episodic retrieval entails distinct systems that contribute to different components of the task while also suppressing each other.Psycholog

Preserved Priming of Novel Objects in Patients with Memory Disorders

Amnesic patients perform poorly on explicit memory tests that require conscious recollection of recent experiences, but frequently show preserved facilitations of performance or priming effects on implicit memory tasks that do not require conscious recollection. We examined implicit memory for novel visual objects on an object decision test in which subjects decide whether structurally possible and impossible objects could exist in three-dimensional form. Patients with organic memory disorders showed robust priming effects on this task---object decision accuracy was higher for previously studied objects than for nonstudied objects---and the magnitude of priming did not differ from matched control subjects or college students. However, patients showed impaired explicit memory for novel visual objects on a recognition test. We argue that priming is mediated by the structural description system, a subsystem of the perceptual representation system, that operates at a presemantic level and is preserved in amnesic patients.Psycholog