The dilemma of trauma-focused therapy: effects of imagery rescripting on voluntary memory

Trauma-focused imagery-based interventions are suspected to alter or even distort declarative voluntary memory of a traumatic event, especially if they involve the active modification of imagery, e.g., as used in imagery rescripting (ImRs). However, systematic research is lacking so far. To investigate whether ImRs modifies voluntary memory of a standardized autobiographical aversive event (Trier Social Stress Test) (Session 1), healthy participants (N = 100) were randomly assigned to either an intervention condition receiving one session of ImRs or to a no-intervention control condition (NIC) (Session 2). Voluntary memory was examined using a free recall (Sessions 2 and 3) and a cued recall (Sessions 3 and 4). Although voluntary memory tended to deteriorate over time, contrary to expectations, this effect was not associated with ImRs. Remarkably, the number of correct details in free recall even improved in ImRs but not in NIC. This challenges the view that ImRs alters voluntary memory

Misdiagnosing bipolar disorder - Do clinicians show heuristic biases?

BACKGROUND: Bipolar disorders (BD) are often misdiagnosed. Clinicians seem to use heuristics instead of following the recommendations of diagnostic manuals. Bruchmüller and Meyer (2009) suggest that 'reduced sleep' is a prototypic criterion that increases the likelihood of a bipolar diagnosis. This study examines if this criterion specifically elevates the likelihood of a bipolar diagnosis or if the finding of the study mentioned above is rather due to the total number of criteria. Furthermore, we want to replicate the finding that patients offering a causal explanation for their manic symptoms are misdiagnosed more often. Additionally, we examine therapeutic attributes that might influence diagnostic decisions as well as treatment consequences following a (mis-)diagnosis. METHODS: 204 Psychotherapists were presented with a case vignette describing someone with a BD and were asked to make a diagnosis. Symptoms and the total number of criteria varied systematically within the vignettes but each still fulfilled enough diagnostic criteria to be diagnosed as bipolar. RESULTS: Almost 60% of the clinicians made misdiagnoses. A correct diagnosis did not depend on the specific criterion of 'reduced sleep' but on the total number of criteria. The causal explanation as well as therapeutic attributes did not significantly influence diagnostic decisions. However, the study showed that a misdiagnosis can lead to severe consequences concerning the treatment recommended by clinicians. LIMITATIONS: The validity of case vignettes is discussible. CONCLUSIONS: It seems as if specific symptoms might not be of so much relevance as assumed. Instead, clinicians seem to follow the additive model when making diagnoses

A Psychometric Evaluation of the German Version of the Responses to Positive Affect Questionnaire

Despite the importance of negative and positive emotion for our understanding of affective disorders, research on emotion regulation has mainly focused on the regulation of negative emotion. To capture individual differences in positive emotion regulation, Feldman et al. (Cognitive Therapy and Research, 32(4): 507–525, 2008) developed the Responses to Positive Affect Questionnaire (RPA), a self-report measure of different cognitive responses to positive emotions, including self-focused rumination, emotion-focused rumination, and dampening thoughts. The main purpose of this study was to develop a German version of this questionnaire and to evaluate its psychometric properties. Participants from two independent samples (N = 403; N = 486) completed a set of questionnaires. An exploratory factor analysis within the first sample did not replicate the 3-factor model of the original English version by Feldman et al. (Cognitive Therapy and Research, 32(4): 507–525, 2008), but rather suggested a 2-factor solution with rumination and dampening reflecting the main factors. A confirmatory factor analysis within the second sample confirmed this 2-factor solution. Although model fit was generally low, both subscales showed adequate internal consistency and acceptable convergent and incremental validity with measures of self-esteem, rumination, depressive symptoms, mania symptoms, and mania vulnerability. Our results support the German RPA as a helpful measure of positive emotion regulation in research on and therapy of affective disorders. The factor structure of the RPA should be further evaluated in future studies

Keep calm and carry on: improved frustration tolerance and processing speed by transcranial direct current stimulation (tDCS).

Cognitive control (CC) of attention is a major prerequisite for effective information processing. Emotional distractors can bias and impair goal-directed deployment of attentional resources. Frustration-induced negative affect and cognition can act as internal distractors with negative impact on task performance. Consolidation of CC may thus support task-oriented behavior under challenging conditions. Recently, transcranial direct current stimulation (tDCS) has been put forward as an effective tool to modulate CC. Particularly, anodal, activity enhancing tDCS to the left dorsolateral prefrontal cortex (dlPFC) can increase insufficient CC in depression as indicated by a reduction of attentional biases induced by emotionally salient stimuli. With this study, we provide first evidence that, compared to sham stimulation, tDCS to the left dlPFC enhances processing speed measured by an adaptive version of the Paced Auditory Serial Addition Task (PASAT) that is typically thwarted by frustration. Notably, despite an even larger amount of error-related negative feedback, the task-induced upset was suppressed in the group receiving anodal tDCS. Moreover, inhibition of task-related negative affect was correlated with performance gains, suggesting a close link between enhanced processing speed and consolidation of CC by tDCS. Together, these data provide first evidence that activity enhancing anodal tDCS to the left dlPFC can support focused cognitive processing particularly when challenged by frustration-induced negative affect