Do older adults respond to cognitive behavioral therapy as well as younger adults? An analysis of a large, multi-diagnostic, real-world sample.

OBJECTIVES: Older adults (OA; ≥55 years of age) are underrepresented in patients receiving cognitive-behavioral therapy (CBT). This study evaluates mental health outcomes for OA compared to younger adults (YA; <55 years of age) receiving CBT. DESIGN: This is a pre-post study comparing the effectiveness of CBT for OA (n = 99) and YA (n = 601) in a CBT service located in a university-affiliated tertiary care hospital in Canada. Data was collected between 2001 and 2021. Participants received a mean of 18.5 sessions (SD 10) of standard, evidence-based CBT with treatment integrity checks. The main outcome was clinically significant change, as measured by the Reliable Change Index (RCI). Secondary outcomes were change in the Global Severity Index (GSI-SCL) of the Symptoms Checklist-90 (Revised), and Clinical Global Improvement scores (CGI). RESULTS: The RCI allowed a comparison of treatment efficacy across diagnoses. Both groups experienced similar improvement on the RCI (2.92 [±3.64] vs. 3.15 [±4.86], p = 0.65). Furthermore, 39% of OA and 42% of YA no longer met criteria for their diagnoses. Groups did not differ with respect to changes in the GSI-SCL. The CGI severity comparison suggested that OA had milder illness. In all outcomes (RCI, CGI and GSI-SCL), participants improved over time. CONCLUSIONS: This real-world study analyzed a large sample of OA and YA undergoing CBT for various mental health conditions. Both groups were found to benefit equally.

Why We Still Use "Organic Causes": Results From a Survey of Psychiatrists and Residents.

The diagnostic category of "organic disorders" was officially removed from the psychiatric nosology in DSM-IV, published in 1994. Despite this change, physicians continue to use the term "organic causes" to refer to medical and neurological causes of psychiatric symptoms, and it remains part of the ICD-10 classification. In the context of increasing integration of psychiatric disorders within a medical and neuroscientific framework, the reasons behind the ongoing use of this term (reminiscent of mind-body dualism) have to be clarified. The authors conducted a survey of 391 Canadian psychiatrists and psychiatric residents to understand attitudes and beliefs related to this terminology and then applied qualitative and quantitative analyses. Results showed that the terminology is used by the majority (55.9%) of psychiatrists and residents for two main reasons: out of a habit that begins in residency training and because of the belief that other specialties do not fully understand alternative terminology. The authors found that some psychiatrists are concerned that their patients will not receive adequate investigation unless it is made clear through use of the "organic cause" term that other medical causes of psychiatric symptoms are suspected. Use of the "organic cause" term was predicted by being of younger age, performing emergency department calls, and finding alternative terminology difficult to use. These findings highlight the importance of reflecting on and discussing the effect of this terminology used in psychiatry.

The attentional blink freezes spatial attention allocation to targets, not distractors: evidence from human electrophysiology.

Previous work found a significant reduction of the amplitude of the N2pc ERP component during the attentional blink in response to lateral visual targets, suggesting that the allocation of attention to visual targets is impaired during the attentional blink. Recent theorizing on the processes reflected by the N2pc suggests the possibility of distinct sets of neural mechanisms underlying its generation, one responsible for target activation, and one for distractor inhibition. To disentangle whether either or both of these mechanisms are impaired during the attentional blink, an RSVP sequence of circles, equidistant from fixation was used. The first target frame (T1) contained the same repeated target colour circle and target whereas the second target frame (T2) contained a distractor colour singleton as well as a target colour singleton. Only the target or only the distractor was presented at a lateral position; the other singleton was presented on the vertical midline so as not to elicit any event-related lateralization. Impaired T2 report accuracy at a short stimulus-onset asynchrony (SOA) was accompanied by a significant delay of the N2pc to lateral T2 targets when compared to a long SOA condition. No such delay was found when the lateralized stimulus was a distractor, suggesting that the attentional blink impacts attention allocation to targets, not distractors. We also observed a lateralized component earlier than the N2pc, a posterior contralateral positivity (Ppc) that did not depend on T1-T2 SOA and that was elicited by both lateral targets and distractors. We conclude that, contrary to N2pc, the Ppc likely reflects activity of bottom-up mechanisms responding unselectively to asymmetrical visual displays.

Colour-specific differences in attentional deployment for equiluminant pop-out colours: evidence from lateralised potentials.

We investigated how target colour affected behavioural and electrophysiological results in a visual search task. Perceptual and attentional mechanisms were tracked using the N2pc component of the event-related potential and other lateralised components. Four colours (red, green, blue, or yellow) were calibrated for each participant for luminance through heterochromatic flicker photometry and equated to the luminance of grey distracters. Each visual display contained 10 circles, 1 colored and 9 grey, each of which contained an oriented line segment. The task required deploying attention to the colored circle, which was either in the left or right visual hemifield. Three lateralised ERP components relative to the side of the lateral coloured circle were examined: a posterior contralateral positivity (Ppc) prior to N2pc, the N2pc, reflecting the deployment of visual spatial attention, and a temporal and contralateral positivity (Ptc) following N2pc. Red or blue stimuli, as compared to green or yellow, had an earlier N2pc. Both the Ppc and Ptc had higher amplitudes to red stimuli, suggesting particular selectivity for red. The results suggest that attention may be deployed to red and blue more quickly than to other colours and suggests special caution when designing ERP experiments involving stimuli in different colours, even when all colours are equiluminant.

Electrophysiological evidence of multitasking impairment of attentional deployment reflects target-specific processing, not distractor inhibition.

We studied the interaction between the control mechanisms subserving spatial attention and central attention using the psychological refractory period (PRP) paradigm. Two stimuli, a pure tone (T(1)) and a circular visual array (T(2)), including a salient target and a salient distractor, were presented at varying stimulus onset asynchronies, each requiring a speeded response. Target-specific and distractor-specific lateralized event-related potentials were isolated by placing one of them at a lateral position and the other on the vertical midline. As SOA was decreased, a progressive reduction and postponement of a T(2)-locked N2pc component was observed with a lateral target and a central distractor. No lateralized potentials were associated with a lateral distractor and a central target. The sustained posterior contralateral negativity (SPCN) was observed independently of SOA modulation, only with a lateral target. We also observed an earlier positive deflection, the Ppc (positivity posterior contralateral), that was contralateral to both lateral targets and distractors, whose amplitude and latency were not affected by SOA variations. We conclude that central processing interferes specifically with target processing reflected by the N2pc and SPCN. We propose that the Ppc reflects an initial, bottom-up response to the presence of a salient stimulus, whereas the N2pc and SPCN reflect the controlled deployment of spatial attention to targets and maintenance of target information in visual short-term memory, respectively.