The effects of eye movements on the content and characteristics of unpleasant autobiographical memories: an extended replication study.

Experimental studies show that vividness and emotionality of aversive memories decrease after recall with eye movements. We aimed at replicating this finding. Relatedly, consistent with Conway's view that memory retrieval is constructive, we examined changes in the content of the memories. If eye movements render a memory less aversive, it may be avoided less, stimulating recall and increasing the opportunity to infer (contextual) details. Two experiments (N = 97 and N = 250) examined whether eye movements affect the number of central and peripheral memory details and characteristics. Female undergraduate students were randomly allocated to either eye movements with recall (EM) or recall only (RO). Before and after the experimental task, participants rated the vividness and emotionality, provided a detailed description and evaluated other memory characteristics. We replicated earlier findings that vividness (both experiments) and emotionality (experiment 2) were reduced more after EM compared to RO. However, conditions did not statistically significantly differ with respect to content details and other memory characteristics. Overall, findings support the idea that eye movements decrease the experience of the memory as vivid and emotional. Results are inconclusive regarding the idea that eye movements alter the number of recalled central and peripheral memory details.

Zygomaticomaxillary complex fracture repair with intraoperative CBCT imaging. A prospective cohort study.

The aim of this study was to evaluate the value of intraoperative conebeam computed tomography (CBCT) imaging in the treatment of zygomaticomaxillary complex (ZMC) fractures. A prospective single center cohort study was performed. Included were consecutive patients who underwent surgery for a unilateral ZMC fracture. An intraoperative CBCT scan was performed after reduction of the ZMC fracture. Revision reduction was performed of the ZMC and/or orbital floor (OF) on indication. The preoperative and postoperative asymmetry of the outer surface of the ZMC was measured on digital 3D-models of CBCT scans, using a mirroring and surface-based matching technique. The postoperative asymmetry of the ZMC in the study group was compared to the asymmetry of the ZMC in the control group with healthy individuals. A total of 38 patients with a unilateral ZMC fracture were included. The mean postoperative asymmetry in the study group (1.67 mm, SD 0.89) was less than the mean preoperative asymmetry (2.69 mm, SD 0.95) (paired samples T-test p < 0.01) but showed no statistically significant difference with the mean asymmetry in the healthy control group (1.40 mm, SD 0.54) (independent samples T-test p = 0.31). Revision reduction of the ZMC and/or OF fracture had been performed in 11 cases after malalignment was noted on the intraoperative CBCT. The indication for intraoperative revision reduction was associated with comminuted ZMC fractures and/or fractures with indication for OF reduction (Pearson Chi Square p < 0.01). Within the limitations of the study, intraoperative CBCT imaging seemed to have a positive influence on ZMC fracture treatment, especially in the case of comminuted ZMC fractures and/or fractures with indication for OF treatment.

A Novel Method for Quantitative Three-Dimensional Analysis of Zygomatico-Maxillary Complex Symmetry.

OBJECTIVE: To develop a reliable and accurate method to quantify the symmetry of the zygomaticomaxillary complex (ZMC). METHODS: Virtual three-dimensional models were created from 53 computed-tomography scans: 15 healthy cases without maxillofacial disorders and 38 patients with ZMC fractures requiring surgical treatment.Asymmetry of the ZMC was measured using a mirroring and surface-based matching technique that uses the anterior cranial fossa as reference to determine the symmetrical position of the ZMC. The measure for ZMC asymmetry was defined as mean surface distance (MSD) between the ZMC-surface and the symmetrical position.Reliability of the method was tested in the 15 healthy cases. Inter-and intra-observer correlation coefficients (Ce) and variabilities were assessed. Accuracy was assessed by comparing ZMC asymmetry between healthy and ZMC fracture cases, and by assessing correlation of ZMC fracture severity with ZMC asymmetry. RESULTS: The average MSD of the 15 healthy cases was 1.40 ± 0.54 mm and the average MSD of the 38 ZMC fracture cases was 2.69 ± 0.95 mm ( P < 0.01). Zygomaticomaxillary complex asymmetry correlated with fracture severity ( P = 0.01). Intra-rater CC was 0.97 with an intra-rater variability of 0.09 ± 0.11 mm. Inter-rater Ce was 0.95 with an inter-rater variability of 0.12 ± 0.13 mm. CONCLUSIONS: Our method is reliable and accurate for quantitative three-dimensional analysis of ZMC-symmetry. It takes into account asymmetry caused by the shape of the ZMC as well as asymmetry caused by the position of the ZMC. CLINICAL RELEVANCE: This method is useful for the evaluation of ZMC asymmetry associated with congenital and acquired disorders of craniofacial skeleton, for surgical planning and for evaluation of postoperative results.

Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older.

BACKGROUND: Several drugs have become available for the treatment of osteoporosis. However, screening and treatment of patients with a high fracture risk is currently not recommended in the Netherlands, because the effectiveness of bone sparing drugs has not been demonstrated in the general primary care population. Here we describe the design of the SALT Osteoporosis study, which aims to examine whether the screening and treatment of older, female patients in primary care can reduce fractures, in comparison to usual care. METHODS: A randomised pragmatic trial has been designed using a stepwise approach in general care practices in the Netherlands. Women aged ≥65 years, who are not prescribed bone sparing drugs or corticosteroids are eligible for the study. First, women with at least one clinical risk factor for fractures, as determined by questionnaires, are randomly assigned to the intervention or control group. Second, women in the intervention group having a high fracture risk according to our screening program, including an adapted fracture risk assessment (FRAX) tool, combined with dual-energy x-ray absorptiometry (DXA), and instant vertebral assessment (IVA), are offered a structured treatment program. The women in the control group receive care as usual and will undergo the same screening as the intervention group at the end of the trial. The follow-up duration will be three years and the primary outcome is time to first incident fracture and the total number of fractures. DISCUSSION: The results of the current study will be very important for underpinnings of the prevention strategy of the osteoporosis guidelines. TRIAL REGISTRATION: ID NTR2430 . Registered 26 July 2010.

Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder.

OBJECTIVE: The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT+SSRI). METHOD: Cost-effectiveness was examined based on the data from a multicenter randomized controlled trial. The Hamilton Anxiety Rating Scale was selected as a primary health outcome measure. Data on costs from a societal perspective (i.e., direct medical, direct non-medical, and indirect non-medical costs) were collected in the study sample (N=150) throughout a 24-month period in which patients received active treatment during the first twelve months and were seen twice for follow-up in the next twelve months. RESULTS: Total costs were largely influenced by costs of the interventions and productivity losses. The mean total societal costs were lower for CBT as compared to SSRI and CBT+SSRI. Costs of medication use were substantial for both SSRI and CBT+SSRI. When examining the balance between costs and health outcomes, both CBT and CBT+SSRI led to more positive outcomes than SSRI. CONCLUSION: Cognitive behavioral therapy is associated with the lowest societal costs. Cognitive behavioral therapy and CBT+SSRI are more cost-effective treatments for panic disorder with or without agoraphobia as compared to SSRI only.

Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia.

OBJECTIVE: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the mono-treatments. METHOD: Patients with PD (n = 150) with or without agoraphobia received CBT, SSRI or CBT + SSRI. Outcome was assessed after 9 months, before medication taper. RESULTS: CBT + SSRI was clearly superior to CBT in both completer and intent-to-treat analysis (ITT). Completer analysis revealed superiority of CBT + SSRI over SSRI on three measures and no differences between CBT and SSRI. ITT analysis revealed superiority of SSRI over CBT on four measures and no differences between CBT + SSRI and SSRI. CONCLUSION: Both the mono-treatments (CBT and SSRI) and the combined treatment (CBT + SSRI) proved to be effective treatments for PD. At post-test, CBT + SSRI was clearly superior to CBT, but differences between CBT + SSRI and SSRI, and between SSRI and CBT, were small.

Assessment of self-statements in agoraphobic situations construction and psychometric evaluation of the Agoraphobic Self-Statements Questionnaire (ASQ).

The study describes the development and psychometric evaluation of a self-report questionnaire for use in both treatment-outcome research and process studies: the Agoraphobic Self-Statements Questionnaire (ASQ). The ASQ comprises two subscales: a positive self-statements subscale and a negative self-statements subscale. Confirmatory factor analysis showed that, with the exception of one item, the proposed bidimensional structure of the ASQ reappeared in a second agoraphobic patient sample. Internal consistency of both subscales was satisfactory. Both subscales appeared to be sensitive to change in treatment and discriminated between agoraphobic patients and normal controls. Construct validity of the negative subscale was satisfactory, whilst additional validation of the positive subscale is required. Findings also revealed that positive thinking may serve as a coping device and that the occurrence of negative self-statements might be considered a sine qua non for the occurrence of positive self-statements. It is concluded that the ASQ can contribute to the understanding of cognitive processes during treatment of agoraphobia.

The role of negative self-statements during exposure in vivo. A process study of eight panic disorder patients with agoraphobia.

The purpose of this study was to evaluate the pattern of cognitive change, and in particular the role of negative self-statements, in relation to improvement during an in vivo exposure treatment. Eight panic disordered patients with agoraphobia, of whom 4 were most and 4 were least improved on a composite measure, were exposed to standardized agoraphobic situations. During the exposure, heart rate, self-statements, and subjective anxiety were registered throughout the sessions. Fixed criteria were set for habituation of heart rate and reduction of subjective anxiety within a session. Results showed that the total frequency of negative self-statements at the start, during, as well as at the end of treatment differentiated best between the most and least improved patients. These results suggest that it may be therapeutically wise to continue exposure therapy not only until habituation of anxiety (subjectively and physiologically) is achieved, but also until the frequency of negative self-statements is reduced until zero.

Overprediction of fear in panic disorder patients with agoraphobia: does the (mis)match model generalize to exposure in vivo therapy?

The purpose of this study was to test the (mis)match model of Rachman and co-workers during real life exposure therapy in panic disorder patients with agoraphobic avoidance. The results showed that although the patients tended to overpredict their expected fear before the exposure sessions, their predictions did not show a tendency to become more accurate in the course of treatment. After an overprediction predicted fear tended to decrease and self-efficacy tended to increase; after a correct match both predicted fear and self-efficacy remained unchanged. Patients reports of fear tended to decrease within and across exposure sessions regardless of the occurrence of correct or incorrect matches. Patients reported significantly more positive self-statements in underprediction sessions compared to overprediction and correct match sessions. Positive self-statements increased both in underprediction and correct match sessions, but decreased in overprediction sessions. The largest reduction in negative self-statement within an exposure session was found in correct match sessions. The theoretical and clinical relevance of the results are discussed in line of the match/mismatch model of Rachman and co-workers.

Somatic symptoms in social phobia: a treatment method based on rational emotive therapy and paradoxical interventions.

Social phobia is often accompanied by somatic symptoms such as trembling, blushing, and sweating. In cases where these symptoms are predominant and, rather than the social situation, represent the feared stimulus, their unpredictable occurrence may reduce the effectiveness of an otherwise successful treatment, such as exposure in vivo. In this study, a paradoxical treatment approach, combined with rational emotive therapy, is employed with three social phobic patients with fears of blushing, trembling, and sweating, respectively. Results indicate that a paradoxical treatment may be an effective strategy in reducing somatic symptoms in social phobia.

Classical conditioning and attentional bias.

The present study was designed to test whether an attentional bias can arise from aversive classical conditioning. Using a differential conditioning paradigm in which slides of angry faces served as conditioned stimuli (CS+/CS-) and electric shock served as unconditioned stimulus (UCS), skin conductance responses (SCRs) of normal subjects (N = 20) were recorded. The effectiveness of the conditioning procedure was proved by differential SCRs to CS+ and CS- slides during the later acquisition trials. During a subsequent extinction phase, sets of three numbers were superimposed on CS+ and CS- slides. subjects were asked to add up these numbers as quickly as possible and to vocalize the results. Vocalization latencies as indexed by chin EMG activity were significantly longer with CS+ than with CS- trials. This result is explained in terms of the attention attracting properties that the CS+ acquires as a result of its pairing with the UCS. It is argued that these properties compete with the attentional resources that are needed for an ongoing task (i.e., addition task). The data suggest that a learning approach to the origins of attentional biases in anxious subjects might be fruitful.

Psychophysiological and subjective reactions of social phobics and normals to facial stimuli.

Nine social phobics and 9 normal control subjects were exposed to slides of angry faces, happy faces, and neutral objects (i.e. flowers or mushrooms). Skin conductance responses (SCRs) to the stimuli and eyeblink rate (EBR) during stimulus exposure were recorded. In addition, subjects were asked to rate the stimuli in terms of pleasantness. While angry face stimuli elicited greater SCRs, stronger inhibition of EBR, and were evaluated more negatively than the other stimuli, there were no differences between social phobics and normals in these respects. Thus, the findings lend no support to the idea that social phobics are particularly sensitive to facial cues in general or to negative facial cues in particular.