The role of relief, perceived control, and prospective intolerance of uncertainty in excessive avoidance in uncertain-threat environments.

Excessive avoidance is a key feature of pathological anxiety. However, the precise mechanisms underlying the development of excessive avoidance are still unknown. In the present study, we tested the hypothesis that excessive avoidance, especially in individuals with high Intolerance of Uncertainty (IU) is aimed at distress reduction via the enhancement of subjective perceived control in uncertain-threat environments. In our experiment, participants learned to avoid an uncertain aversive sound through a discriminated free operant procedure. In a later test phase in extinction, we manipulated the amount of avoidance responses available per trial by creating a limited and an unrestricted response condition. Nonetheless, the aversive sound could be effectively avoided in both conditions. We measured response frequency, avoidance confidence ratings and anxiety-predisposing traits such as intolerance of uncertainty, trait anxiety and distress tolerance. The degree of distress suffered during trials was inferred from post-trial relief ratings that were requested after trials in which the aversive sound had been omitted. In the avoidance acquisition phase, we found a positive association between prospective intolerance of uncertainty (P-IU) and the decline rate of distress. This relationship was not significant, however, when inhibitory intolerance of uncertainty (I-IU) was controlled for. At test, we found that the increase in avoidance responses led to distress reduction through the enhancement of avoidance confidence. Finally, we found a significant modulating role of P-IU in the effect of response limit on distress reduction that lends further support to our hypothesis. Specifically, P-IU was positively associated with the effect of response limit on distress. However, such modulating role was not significant when controlling for trait anxiety or I-IU.

Intolerance of uncertainty and decisions about delayed, probabilistic rewards: A replication and extension of Luhmann, C. C., Ishida, K., & Hajcak, G. (2011).

Intolerance of Uncertainty (IU) is thought to lead to maladaptive behaviours and dysfunctional decision making, both in the clinical and healthy population. The seminal study reported by Luhmann and collaborators in 2011 [1] showed that IU was negatively associated with choosing a delayed, but more probable and valuable, reward over choosing an immediate, but less probable and valuable, reward. These findings have been widely disseminated across the field of personality and individual differences because of their relevance for the understanding of the role of IU in the development and maintenance of anxiety-related disorders. Given their importance it would be desirable to have replications of this study, but none have been carried out so far. The current study has been designed to replicate and extend Luhmann et al.'s results. Our sample will include 266 healthy participants (more than five times the sample size used by Luhmann et al.) to detect with a power of 95% the effect size that can be detected with a power of 33% in the original study. To increase our chances of getting such a sample size, the experiment will be conducted online, To increase our chances of getting such a sample size, the experiment will be conducted online, adding check trials to the original decision-making task to monitor participants' engagement. Additionally, we will explore the role of impulsivity in the relationship between IU and willingness to wait. This study will add empirical evidence about the role of IU in decision making and, in case of replication of Luhmann et al.'s results, will support the hypothesis that high-IU individuals may engage in inefficient or costly behaviour in exchange for less time enduring an uncertain situation.

Prospective intolerance of uncertainty is associated with maladaptive temporal distribution of avoidance responses: An extension of Flores, López, Vervliet, and Cobos (2018).

BACKGROUND AND OBJECTIVES: Excessive maladaptive avoidance has been claimed to be one of the mechanisms through which intolerance of uncertainty (IU) may play its causal role in the development and maintenance of several anxiety and compulsive disorders. Consistently, Flores et al. (2018) found that individuals with higher Prospective IU (P-IU), a specific IU subfactor, display excessive avoidance response repetitions in a free-operant discriminative task to avoid an aversive noise. In the present study we tested the hypothesis that P-IU not only predicts the amount of avoidance responses but also how well the temporal distribution of such responses fits the temporal distribution of threats. METHODS: Further correlation and hierarchical regression analysis of Flores et al.'s (2018) data served to test this hypothesis. We evaluated two aspects of the temporal distribution of responses: a) for how long participants were performing the responses; b) the behavioral discrimination between threatening and safe time periods. RESULTS: The results showed that scoring high in P-IU was positively associated with longer periods of time dedicated to avoiding and with worse behavioral discrimination between threatening and safe time periods. Hierarchical regression analyses indicated that later addition of inhibitory intolerance of uncertainty and trait anxiety did not significantly improved the explained variance. LIMITATIONS: Our results are exclusively based on the use of a low-cost avoidance response, and the present study does not clarify the precise mechanisms that lead high P-IU people to engage in non-optimal avoidance response distribution through time. CONCLUSIONS: These results suggest that excessive avoidance is also driven by uncertainty of threat timing and highlight the relevance of P-IU as a vulnerability factor for excessive and outspread avoidance behaviors.

Learned predictiveness acquired through experience prevails over the influence of conflicting verbal instructions in rapid selective attention.

Previous studies have provided evidence that selective attention tends to prioritize the processing of stimuli that are good predictors of upcoming events over nonpredictive stimuli. Moreover, studies using eye-tracking to measure attention demonstrate that this attentional bias towards predictive stimuli is at least partially under voluntary control and can be flexibly adapted via instruction. Our experiment took a similar approach to these prior studies, manipulating participants' experience of the predictiveness of different stimuli over the course of trial-by-trial training; we then provided explicit verbal instructions regarding stimulus predictiveness that were designed to be either consistent or inconsistent with the previously established learned predictiveness. Critically, we measured the effects of training and instruction on attention to stimuli using a dot probe task, which allowed us to assess rapid shifts of attention (unlike the eye-gaze measures used in previous studies). Results revealed a rapid attentional bias towards stimuli experienced as predictive (versus those experienced as nonpredictive), that was completely unaffected by verbal instructions. This was not due to participants' failure to recall or use instructions appropriately, as revealed by analyses of their learning about stimuli, and their memory for instructions. Overall, these findings suggest that rapid attentional biases such as those measured by the dot probe task are more strongly influenced by our prior experience during training than by our current explicit knowledge acquired via instruction.

Intolerance of uncertainty as a vulnerability factor for excessive and inflexible avoidance behavior.

Recent studies have shown that avoidance behavior may become excessive and inflexible (i.e., detached from its incentive value and resistant to extinction). On the other hand, prospective intolerance of uncertainty (P-IU) has been defined as a factor leading to excessive responding in uncertain situations. Thus, uncertain avoidance situations may be taken as a relevant scenario to examine the role of intolerance of uncertainty as a factor that facilitates excessive and inflexible avoidance behavior. In our experiment, we tested the hypothesis that P-IU is associated with excessive and inflexible avoidance in an outcome devaluation paradigm. Specifically, healthy participants learned in a free-operant discriminative task to avoid an aversive sound, and were tested in extinction to measure the sensitivity of avoidance responses to the devaluation of the sound aversiveness. The results showed that an increase in P-IU was positively associated to an increase in insensitivity to the devaluation. Moreover, P-IU was also related to an increase in the frequency of avoidance responses during the instrumental learning phase, and to resistance to extinction. Interestingly, these associations involving P-IU were still significant when trait anxiety was controlled for. The pattern of results suggests that P-IU may be a vulnerability factor for excessive and inflexible avoidance, which, in turn, has been found to be associated with several mental disorders.

Previously acquired cue-outcome structural knowledge guides new learning: Evidence from the retroactive-interference-between-cues effect.

The effect of retroactive interference between cues predicting the same outcome (RIBC) occurs when the behavioral expression of a cue-outcome association (e.g., A→O1) is reduced due to the later acquisition of an association between a different cue and the same outcome (e.g., B→O1). In the present experimental series, we show that this effect can be modulated by knowledge concerning the structure of these cue-outcome relationships. In Experiments 1A and 1B, a pretraining phase was included to promote the expectation of either a one-to-one (OtO) or a many-to-one (MtO) cue-outcome structure during the subsequent RIBC training phases. We hypothesized that the adoption of an OtO expectation would make participants infer that the previously learned A→O1 relationship would not hold any longer after the exposure to B→O1 trials. Alternatively, the adoption of an MtO expectation would prevent participants from making such an inference. Experiment 1B included an additional condition without pretraining, to assess whether the OtO structure was expected by default. Experiment 2 included control conditions to assess the RIBC effect and induced the expectation of an OtO or MtO structure without the addition of a pretraining phase. Overall, the results suggest that participants effectively induced structural expectations regarding the cue-outcome contingencies. In turn, these expectations may have potentiated (OtO expectation) or alleviated (MtO expectation) the RIBC effect, depending on how well these expectations could accommodate the target A→O1 test association. This pattern of results poses difficulties for current explanations of the RIBC effect, since these explanations do not consider the incidence of cue-outcome structural expectations.

Dependent measure and time constraints modulate the competition between conflicting feature-based and rule-based generalization processes.

In our study, we tested the hypothesis that feature-based and rule-based generalization involve different types of processes that may affect each other producing different results depending on time constraints and on how generalization is measured. For this purpose, participants in our experiments learned cue-outcome relationships that followed the opposites rule: Single cues that signaled the same outcome (e.g., A-1/B-1) predicted the opposite outcome when presented in compound (e.g., AB-2). Some cues were only presented in compound during training (e.g., EF-1) to see if at test participants tended to generalize according to rule-based (i.e., E-2/F-2) or according to feature-based generalization (i.e., E-1/F-1). The generalization test used 2 different tasks: a predictive judgment task, and a cued-response priming task. In Experiment 1, participants' verbal ratings were consistent with rule-based generalization. However, participants' reaction times (RTs) in the cued-response priming task were consistent with feature-based generalization. Experiment 2 replicated the results from Experiment 1, and it also provided evidence consistent with feature-based or rule-based generalization depending on whether a short stimulus onset asynchrony (SOA; 200 ms) or a long SOA (1300 ms), respectively, was used in the priming task. Our results are interpreted as supporting the idea that feature-based generalization process relies on fast, associative processes, whereas rule-based generalization is slow and depends on executive control resources. The latter generalization process would inhibit the former when enough time and resources are available. Otherwise, feature-based generalization would take control of responses. (PsycINFO Database Record

PRE-CLINICAL SKILLS: A competency-based assessment integrated course implemented early in the curriculum to prepare second-year medical students prior to entering clinical settings.

This article was migrated. The article was marked as recommended. Objective: This Case Study describes the experience of Rovira i Virgili University School of Medicine (URV) with the early introduction of pre-clinical skills learning in the undergraduate medical curricula to monitor and assessing these competencies as a prerequisite for medical students accessing their training in clinical settings. Course Development: A PRE-CLINICAL SKILLS course has been developed to guarantee medical student's performance in managing clinically relevant basic medical sciences to interpret clinical scenarios, to develop technical communication skills and to value professional behavior throughout the first two years of medical education. The set of pre-clinical competencies evaluated in this course as well as the corresponding assessment methods have been established according to an international reference standards review work in collaboration with the regional quality assurance agency. An integrated formative assessment is being used. Course Advantages, Added Values and Outcome Measures: Since the academic year 2009-2010 about 130 students from second-year of Medicine follows this integrated trunk-course while being enrolled in parallel in other core courses as Physiology, Anatomy, and Histology. The program doesn't include lectures but only learning activities to train and monitor the successful achievement of the pre-clinical skills by medical students. A good majority of the participants achieve readiness for start training in clinical settings. As a whole, this course is useful ensuring patient's safety by identifying weaknesses acquisition of pre-clinical skills and predicting medical students who will have difficulty during their clinical training. Conclusions: Reflecting on our experience, we believe that the named course "PRE-CLINICAL SKILLS" overcomes the disadvantages of the traditional teaching methods. Helping students to conceptualize rather than memorize and encouraging them to integrate clinically relevant basic medical sciences concepts and principles by training pre-clinical skills in this competence-based assessment course prior entering into clinical settings.

The influence of causal connections between symptoms on the diagnosis of mental disorders: evidence from online and offline measures.

An experiment conducted with students and experienced clinicians demonstrated very fast and online causal reasoning in the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. The experiment also demonstrated that clinicians' causal reasoning is triggered by information that is directly related to the causal structure that explains the symptoms, such as their temporal sequence. The use of causal theories was measured through explicit, verbal diagnostic judgments and through the online registration of participants' reading times of clinical reports. To detect both online and offline causal reasoning, the consistency of clinical reports was manipulated. This manipulation was made by varying the temporal order in which different symptoms developed in hypothetical clients, and by providing explicit information about causal connections between symptoms. The temporal order of symptoms affected the clinicians' but not the students' reading times. However, offline diagnostic judgments in both groups were influenced by the consistency manipulation. Overall, our results suggest that clinicians engage in fast and online causal reasoning processes when dealing with diagnostic information concerning mental disorders, and that both clinicians and students engage in causal reasoning in diagnostic judgment tasks.

Detecting fast, online reasoning processes in clinical decision making.

In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed.

Associative repetition priming as a measure of human contingency learning: evidence of forward and backward blocking.

Associative theories have been widely used to explain human contingency learning. Standard experimental procedures in the field have requested verbal judgments as a measure of the cue-outcome relationships learned. According to these theories, knowledge retrieval is based on spreading activation processes. However, verbal judgments may allow or even promote the engagement of high-order processes that may hinder the interpretation of verbal judgments as the output of automatic retrieval processes like those posited. However, previous studies on human associative memory have shown that priming tests, under the right conditions, can minimize the engagement of high-order processes and serve as a measure of low-level automatic retrieval processes. Thus, a new human contingency learning task that incorporates a recognition priming test was developed and tested here. The results showed that, as predicted by associative theories, repetition priming was found after training. In addition, the results showed that relevant learning phenomena such as forward and backward blocking could also be detected using this test. Finally, training based on instructions did not modulate the priming effect. The relevance of these findings for theories of human contingency learning and priming is discussed.

Renewal effects in interference between outcomes as measured by a cued response reaction time task: further evidence for associative retrieval models.

Two experiments demonstrated renewal effects in interference between outcomes in human participants. Experiment 1 revealed a XYX renewal effect, whereas Experiment 2 showed a XYZ renewal effect. The results from both experiments conformed to Bouton's (1993) theory of interference and recovery from interference, and contradicted the predictions derived from alternative accounts. Unlike previous demonstration of renewal effects, a cued response reaction time (RT) task was used, able to detect the effects of fast retrieval processes based on associative activation and that allowed little impact of inferential reasoning.

The role of outcome inhibition in interference between outcomes: a contingency-learning analogue of retrieval-induced forgetting.

Current associative theories of contingency learning assume that inhibitory learning plays a part in the interference between outcomes. However, it is unclear whether this inhibitory learning results in the inhibition of the outcome representation or whether it simply counteracts previous excitatory learning so that the outcome representation is neither activated nor inhibited. Additionally, these models tend to conceptualize inhibition as a relatively transient and cue-dependent state. However, research on retrieval-induced forgetting suggests that the inhibition of representations is a real process that can be relatively independent of the retrieval cue used to access the inhibited information. Consistent with this alternative view, we found that interference between outcomes reduces the retrievability of the target outcome even when the outcome is associated with a novel (non-inhibitory) cue. This result has important theoretical implications for associative models of interference and shows that the empirical facts and theories developed in studies of retrieval-induced forgetting might be relevant in contingency learning and vice versa.

Interference between outcomes, spontaneous recovery, and context effects as measured by a cued response reaction time task: evidence for associative retrieval models.

The most common associative explanation of interference is based on a retrieval failure. Retrieval, in turn, is considered as the result of an associative activation mechanism that is thought to be fast and automatic. However, up-to-date, there is no evidence of interference based on dependent measures specifically related to this kind of low level processes. The objective of the present study was to test whether interference phenomena can be observed by using a cued response task designed to detect low level retrieval processes. Experiment 1 evaluated whether the cued response task served to show a priming effect. Such effect allowed us to interpret the results found in the remaining experiments of the series. Experiment 2 aimed to find the interference effect by using the cued response task. Experiments 3 and 4 were conducted to assess whether spontaneous recovery and context-change effects could also be observed. The results showed that interference and recovery from interference phenomena can be attributable to fast retrieval processes, which is consistent with associative accounts of interference.

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Spontaneous recovery from interference between cues but not from backward blocking.

In the present study, we examined the differential effect on backward blocking (BB) and on interference between cues (IbC) of including a delay right before the test phase vs. between training phases 1 and 2 in humans. While models of IbC predict a spontaneous recovery (SR) of responding if the delay is placed immediately before the test instead of between phases 1 and 2, BB models predict that no difference should be observed due to the position of the delay. In our experiment, we obtained the SR from IbC but not from BB. These results suggest that backward blocking and interference between cues are likely to be the result of different processes.

[Double vascular pedicle iliac crest flap]. / Colgajo de cresta ilíaca de doble pedículo vascular.

INTRODUCTION: The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein (ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. MATERIAL AND METHOD: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularised iliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. RESULTS: The 3 cases showed a favourable outcome. This "supercharging" variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested. CONCLUSIONS: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis.

Colgajo de cresta ilíaca de doble pedículo vascular / Double vascular pedicle iliac crest flap

Introducción: el colgajo de cresta ilíaca (CCI) es uno de los utilizados con mayor frecuencia en la reconstrucción facial. Su vascularización depende de los vasos circunflejos ilíacos profundos (ACIP, VCIP). Este trabajo describe, por primera vez, la posibilidad de doble irrigación de la isla cutánea del CCI incluyendo el sistema circunflejo ilíaco superficial para la reconstrucción de cabeza y cuello. Material y método: se diseccionaron 10 regiones inguinales de 5 cadáveres en el Departamento de Anatomía de la Facultad de Medicina Rovira i Virgili de Reus (Tarragona). En el periodo 2005-2007, 3 pacientes fueron intervenidos en el Servicio de Cirugía Maxilofacial del Hospital Joan XXIII de Tarragona, requiriendo un colgajo osteomiocutáneo microvascularizado de cresta ilíaca. Resultados: los 3 casos clínicos mostraron una evolución satisfactoria. Esta técnica proporciona una mayor vascularización del colgajo y una mayor disponibilidad tridimensional e implica menor morbilidad de la zona donante, ya que se necesita tallar menos cantidad de oblicuo pues la irrigación de los vasos perforantes no depende de la ACIP. Conclusiones: esta variación técnica del colgajo de cresta ilíaca puede sernos de gran utilidad en la reconstrucción de defectos complejos maxilofaciales a cambio de realizar una disección vascular y su anastomosis extra (AU)

Introduction. The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein(ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. Material and method: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularisediliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. Results: The 3 cases showed a favourable outcome. This “supercharging” variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested Conclusions: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis (AU)

Interference between cues of the same outcome in a non-causally framed scenario.

Retroactive interference between cues of the same outcome (i.e., IbC) occurs when the behavioral expression of an association between a cue and an outcome (e.g., A-->O1) is reduced due to the later acquisition of an association between a different cue and the same outcome (e.g., B-->O1). Though this interference effect has been traditionally explained within an associative framework, there is recent evidence showing that IbC effect may be better understood in terms of the operation of higher order causal reasoning processes. The results from Experiments 1 and 2 showed an IbC effect in a learning task within a game scenario suggesting non-causal relationships between events. Thus, these results showed that IbC may have a diverse origin, one of them being of an associative nature.

Interference between cues of the same outcome depends on the causal interpretation of the events.

In an interference-between-cues design, the expression of a learned Cue A --> Outcome 1 association has been shown to be impaired if another cue, B, is separately paired with the same outcome in a second learning phase. In the present study, we assessed whether this interference effect is mediated by participants' previous causal knowledge. This was achieved by having participants learn in a diagnostic situation in Experiment 1a, and then by manipulating the causal order of the learning task in Experiments 1b and 2. If participants use their previous causal knowledge during the learning process, interference should only be observed in the diagnostic situation because only there we have a common cause (Outcome 1) of two disjoint effects, namely cues A and B. Consistent with this prediction, interference between cues was only found in Experiment 1a and in the diagnostic conditions of Experiments 1b and 2.