Essays
-
Clarifying the Nature and Structure of Personality Disorder - Suzuki, Takakuni
Past research has suggested that personality disorders (PDs) are best conceptualized as a maladaptive extreme variants of the same traits that define general personality. Such a dimensional approach to PD classification has officially been included in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) as an alternative diagnostic model for PD. The current essay provides an overview of the rationale for the dimensional approach to PDs and highlights compelling directions for future research. -
Cognitive Bias Modification in Mental - Reuland, Meg M.
Cognitive biases refer to a tendency to favor a particular way of processing information, such as habitually attending to threatening information in the environment, or interpreting ambiguous information in a negative way. Importantly, cognitive biases are linked to a number of emotional problems, such as anxiety and depression, raising the question of whether altering cognitive biases could relieve the symptoms of these disorders. Cognitive bias modification (CBM) refers to a group of interventions typically delivered via computer that alter cognitive biases through repeated practice in processing information in a healthy way (e.g., learning to attend to neutral, rather than threatening, cues). Some research suggests that CBM can ameliorate symptoms of mental illness and reduce emotional vulnerability to stressors. Moreover, CBM's computerized format offers a potentially cost‐effective option for wide dissemination, which could prevent and reduce the public health burden of mental illness. At the same time, mixed research findings suggest more research is needed before CBM can be considered a frontline treatment for psychopathology. The current essay describes CBM's theoretical framework, reviews the CBM outcome literature, and explores key questions for future research, such as how CBM works, for whom it works best, and optimal delivery conditions. -
Cognitive Remediation in Schizophrenia - Reeder, Clare
It is well established that many people with a diagnosis of schizophrenia experience significant problems with thinking skills such as concentration, memory, comprehension of social information, reasoning, and organization. These are often experienced by the individuals themselves as debilitating and demoralizing, but crucially, they also can limit people in their capacity to achieve fundamental life goals, such as working, having fulfilling relationships and living independently, which underpin well‐being and a satisfactory quality of life. Cognitive remediation for schizophrenia is a psychological therapy that aims to improve thinking skills and consequently to benefit other more general areas of functioning and improve quality of life. -
Coping with Perceived Chances and Risks Associated with Social Change - Silbereisen, Rainer K.
Social change in the form of political transformation in the context of globalization and individualization is prevalent worldwide. Such change can occur gradually or abruptly and not always as part of people's conscious experience. In such situations, features of the broader ecological contexts in which people live moderate the process of coping. Successfully coping affects well‐being and other psychosocial outcomes and in most, but not all instances, requires active engagement, development of a sense of control and capitalizing on proximate social and personal resources. Future research should emphasize cross‐national study of objective and subjective outcomes, and the relationships between demands (broadly defined), varieties of mechanisms for coping, and the full range of personal and social resources available for doing so. The aim of such research must be to inform social policies designed to empower people's sense of personal agency and aligned with relevant changes in opportunity structures. -
Deep Brain Stimulation for Psychiatric Disorders - Widge, Alik S.
In this monograph, we briefly review the rationale for deep brain stimulation (DBS) for psychiatric illness, beginning with current noninvasive treatment options and progressing to the evolution and success of DBS as a therapy. This discussion will focus on obsessive‐compulsive disorder (OCD) and major depressive disorder (MDD) particularly, as these are the only two diagnoses that have been subjected to adequately controlled DBS trials to date. The majority of the essay then describes the significant limitations that DBS is currently facing and emerging approaches to address them. This will lead into a discussion of new technologies such as patient‐specific modeling of electric fields and closed‐loop DBS systems and how we can best utilize these to increase our understanding of DBS and the overall efficacy of this novel therapy. -
Delusions - Coltheart, Max
A delusional belief is a belief adopted on the basis of insufficient evidence and held strongly in the face of much counterevidence. Some people with a delusional condition have a single delusional belief—this is monothematic delusion and much is now understood about what cause the various kinds of monothematic delusion. I describe six kinds of monothematic delusions. Other people with a delusional condition have many different delusional beliefs about a wide variety of topics—this is polythematic delusion, and what could be the causes of polythematic delusional conditions is still very poorly understood. -
Depression - Gotlib, Ian H.
Major depressive disorder (MDD) is a costly, prevalent, and recurrent psychiatric disorder that can involve significant impairment across multiple domains of functioning. In this essay, we provide an overview of the theory and research associating aberrant information processing and neural structure and function with the etiology and maintenance of MDD. We begin by highlighting the foundational work that characterizes depressed persons' cognitive and neural responses to valenced stimuli. We then examine recent efforts to clarify the nature of the temporal relation between depression and these cognitive and neural anomalies, focusing on research designed to identify abnormalities that are present before the onset on MDD and to examine the consequences of manipulating cognitive and neural anomalies. Finally, we describe several areas and questions to be examined in future research that we believe will lead both to a more comprehensive psychobiological understanding of MDD and to improvements in the assessment, diagnosis, and treatment of this disorder. In particular, we focus on the need for innovation in diagnosis, better characterization of symptom heterogeneity in MDD, on extending neural research in MDD to the study of abnormalities in larger‐scale brain networks, and on elucidating the mechanisms that underlie the successful effects of training programs designed to reduce cognitive biases in depression. -
Disorders of Consciousness - Monti, Martin M.
Disorders of consciousness are a spectrum of neurological disorders, encompassing coma, the vegetative state, and the minimally conscious state, in which patients acquire or develop an impairment of the two cardinal elements of consciousness–wakefulness and awareness. One of the main sources of complexity in this context is how to recognize and tell apart patients who retain some level of awareness from patients who do not. Indeed, in the absence of any direct means of assessing one's level of awareness, we are forced to indirectly infer a patient's state on the basis of their ability to perform behaviors that, appearing clearly voluntary, imply the presence of consciousness. In this contribution, we explore recent evidence showing how brain imaging can be harnessed to address the problem of consciousness in patients surviving severe brain injury. First, we focus on recent experiments demonstrating how neuroimaging can be used to detect the presence of voluntary “brain behavior” in otherwise non responsive patients, and to allow a rudimentary form of non muscle‐dependent communication strategy based solely on voluntary brain activity. Second, we discuss recent findings concerning network activity at different levels of awareness, and the relationship between thalamo cortical circuits and consciousness. -
Dissociating Enhancing and Impairing Effects of Emotion on Cognition - Dolcos, Florin
Emotion is a “double‐edged sword” that can either enhance or hinder various aspects of our cognition and behavior. The emotional charge of an event can increase attention to and memory for that event, whereas task‐irrelevant emotional information may lead to increased distraction and impaired performance in ongoing cognitive tasks. These opposing effects of emotion can be identified at different levels, both within the same cognitive process and across different processes, and could also be identified at more general levels, such as in the case of the response to stress. The present review discusses emerging evidence regarding factors that influence opposite effects of emotion on cognition in healthy functioning, and how they may be linked to clinical conditions. These issues are important for understanding mechanisms of emotion‐cognition interactions in healthy functioning and in emotional disturbances, where both of these effects are exacerbated and tend to co‐occur. Overall, the present review highlights the need to consider the various factors that can influence enhancing or impairing effects of emotion on cognition, in studies investigating emotion‐cognition interactions. -
Emerging Evidence of Addiction in Problematic Eating Behavior - Gearhardt, Ashley
Obesity continues to be a pressing global health crisis with few nonsurgical means of long‐term successful treatment. In addition, in the last year, binge eating disorder (BED), which shares several behavioral characteristics with traditional substance use disorders, has been recognized in the DSM‐V as a distinct eating disorder diagnosis. In light of such trends, an emerging and controversial hypothesis is that an addictive response to certain types of foods may be contributing to eating‐related problems. If certain individuals are experiencing an addiction to highly palatable foods, the treatment and prevention of problematic eating may need to be altered in such circumstances. Further, if certain food (or ingredients in food) are identified as having an addictive potential, policy approaches employed to reduce the public health impact of other types of addictive substances (e.g., reducing advertising to minors, taxation) may be of use in the obesity epidemic. In the following piece, we will review the research linking addiction and eating, but most importantly, we will identify directions for future research in this relatively new field of study. -
Insomnia and Sleep Disorders - Mason, Elizabeth C.
Sleep is common to all animals and yet there are so many mysteries surrounding its function. Insomnia, the most common sleep disorder, is prevalent and debilitating and has been shown to play a role in the onset and maintenance of other mental health disorders, such as depression, anxiety, and bipolar disorder. This chapter outlines a basic overview of sleep, followed by a summary of cutting‐edge research investigating insomnia as well as its relationship to other psychiatric disorders. It is suggested that a bidirectional relationship exists between sleep and emotion and research supporting this framework is addressed briefly. We describe the treatment of choice for insomnia, cognitive behavioral therapy, as well as outline other exciting developments in the treatment of insomnia, including bright light therapy, intensive sleep retraining therapy, and Internet‐based treatments. Finally, we end on a discussion of areas that are ripe for future investigation, including biological mechanisms, sleep medications, and other sleep disorders such as hypersomnia. -
Mechanisms of Fear Reduction - Lancaster, Cynthia L.
Over the past century, numerous theories have been advanced toward a unified account of fear reduction and have achieved various degrees of empirical support. Here, we first provide a brief overview of the basic models that account for fear acquisition, then we provide a review of several of the most prominent theories of fear reduction, and finally, we describe important cutting‐edge directions for future research. -
Mental Imagery in Psychological Disorders - Holmes, Emily A.
Mental imagery involves having an experience like perception but in the absence of a percept. We frequently have mental images such as when we remember an event or imagine the future. In psychological disorders, emotional mental images can flash to mind and be highly distressing, including traumatic memories or simulations of feared future events. However, emotional images have been neglected in research and therapy. This entry combines perspectives from cognitive science (mental imagery) and clinical psychology (psychological disorders). Cognitive science suggests that compared to verbal thoughts, mental imagery has a more powerful impact on emotion. Therefore, it is useful to ask about imagery in clinical assessment of emotional disorders. However, this approach has been largely restricted to PTSD (posttraumatic stress disorder). First, we illustrate that emotional mental imagery occurs across a wide variety of disorders. Second, by mapping the nature of imagery in disorders where it has been neglected (e.g., bipolar disorder), we may be able to import existing imagery therapy techniques (e.g., from PTSD) to improve treatment. Third, by drawing on cognitive science, we can capitalize on the properties inherent to mental imagery to suggest novel techniques. For example, maladaptive imagery may be reduced by cognitive tasks, which interfere with holding an image in mind. Also, adaptive imagery may be boosted by computerized training in generating positive imagery. Intriguingly, this opens the possibility of cognitively informed and computerized psychological treatments that may look rather different from traditional talking therapies. -
Normal Negative Emotions and Mental Disorders - Horwitz, Allan V.
The basic goal of psychiatric diagnosis is to distinguish genuine mental dysfunctions from normal, albeit distressing, emotions. This task is especially difficult because, unlike other medical specialties, psychiatry does not have biological markers that can validate diagnoses of mental disorders. Therefore, diagnostic criteria have an outsized role in psychiatry compared to other medical fields. Until the development of the DSM‐III in 1980, psychiatric diagnoses were general, continuous, and causal. In contrast, the diagnostic system that emerged in the DSM‐III and that has remained basically intact until the present has been specific, categorical, and a causal. This type of classification, however, is prone to mistake contextually appropriate symptoms as indicators of mental disorders. Cutting‐edge research incorporates the context in which symptoms emerge and persist to separate normal, distressing emotions from mental illnesses. It also develops alternatives to the DSM's categorical diagnoses. Other valuable studies try to differentiate conditions that stem from evolutionarily normal genes that no longer fit modern environments rather than from genetic or psychological dysfunctions within individuals. Going forward, research must attempt to use biological, psychological, and social factors to develop definitions that adequately distinguish normal responses to stressful environments, evolutionary mismatches, and mental disorders. It will also try to find biomarkers that can set appropriate boundaries between natural and pathological conditions. Finally, it will consider the best ways to optimize the balance between under‐ and over‐diagnosing mental illnesses. -
Peers and Adolescent Risk Taking - Chein, Jason
Adolescent risk taking occurs most often when teens are in the presence of their peers. An extensive body of prior work has attempted to explain this phenomenon with respect to peer pressure, social conformity, and affiliation with deviant peers. Recent experimental work, however, suggests that peer influences on adolescent decision making may be rooted in an even more basic process by which social context alters adolescents' sensitivity to the potential rewards of risky decisions. Emerging findings from empirical studies pursuing this alternative account of peer influences on adolescent decision making are presented, along with a consideration of some key directions for future research. -
Positive Emotion Disturbance - Gruber, June
The longstanding assumption has been that positive emotions and associated feelings are entirely adaptive. As a result, less scientific attention has been devoted to understanding the ways in which positive emotions might also be a source of dysfunction for our psychological health. However, the empirical tides have recently begun to change, and with it, a new wave of research has pointed to ways in which positive emotionality is also related to a range of poor health outcomes and maladaptive clinical syndromes. How might this be possible? Here, we provide cutting‐edge insights into unpacking the nature of positive emotion disturbance by highlighting six key themes outlining the ways positive emotion may go awry. We conclude by providing a roadmap for future research aimed at providing an integrative model for understanding positive emotion as well as how to harness and cultivate appropriate positive feelings. -
Problems Attract Problems: A Network Perspective on Mental Disorders - Cramer, AngéLique O. J.
What is the nature of mental disorders such as major depression and panic disorder? Are mental disorders analogous to tumors, in that they exist as separate entities somewhere in people's minds? Do mental disorders cause symptoms such as insomnia and fatigue? Until very recently, it was exactly this sort of thinking that (implicitly) permeated many, if not all, research paradigms in clinical psychology and psychiatry. However, in recent years, a novel approach has been advocated (i.e., the network perspective), in which mental disorders are not conceived of as entities that have a separate existence from their respective symptoms. Instead, mental disorders are hypothesized to be networks of symptoms that directly influence one another. So, for example, from a network perspective, insomnia and fatigue are not caused by the same underlying disorder (i.e., major depression) but causally influence one another (i.e., insomnia → fatigue). A disorder, then, develops because of such direct relations between symptoms in which positive feedback mechanisms (i.e., vicious circles) are present: for example, insomnia → fatigue → feelings of guilt → insomnia. These feedback mechanisms may propel the aggravation of one's condition and make a person end up in, for example, a full‐fledged depressive episode. In this contribution, we elaborate on network perspectives on the nature of mental disorders as well as their implications for our outlook on diagnosis and comorbidity. -
Rumination - Watkins, Edward R.
Rumination is repetitive thinking about personal and self‐related concerns. Such rumination focused on symptoms and feelings has been implicated in the onset and maintenance of depression, through both experimental and longitudinal prospective studies, consistent with the Response Styles Theory. Rumination is also conceptualized within a control theory perspective, as an instrumental response to unresolved personal goals. Rumination acts to exacerbate existing mood states and elaborate preexisting cognition—in this way, it can act as a vulnerability factor for psychopathology. However, there is emerging cutting edge evidence that rumination can also have adaptive consequences, when it either focuses on positive information or involves a processing mode that is more concrete, focused on the specific details and mechanics of situations. Rumination is also being proposed as a strong candidate for a transdiagnostic process that contributes to multiple emotional disorders. New approaches to the treatment of rumination have recently been developed with preliminary encouraging data, although further large‐scale trials are required. Key issues for research into rumination going forward include more detailed unpacking of the underlying cognitive and attentional mechanisms determining individual differences in rumination and examining the contribution of rumination across physical and mental health. -
Terror Management Theory - Ayars, Alisabeth
Terror management theory (TMT), based on the works of Ernest Becker, asserts that the fear of death contributes to many aspects of human thought and behavior. According to TMT, people use self‐esteem and cultural worldviews to buffer awareness of death. In this short review paper we review fundamental research in TMT, including the findings that after being reminded of death people bolster their cultural worldviews and strive for self‐esteem. Cutting‐edge research in TMT, including research on intergroup conflict, psychological disorders, religious beliefs, and brain imaging, is discussed. Finally, we review key issues in TMT research going forward. -
Understanding Risk-Taking Behavior: Insights from Evolutionary Psychology - Machluf, Karin
Evolutionary developmental psychology posits that natural selection has operated across the lifespan, but especially in childhood, shaping psychological mechanisms that foster survival during the early years of life and also preparing children for life as adults. The tenets of evolutionary developmental psychology are briefly reviewed, along with a summary of life‐history theory. Differential susceptibility theory and biological sensitivity to context theory are also outlined and applied to mental health. Adolescent risk‐taking behavior is then examined from an evolutionary developmental perspective, assessing the independent contributions of environmental harshness and unpredictability in early childhood to later psychological functioning. -
What is Neuroticism, and Can We Treat it? - Ametaj, Amantia
We review the substantive role of neuroticism and related temperaments such as extroversion in the development and maintenance of anxiety, mood, and related disorders subsumed under the term emotional disorders (EDs). We note that splitting these disorders into discrete categories as in the current Diagnostic and Statistical Manual (DSM‐5) diagnoses may be highlighting relatively superficial differences. Research on the structure of anxiety, mood, and related disorders indicates that neuroticism, emerging from genetic, neurobiological, and psychological factors, is central to the development of these disorders. We make a case for shifting the focus of psychological treatment of EDs to target core temperaments such as neuroticism, and discuss a dimensional approach to assessing EDs that focuses on the underlying temperament. We examine key issues requiring additional research to evaluate this possibility.