Open Paper examples
Example A: Neuroimaging and CBT in anxiety disorders
Prasko, J., Horacek, J, Paskova, B. Prague Psychiatric Centre; 3rd Medical Faculty of Charles University and Centre of Neuropsychiatric Studies, Prague, Czech Republic Praskova, H., Out-patients Psychiatric Clinic, Horni Palata, Prague, Czech Republic
Neuroimaging studies on anxiety disorders is at relatively preliminary stage. Nevertheless, findings are arguably consistent with involvement of limbic, paralimbic, and prefrontal regions. In studies with positron emission tomography (PET) patients suffering with GAD have increased relative metabolic rates in the right posterior temporal lobe, right precentral frontal gyrus, and left inferior area 17 in the occipital lobe but reduced absolute basal ganglia rates (Wu et al. 1991). Imaging studies that have pooled or compared findings across different anxiety disorders may also shed light on the underlying neuroanatomy of anxiety symptoms that are not disorder specific. An analysis of pooled PET symptom provocation data from patients with OCD, PTSD, and specific fobia, for example, reported activation of paralimbic structures (right posterior medial orbitofrontal cortex, bilateral insular cortex), right inferior frontal cortex, bilaterl lenticulate nuclei , and bilaterl brain-stem foci (Rauch et al. 1997). There is growing realization of the importance of various CSTC loops in a range of behavioral disorders (cortico-striatal-thalamic-cortical circuit), particularly in relation to certain kinds of cognitive affective cues, and appear most relevant in OCD. Functional imaging studies provide some of the most persuasive evidence of the role of CSTC circuits in OCD. Patients have increased activity in the orbitofrontal cortex, anterior cingulate, and basal ganglia (Rauch and Baxter 1998). Additionally, question remain about precise nature of CSTC dysfunction in OCD and its normalization by effective treatment. Decreased orbitofrontal activity in OCD predicts positive response to pharmacotherapy, whereas higher orbitofrontal activity predicts positive response to behavioral therapy (Brody et al. 1998). Preliminary evidence from brain imaging shows the importance of amygdala and paralimbic structures in panic disorder. CT study suggested prefrontal abnormalities (Wurthmann et al. 1998), a SPECT study showing asymmetry of inferior frontal cortical perfussion (De Cristofaro et al. 1993). Although it has been hypothesized that cognitive-behavioral therapy exert effects in panic disorder by behavioral desensitization of hyppocampal-mediated contextual conditioning, or by cognitive techniques tha strengthen medial prefrontal cortex inhibition of amigdala (Gorman et al. 2000), the relevant empirical studies have not yet been undertaken. We will present preliminary PET data of 12 patients with panic disorder. Patient were measured before and after therapy with antidepressant or CBT. The finding will be discussed, compared with results of other studies and showed with accordance of neurobiological theories.
Example B: Relationships between schemas (Young’s model) and the bis/bas individual differences (Gray’s model).
Cid, J, Servei de Rehabilitació. Parc Hospitalari Marti i Julià. I.A.S. Girona ; Torrubia, R, Unitat de Psicología Mèdica. Universitat Autònoma de Barcelona. Barcelona.
Schemas have a central role in cognitive psychopathology. In fact, a cognitive model assumes that schemas are developed in response to biological predispositions and environmental influences. However, little is known in terms of empirical data with regard to how they are related to biological or temperamental variables. Furthermore, the cognitive-behavioural case conceptualization has not usually taken into account the influence of temperamental variables. Nowadays, there are several approaches both to the study of schemas (e.g. Beck et al., 1990; Arntz, 1999; Young, 1990) and to the study of biological or temperamental bases of personality (e.g. Gray, 1988; Cloninger, 1986, 1987). The theoretical frameworks of our research were the schema-focused model (Young, 1990) and Gray’s personality model. The first defines schemas (Early Maladaptive Schemas, EMS) as “broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime and dysfunctional to a significant degree” (Young, 1994). Gray’s model of personality, includes two neuropsychological systems, the Behavioural Inhibition System (BIS) and the Behavioural Activation System (BAS) which underlie the personality dimensions of anxiety and impulsivity, respectively. The aim of this study was to investigate the psychometric relationships between schemas and the individual differences in the activity of BIS and BAS. A total of 115 psychiatric patients from a Catalonian Mental Health Centre were included in the study. To evaluate schemas, we used the Spanish Version of the Young Schema Questionnaire (Cid, Tejero and Torrubia, 1999; Cid and Torrubia, 2001); this is a 205-item self-report that assesses 16 early maladaptive schemas. To evaluate individual differences in BIS/BAS, we administered the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ, Torrubia, Avila, Moltó, and Caseras; 2001). Statistical analyses consisted of a Principal component analysis with Varimax rotation including schema and personality scales, and a multiple regression analysis using the Sensitivity to punishment (SP) and Sensitivity to reward (SR) scales as independent variables, and each schema as a dependent variable. Principal component analysis yielded three factors with eigen values higher than 1 which accounted for 69.19 % of variance. The first was loaded by SP and the schema scales Failure, Social Undesirability, Dependence, Defectiveness, Social Isolation, Insufficient Self-control and Subjugation, the second by the schema scales Self-sacrifice, Unrelenting standards, Emotional deprivation, Mistrust, Emotional inhibition, Abandonment and Vulnerability to harm and illness, and the third by SR and the schema scales Enmeshment and Entitlement. Results from multiple regression analyses showed that SP and SR scales accounted for a significant percentage of variance in all of the schemas. In the discussion, we develop the implications of these results for the assessment, case conceptualization, and cognitive-behavioural treatment of personality disorders.
