Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy.
Background: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review ( Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. Method: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. Results: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77-1.25), as well as at 6-and 12-month follow-up. Conclusions: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.
A paired watershed approach was utilized to study the effects of three water management regimes on storm event hydrology in three experimental watersheds in a drained loblolly pine (Pinus taeda L.) plantation in eastern North Carolina. The regimes were: (1) conventional drainage, (2) controlled drainage (CD) to reduce outflows during spring fish recruitment, and (3) controlled drainage to reduce outflows and conserve water during the growing season. Data from two pit-treatment years and three years of CD treatment with raised weirs at the watershed outlet are presented. CD treatment resulted in rises in water table elevations during the summer. But the rises were small and short-lived due to increased evapotranspiration (ET) rates as compared to the spring treatment with lower ET demands. CD treatment had no effect on water tables deeper than 1.3 m. CD treatments, however, significantly (a = 0.05) reduced the stonn outflows for all events, and peak outflow rates for most of the events depending upon the outlet weir level. In some events, flows did not occur at all in watersheds with CD. When event outflows occurred, duration of the event was sharply reduced because of reduced effective ditch depth. Water table depth at the start of an event influenced the effect of CD treatment on storm event hydrology.(KEY TERMS: controlled drainage; loblolly pine; water table; drainage outflow; event hydrograph.)1Paper No.
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