Implicit Cognitive Therapy

Notes from Meetings

January 25, 2006

Meeting attendees: Jamie, Kenny, Mark, Forrest, Martin
Started with a discussion of how everyone in the group might potentially be related to this research program. Kenny originally gave a presentation to the cognitive area about cognitive therapy, which highlighted the differences between the ways that clinical and cognitive psychologists view cognition. One of the most notable differences was the focus on unconscious/implicit cognition in cognitive psychology which was lacking in clinical psychology. The idea of writing a grant to try to use implicit tasks as part of therapy surfaced again in Mark's class on unconscious cognition, which was attended by Jamie, Joe and Chris. All four of these individuals expressed an interest in persuing work on this topic. One suggestion of Mark's was that computer-based therapy could be particularly useful for rural populations since it would not require direct intervention of a therapist. Forrest has previous experience in this area, and in a conversation with Jamie indicated his interest in the project. For his dissertation, Martin plans to administer a form of CBT over PDAs. It might also be possible to perform implicit cognitive therapy in a similar way, and so Martin was asked to join the group.
Forrest mentioned that there currently is a body of work on automatic thoughts in the clinical literature that might be worth investigating.
The basic focus of implicit cognitive therapy would be to change either the accessibility of particular concepts, the associations between particular concepts, or the attention that is automatically given to particular types of stimuli.
Forrest and Kenny mentioned that there is relatively little work even investigating the use of implicit measures in relation to therapy, and so we might be better off starting with assessment issues instead of immediately trying to design interventions.
Performance on an implicit measure might be particularly related to how well someone behaves when they are in stressful or distracting enviornments because these are the situations where automatic processes will have dominating influences.
Kenny suggested that we might try collecting some pilot data using the PY101 pool. One useful topic might be dating skills. This topic is relevant to most of the population, and the performance probably has a strong automatic component to it.
Forrest mentioned some work by Segal that might be relevant. One article is available on this website.
The following suggestions were made as to profitable directions to pursue at this point in time.

Collect pilot data with theraputic implications.
Consider writing an R03 or an R34
Talk to the clinic about regularly collecting implicit measures on clients
Have a group meeting with Steve Holland (a big name in CBT) when he comes to Alabama in March.
Contact researchers already known to be investigating similar topics: Michael Vasey, Bethany Teachman

February 8, 2006

Meeting attendees (specifically for cog folks): Jamie D, Mark, Joe, Jamie O, Chris
We started with a discussion of the Gemar, et al. (2001) article. While we thought it was very promising in that it indicated that clinical psychologists would be receptive to the use of implicit measures, we noticed a number of methodological flaws.

The IAT results were broken down by the type of response ("me" vs. "not me"), while the standard IAT just looks at consistent vs. inconsistent. This implies that the overall results may not have been significant.
The reported IAT effect don't use Greenwald's new measure (d) which corrects for the overall response time. Looking at the pattern of results we believe the strength of the effects would be weaker if they used the more appropriate measure.
The authors emphasize that significant results were found in the "me" condition but not in the "not me" condition, but the pattern found in both are fairly similar.
When interpreting the results the authors don't seem to appreciate that implicit and explicit cognition may result from different processes.

We next talked about choosing measures that might be useful to give to people when they enter and exit the psychological clinic. We wanted to focus on well-established measures that would most directly be relevant to people entering the clinic. Broadly, we plan to investigate construct accessibility, implicit self-esteem, and positivity bias. We plan to use the following measures.

Attitude accessibility (for things most relevant to psychological problems, such as relationship words, job words, work words, and self-related words.
Implicit self esteem
Stroop task for negativity bias
Baldwin's social search task to detect attention to affect
Self-esteem IAT

Our plan is to first test a bunch of intro psych students on these measures across two time points and see which are stable over time. Measures that don't represent stable psychological constructs will not be likely to give us any useful information.
Each of the attendees agreed to get more details on one of these measures. We plan to meet again once everyone has had a chance to investigate their topic. The assignments are:

Jamie D- attitude accessibility
Jamie O - Implicit self-esteem
Joe - Stroop
Chris - Baldwin's social search task
Mark - Self-esteem IAT

March 7, 2006

Meeting attendees (again, specifically for cog folks): Jamie D, Mark, Chris, Jamie O
Jamie D suggested (based on conversations with Heather Claypool and Anne-Marie Leistico) that we additionally consider the mere exposure task to provide a measure of an individual's resistance to change.
Obtained specific references for each of the implicit measures that we are considering. These articles are posted on the website in the readings section above.
Jamie O provided an article by Bosson that reports the test-retest reliability of several measures of implicit self-esteem. The only two that seem to work well are the Name letter effect and the IAT.
We should collect a measure of explicit self-esteem, since some prior research has indicated that the interaction between implicit and explicit self-esteem can be particularly important. Two possible measures of explicit self esteem would be the Rosenberg self-esteem scale (which Joe used in his masters) and the Beck Depression Inventory.
Baldwin's social search task originally looked to see how performing this task influenced later performance on a Stroop task. However, we will probably just want to just look at performance on this task separately as a measure of positivity/negativity bias. We may also want to vary the method so that on some trials participants are searching for positive faces while on others they are searching for negative faces. At the beginning of each trial we can have participants click a work in the center of the screen that tells them which type of face they will be searching for. This not only guarantees that they know what they are supposed to do, but it also brings the mouse to the center of the screen at the beginning of each trial. We will probably want to use real faces - Mark mentioned that he has a database of faces with different characteristics that we might use. Jamie D also has a large number of photos from an online photo archive.

March 10, 2006

Meeting attendees: Steve Hollon (guest speaker with a strong familiarity with cognitive therapy), Jamie D, Mark, Forrest, Kenny, Martin
Steve mentioned the fact that the types of things we examine with our implicit measures (schemas, construct accessibility, underlying associations, etc.) are actually talked about a great deal in cognitive therapy, even though therapists currently don't have any good ways of measuring them.
Steve mentioned that after people have a depressive episode, they remain more vulnerable to having future episodes even after their emotional standing has returned to normal. A new event can bring them right back to where they were when they first needed therapy. This implies that there is something that has specifically not been changed in the person, even though they show improvement on measures of depression.
We might want to consider using pharmacotherapy as a control group. Pharmacothereapy really should have no ability to change any underlying cognitive structures even though it is often shown to be just as effective at reducing symptoms as psychological therapy. Evidence for this is found in that CBT seems the reduce the probability of future setbacks relative to pharmacotherapy, even though both appear to perform equally well in reducing symptoms of depression.
Early phases of therapy appear to require explicit effort, but techniques become more automatized over time.
Different areas of the brain appear to be affected by pharmacotherapy and CBT. Research on this is being performed by Segal (neuroscientist) and Thase (clinician) at Pittsburgh, and Mayberg at Emory.
Steve was involved in the development of an "Automatic Thoughts Questionnaire," but he feels that this doesn't truly capture automaticity. Instead, it captures those things that actually *are* consciously available to the respondent. Gets more at spontaneous thoughts than implicit associations/accessibility.
To uncover what implicit associations an individual has, a therapist will first ask a client to imagine a situation and then ask "What would it mean if..." (some negative event). This then would lead to a new event, about which a the therapist could ask another "What would it mean if..." question. Tracing things down you can usually determine what underlying negative automatic responses the client has. You get different "trajectories" from clients who have good versus poor coping skills.
Differences at the implicit level likely have their greatest influence once a client is actually no longer having an active episode, determining their vulnerability to new episodes.
We likely don't need to worry about randomly assigning people to pharmacothereapy/psychotherapy groups when we are examining assessment. We could therefore simply try to connect with a pharmacotherapist and just ask them to have their clients fill out our implicit measures before and after treatment, and then do the same with similar patients going to a psychologist. We will, however, need to worry about random assignment if we want to examine a treatment. However, this itself brings up possible ethical/practical issues of failing to provide optimal care for clients. Existing institutions will be very resistent to methodological innovations. Sometimes adminstrators will violate the random assignment to try to help people as much as possible. It might be easiest to have a design comparing pharmacological treatment + ICT treatment to pharmacology treatment alone.

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