Defeatist Attitudes Research Articles

Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia

Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max− 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.

Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients.

BackgroundNegative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn).ObjectiveThe primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia.MethodsParticipants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms.ResultsRetention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes.ConclusionsThe findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia.Trial RegistrationClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696

How Can Initial Teacher Education Tackle "Super-Wicked" Problems?

The concept of "Super-wicked" problems is attracting increasing attention and scrutiny through research and publication in wide-ranging interdisciplinary areas. The concept is being lionised in the literature to draw attention to the urgency that is required to act immediately on problems such as climate change and sustainability. Importantly, the solutions to super-wicked problems are not based on defeatist attitudes but seek instead to build resilience among key stakeholders specifically to bring about change. This paper charts the internationally unique alignment in Scotland between Scottish Government education policy and the General Teaching Council for Scotland's Professional Standards. In so doing, it distinguishes between the international concept of Education for Sustainable Development (ESD) and the more expansive Scottish concept known as Uearning for Sustainability (UfS). A qualitative case study based on Appreciative Inquiry was adopted to answer the Research Question: “How do students and their Programme Director on a Programme designed to promote teacher activism understand and engage with LfS?” The Programme Director and then four students from the recently-accredited MSc in Transformative Uearning and Teaching (TUT) were interviewed to discover how they were navigating their way through the UfS policy landscape and whether, and to what extent, the Professional Standards for UfS were embedded in the Programme. The study found that all five were very aware of some of the implications of UfS because they valued contested interpersonal relationships, views and ideologies. Furthermore, they advocated the use experiential learning in diverse places in order to include the emotional and cognitive domains of learning. As such, the Programme was found to be an early innovator of UfS implementation, specifically in demonstrating an ethical disposition towards the human community. In keeping with the essential UfS concept of interconnectedness, this study recommends that these ethics should be extended beyond the human community to include care for the non-human. Furthermore, if one of the purposes of the Professional Standards is to embed UfS within Scottish Programmes, and by extension educational responses to sustainability worldwide, the early innovators who are working to embed this into their practices need greater support from the registration bodies responsible for monitoring and enhancing professionalism. Finally, in keeping with the concept of super-wicked problems, in order to bring about systemic change to ITE programmes worldwide, there is a need for additional support from bold, futurethinking, decision makers at all levels of leadership among stakeholders, including universities that offer ITE programmes.

The role of adult attachment orientation and coping in psychological adjustment to living with skin conditions

Skin conditions can impact significantly on everyday life, particularly relationships. However, some patients are more distressed by these problems than others, regardless of disease severity. There is some evidence that the extent to which patients seek support from friends and family (“attachment orientation”) predicts how well they cope with chronic health conditions, but there has been little previous research with regard to skin disorders. These psychologists in Sheffield, UK, investigated this using online questionnaires in 206 adults recruited through universities and patient support groups. Participants had to have been diagnosed with a skin condition by a health care professional and experiencing symptoms over the last 6 months. Psychological adjustment to their skin disorder was assessed using scores for appearance‐related distress and skin‐related quality of life (QoL). Two dimensions of attachment orientation were measured: fear of intimacy (“attachment avoidance”) and fear of abandonment (“attachment anxiety”). The use of 2 coping strategies was also studied: defeatism (e.g. giving up, denial or turning to drugs or alcohol) and activity (humour, venting, seeking help or coming up with a plan). They found that people showing higher attachment avoidance and attachment anxiety reported more defeatist attitudes, resulting in higher levels of appearance‐related distress and lower QoL, both emotional and functioning aspects. Surprisingly, people using active coping strategies also experienced more appearance‐related distress, perhaps being less accepting of their condition. The authors conclude that people with insecure attachment orientation are more troubled by their skin condition and might benefit from psychological interventions targeting underlying attachment orientation.

What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors.

Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.

Improvement in Negative Symptoms and Functioning in Cognitive-Behavioral Social Skills Training for Schizophrenia: Mediation by Defeatist Performance Attitudes and Asocial Beliefs

Psychosocial interventions have significant but modest impact on negative symptoms and functioning in schizophrenia. Identifying mechanisms of change in these interventions can inform treatment targets to strengthen these interventions. A number of studies have found associations between dysfunctional attitudes negative symptoms and functioning in schizophrenia. We previously found improvement in experiential negative symptoms and functioning in cognitive-behavioral social skills training (CBSST) in participants with schizophrenia (N = 149), and the present study examined whether improvements in CBSST in that trial were mediated by the group effect on defeatist performance attitudes and asocial beliefs. In multilevel mediation analyses, the effect of treatment group on experiential negative symptoms and functioning was mediated prospectively through defeatist attitudes but asocial beliefs only mediated effects on experiential negative symptoms. The findings suggest that cognitive-behavioral therapy interventions that target dysfunctional attitudes can lead to improvement in negative symptoms and functioning in schizophrenia.

SA119. Defeatist Attitudes and Self-Stigma Associations in Patients With Schizophrenia

SA119. Defeatist Attitudes and Self-Stigma Associations in Patients With Schizophrenia

104. Combined CBSST and Oxytocin for Social Function in People With Schizophrenia

Background: A significant proportion of people with schizophrenia are characterized by impaired ability to socially engage with others, which may reflect social aversion secondary to defeatist beliefs; decreased motivation for social interactions; and/or impairment in the normal reinforcement value of social interactions. Unfortunately, pharmacological interventions have limited benefits for impaired social function, whereas psychosocial interventions provide only partial benefit for this critical aspect of the illness. The development of an effective intervention for functional outcomes remains a central therapeutic challenge. The current study assessed whether the addition of intranasal oxytocin to Cognitive Behavioral Social Skills Training (CBSST) improved social function. Methods: Participants with DSM-IV-TR schizophrenia or schizoaffective disorder entered a 24-week, double-blind, placebo-controlled, randomized clinical trial with a 3-month follow-up evaluation. The study was conducted at two sites: Maryland and California. Participants were randomized to either: intranasal oxytocin 36 I.U. (3 sprays) BID (n = 31) or intranasal placebo-oxytocin 3 sprays BID (n = 31). All participants received CBSST, which was delivered in four 6-session modules (cognitive, social, and problem-solving CBSST modules plus a module adapted from Social Cognition and Interaction Training). The modules were delivered twice in biweekly 1-hour sessions, for a total of 48 sessions over 24 weeks. Birchwood Social Functioning Scale (SFS) was used to assess social function; the Defeatist Performance Attitude Scale (DPAS) was used to assess defeatist beliefs; the Asocial Beliefs Scale (ABS) was used to assess social disinterest and aversion; and the Scale for the Assessment of Negative Symptoms (SANS) total score was used to assess negative symptoms. Results: In the intent-to-treat analyses, there were no significant group differences in the SFS total score (Treatment × Week interaction: F = 0.96; df = 2, 40; P = .39) or ABS total score (Treatment × Week interaction: F = .12; df = 2, 39.7; P = .89). There was a trend for a significant reduction in defeatist beliefs among the participants randomized to oxytocin (Treatment × Week interaction: F = 2.86; df = 2, 67.2; P = .07). There were no significant group differences in SANS total score (Treatment × Week interaction: F = 0.96; df = 6, 39.7; P = 0.46), though the interpretation of the effect of oxytocin on SANS total score was complicated by the presence of a significant site effect: there was a significant placebo effect at the California site, which was markedly greater in magnitude than the observed oxytocin effect for these symptoms. Conclusion: The results of the intent-to-treat analyses provide minimal support for the utility of add-on intranasal oxytocin to CBSST for improvement in social function. Oxytocin was associated with trend improvement in defeatist attitudes and greater reduction in negative symptoms at one of the two study sites. (clinicaltrials.gov, trial number: NCT01752712)

The “Franco-Russian Marseillaise”: International Exchange and the Making of Antiliberal Politics in Fin de Siècle France

The “Franco-Russian Marseillaise”: International Exchange and the Making of Antiliberal Politics in Fin de Siècle France

Is Pupillary Response a Biomarker for Effort and Defeatist Attitudes in Patients With Schizophrenia?

Is Pupillary Response a Biomarker for Effort and Defeatist Attitudes in Patients With Schizophrenia?

Pupillary Responses as a Biomarker of Diminished Effort Associated With Defeatist Attitudes and Negative Symptoms in Schizophrenia

BackgroundThe hypothesis that defeatist performance attitudes are associated with decreased goal-directed task effort and negative symptoms in consumers with schizophrenia was investigated by using pupillary responses as a biomarker of task effort. Pupillary dilation during cognitive tasks provides a biomarker of effort devoted to the task, with greater dilation indicating greater effort. MethodsDefeatist attitudes were assessed in 149 consumers with schizophrenia or schizoaffective disorder and 50 healthy control subjects, and consumers were divided into three groups (tertile split) with respect to severity of defeatist attitudes. Pupillary dilation responses were recorded during a digit-span task with three-, six-, and nine-digit spans. ResultsEffort allocation (pupillary responses) to the task increased as the processing load increased from low (three-digit) to moderate (six-digit) demands in healthy control subjects and consumers with schizophrenia with mild and moderate severity of defeatist attitudes. In contrast, consumers with severe defeatist attitudes did not increase their effort when processing demands increased from low to moderate loads. These consumers showed significantly less effort in the six-digit condition relative to consumers with mild defeatist attitudes. Moreover, consumers with severe defeatist attitudes showed significantly greater severity of negative symptoms relative to consumers with mild defeatist attitudes and negative symptoms were significantly correlated with defeatist attitudes. ConclusionsThese results suggest a relationship between defeatist performance attitudes, goal-directed task effort indexed by pupillary responses, and negative symptoms in schizophrenia. The findings have implications for using cognitive therapy to reduce defeatist attitudes that may contribute to diminished effort and negative symptoms in schizophrenia.

The role of dysfunctional attitudes in models of negative symptoms and functioning in schizophrenia

Neurocognitive impairment is associated with negative symptoms and poor real world functioning in schizophrenia. Dysfunctional attitudes (e.g., “If I fail partly, it is as bad as being a complete failure”) have been found to mediate these relationships between neurocognition and negative symptoms and functioning. In this study, these relationships were examined in 179 participants with schizophrenia or schizoaffective disorder using structural equation modeling. Defeatist attitudes were found to mediate the relationship between neurocognition and negative symptoms but not the relationships between neurocognition and performance-based or self-reported functioning. A full model with the best fit showed mediation between neurocognition and self-reported functioning through two different pathways: One from neurocognition to functional skill capacity to real-world functioning, and a second from neurocognition to defeatist attitudes to negative symptoms to real-world functioning. These results may implicate skill deficits and defeatist attitudes as a separate treatment targets for negative symptoms and functioning in schizophrenia.

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

To determine whether Cognitive Behavioral Social Skills Training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST. An 18-month, single-blind, randomized controlled trial. Outpatient clinic at a university-affiliated Veterans Affairs hospital. Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N= 79) age 45-78. CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem-solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals. Blind raters assessed functioning (primary outcome: Independent Living Skills Survey), CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction. Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem, and life satisfaction. CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self-esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning. ClinicalTrials.Gov #NCT00237796 (http://clinicaltrials. gov/show/NCT00237796).

Dysfunctional Attitudes and Expectancies in Deficit Syndrome Schizophrenia

The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.

Dr. Harvey Replies

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. Harvey RepliesPHILIP D. HARVEY Ph. D.,PHILIP D. HARVEY Ph. D.Search for more papers by this author,Published Online:1 Jun 2008https://doi.org/10.1176/appi.ajp.2008.08020229rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Drs. Beck and Grant call to our attention the very important point that the influence of cognitive functioning on everyday outcomes is affected by the presence of defeatist attitudes. These attitudes have a mediating effect and supplement the influence of cognitive impairment in the prediction of everyday outcomes. Thus, competence (i.e., what one can do, such as cognitive performance) is only one of several predictors of real-world functional performance (i.e., what one actually does). In fact, we previously demonstrated that there are multiple competence domains of importance, including neuropsychological performance and the capacity to perform everyday living and social activities (i.e., functional capacity) (1) . Both of these competence variables were described in the three Measurement and Treatment Research to Improve Cognition in Schizophrenia articles discussed in our editorial. Although defeatist attitudes are clear mediators, there are other factors that may also mediate between neurocognitive functioning and everyday outcomes, including patients’ psychological characteristics (e.g., depression, motivational factors, social and cognitive abilities) as well as societal and individual factors (e.g., disability compensation, ethnicity). In the effort to account for everyday impairment in individuals with schizophrenia, it appears that a well-defined separation of competence, performance, and mediating factors will lead to the most distinct analysis of contributors to this impairment. These distinctions could result in important treatment implications, since pharmacological and psychosocial treatments are unlikely to affect all of the multiple influences on impairment equally, and they are unlikely to affect some of these influences at all. Atlanta, Ga.The author’s disclosures accompany the original article.This letter (doi: 10.1176/appi.ajp.2008.08020229r) was accepted for publication in March 2008.Reference1. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD: Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry 2006; 163:418–425Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 165Issue 6 June, 2008Pages 772-772THE AMERICAN JOURNAL OF PSYCHIATRY June 2008 Volume 165 Number 6 Metrics PDF download History Published online 1 June 2008 Published in print 1 June 2008

Competencias profesionales: del conflicto a la oportunidad

The tough [correction of turf] battles with other specialties that tend to take control of the radiological practice and some of our areas of interest are one of the most important problems that Radiology must face at the present time. Interventional Radiology is the last one and the more recent example of this phenomenon that spreads world-wide. Far from defeatist attitudes, we must learn from our past mistakes to turn this scenario into an opportunity to evolve towards a more competitive and updated specialty according to our time. The authors review the present situation of the tough [correction of turf] batlles of Radiology with other specialties, pointing to their possible causes and proposing the resolution strategies.

Participation Rhetoric or Community-Based Management Reality? Influences on Willingness to Participate in a Venezuelan Freshwater Fishery

Community-based management (CBM) has progressed from the conceptual fringe to the dialogical heart of environmental management. Despite its rhetorical popularity, limited quantitative data exist on factors influencing local involvement. A quantitative survey of three Venezuelan fishing villages resulted in a predictive model of willingness to participate in CBM. Sense of community and fishery dependence were significant positive influences. High level of concern about the current and future state of the fishery correlated with an unwillingness to participate, indicating a defeatist attitude about perceived insurmountable problems. We explore sense of community, defeatist attitudes, and education in CBM project formulation and implementation.