Within-session Change Research Articles

TEAM-CBT for Adolescents and Young Adults With Depression and Anxiety: Testing Short-Term Impact and Within-Session Change

The prevalence of mental health disorders has shown a notable rise in adolescents and young adults (Parodi et al., 2022). These developmental stages, adolescence and young adulthood, are peak periods for emerging mental health disorders, affecting around 49.5% of young individuals. Anxiety and depression have significant adverse and long-term effects that interfere with developmental tasks if not successfully treated (Merikangas, 2010).An evidence-based model, TEAM-CBT, incorporates the following treatment components: testing, empathy, agenda setting, and methods. The model’s impact on depression and anxiety was tested in a naturalistic study of adolescent and young adult clients in a group practice setting. T-tests and ANOVAs were used to test treatment effects, including changes between the first and final sessions, within-session changes, and the treatment response pattern.A total of N = 116 patients’ data was included in the analysis. Both depression and anxiety scores were significantly lower at posttest compared to pretest. The majority of adolescents and young adults achieved clinically significant improvement: 80% of youth no longer met criteria for clinically significant symptoms of depression symptoms, and 87% of youth for anxiety symptoms. No correlation was found between the number of sessions received and the treatment outcome. Within-session symptom reduction was clinically significant in each of the 10 sessions. The largest symptom reductions occurred over the first five sessions. Findings, recommendations, and implications are discussed.

The dynamic strategy shifting task: Optimisation of an operant task for assessing cognitive flexibility in rats.

Although schizophrenia is associated with a broad range of symptoms including hallucinations, delusions, and reduced motivation, measures of cognitive dysfunction, including cognitive flexibility and executive function, are the strongest predictors of functional outcomes. Antipsychotic medications are useful for reducing psychotic symptoms, but they are ineffective at improving cognitive deficits. Despite extensive investment by industry, the transition from preclinical to clinical trials has not been successful for developing precognitive medications for individuals with schizophrenia. Here, we describe the optimisation of a novel dynamic strategy shifting task (DSST) using standard operant chambers to investigate the optimal stimuli required to limit the extensive training times required in previous tasks. We determined that optimal learning by male and female Sprague Dawley rats for the flexibility task incorporated dynamic strategy shifts between spatial rules, such as following a visual cue or responding at one location, and non-spatial rules, such as responding to a central visual or auditory cue. A minimum of 6 correct consecutive responses were required to make a within-session change in the behavioural strategies. As a proof of concept, we trained and tested 84 Sprague Dawley rats on the DSST, and then assessed their cognitive flexibility using a within-subject design after an acute dose of ketamine (0, 3, 10 mg/kg). Rats made fewer premature and more perseverant responses to initiate a trial following ketamine. The effects of ketamine on trials to criterion was dependent on the rule. Ketamine induced a significant improvement on the reversal of a non-spatial visual discrimination rule. There was no significant effect of ketamine on the spatial visual or response discrimination rules. The DSST is a novel assay for studying distinct forms of cognitive flexibility and offers a rapid and adaptable means of assessing the ability to shift between increasingly challenging rule conditions. The DSST has potential utility in advancing our understanding of cognitive processes and the underlying neurobiological mechanisms related to flexibility in neuropsychiatric and neurological conditions where executive dysfunctions occur.>.

How to assess and analyse session-specific effects and predictors: An example with the Metacognitive Training for Obsessive-Compulsive Disorder intervention.

It is essential to understand the effects of specific therapy elements (i.e., mechanisms of change) to optimize the efficacy of available treatments. There are, however, existing challenges in the assessment and analysis of constructs of interest. The present study aims to improve research on the effects of specific therapy elements using the example of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD) intervention. Specifically, we introduce an innovative analytical method to identify predictors of treatment outcome and expand the assessment of common factors (e.g., coping expectations). A sample of 50 day- and inpatients with OCD was assessed before and after participation in an 8-week MCT-OCD programme. We investigated within-session change in scores on revised questionnaires administered before and after each session. Linear mixed models (for session-effects) and lasso regression (for prediction analyses) were used to analyse data. The revised assessments and data analyses showed greater improvement in dysfunctional (meta-)cognitive beliefs over the time of the intervention and within sessions compared to previous MCT-OCD studies. Some predictors, for example, improvement in coping expectation after the module on overestimation of threat for treatment outcome, were identified. The present study contributed to a better understanding of how to assess and analyse data of a modular intervention and demonstrated the strengths and weaknesses of different analytic approaches. Moreover, the analyses provided a deeper understanding of the specific effects and mechanisms of change of MCT-OCD modules, which can be refined and examined in future studies.

Rhythmic auditory stimulation to improve gait rehabilitation outcomes for children with acquired brain injury: a pilot study

Background/Aims Children with severe acquired brain injury frequently have walking rehabilitation goals. The aim of this study was to investigate if rhythmic auditory stimulation would improve walking speed and gait quality in children with acquired brain injury. Methods A total of four children were included in this study (age 10–12 years; mean time since acquired brain injury 12.75 weeks). A multiple baseline single case experimental study design was followed. The baseline phase (phase A) consisted of standard rehabilitation (10 physiotherapy sessions a week) and for the intervention phase (phase B), two out of the 10 sessions were replaced with rhythmic auditory stimulation. A 10-metre walk test and the Edinburgh Visual Gait Score was completed twice a week at the beginning and end of the session. Visual analysis of level, slope and trend, and statistical analysis of effect size (Tau-U) was conducted across phases. Descriptive analysis of within-session change was completed. Results All children showed improvement. In the 10-metre walk test, three children demonstrated a steeper trendline in phase A and one child demonstrated consistent trendlines between phases A and B. Tau-U indicated a small effect size (−0.207 (z =−1.32, P=0.1853)) that was not statistically significant for the Edinburgh Visual Gait Score; one child showed a steeper trendline in phase A and one in phase B, while others were consistent. One child’s Edinburgh Visual Gait Score improved greatly in phase B. Tau-U indicated a large effect size (−0.6235 (z=−3.9981, P=0.0001)) that was statistically significant. Within session changes indicated that, overall, children showed greater immediate changes with the Edinburgh Visual Gait Score and 10-metre walk test with the rhythmic auditory stimulation than with standard physiotherapy. Conclusions In addition to standard physiotherapy, rhythmic auditory stimulation may be of benefit to children relearning to walk after an acquired brain injury, potentially having a greater effect on gait biomechanics than walking speed. Rhythmic auditory stimulation can be considered alongside other gait interventions, but more research is required.

Improved symptoms of complex regional pain syndrome after novel lymphatic treatment and interdisciplinary pain management

IntroductionComplex regional pain syndrome (CRPS) is a pain syndrome with no singular mechanism and no specific cure. The aim of this case report is to study the impact of Lymphatic Enhancement Technology (LET) treatment on CRPS-related symptoms. MethodsA 51 year-old female presented with a chief complaint of severe, refractory ankle pain and CRPS related to a tibial and fibular fracture sustained three years earlier. The patient completed twelve cognitive behavioral therapy sessions over a 4-week period, and eleven physical therapy sessions over a four-month period, six of which utilized LET. ResultsPain and swelling were largely unchanged with interdisciplinary treatment before the introduction of LET. A within-session change of 37.5% in pain intensity and 87.5% in ankle girth was observed immediately after the first application of LET. Three months after beginning LET treatment, the patient maintained a 43.8% improvement in pain intensity and 100% improvement in measurements of lower extremity girth and ankle range of motion. No side effects or adverse events were associated with the LET treatment. ConclusionSwelling, pain, and mobility loss are common symptoms and features of CRPS. LET is a novel, non-invasive treatment that appears to be quite safe and effective for improving pain, swelling, and mobility loss related to CRPS.

Temporal Relationship Between Change in Subjective Distress and PTSD Symptom Decrease During Prolonged Exposure Therapy for Posttraumatic Stress Disorder

There is growing evidence that change in distress is an indicator of change during Prolonged Exposure (PE) for posttraumatic stress disorder (PTSD). However, temporal sequencing studies investigating whether change in distress precedes PTSD symptom decline are lacking. These studies are essential since the timeline between indicators of change and treatment outcome is a key assumption for mediation. The aim of the present study was to assess the temporal relationship between within- and between-session change in subjective distress and PTSD symptom decrease. We analyzed session data from 86 patients with PTSD. Data were analyzed using dynamic panel models. We distinguished temporal effects (within-persons) from averaged effects (between-persons). Results regarding the temporal effect showed that within-session change in subjective distress preceded PTSD symptom improvement while the reversed effect was absent. Averaged within-session change in subjective distress was also related to PTSD symptom improvement. Results regarding the temporal effect of between-session change in subjective distress showed that it did not precede PTSD symptom improvement. Averaged between-session change in subjective distress was related to PTSD symptom improvement. This study provides evidence for within- but not between-session change in subjective distress as indicator of change during PE. We also found that the way of modeling potential indicators of change affects results and implications. We recommend future studies to analyze mediators during treatment using temporal rather than averaged effects.

Psychophysiology during exposure to trauma memories: Comparative effects of virtual reality and imaginal exposure for posttraumatic stress disorder.

This investigation involved an in-depth examination of psychophysiological responses during exposure to the trauma memory across 10 sessions among active duty soldiers with combat-related posttraumatic stress disorder (PTSD) treated by Prolonged Exposure (PE) or Virtual Reality Exposure (VRE). We compared psychophysiological changes, session-by-session, between VRE and traditional imaginal exposure. Heart rate (HR), galvanic skin response (GSR), and peripheral skin temperature were collected every 5 min during exposure sessions with 61 combat veterans of Iraq/Afghanistan and compared to the PTSD Checklist (PCL-C) and Clinician-Administered PTSD Scale (CAPS) outcomes using multilevel modeling. Over the course of treatment, participants in the PE group had higher HR arousal compared to participants in the VRE group. With reference to GSR, in earlier sessions, participants demonstrated a within-session increase, whereas, in later sessions, participants showed a within-session habituation response. A significant interaction was found for GSR and treatment assignment for within-session change, within-person effect, predicting CAPS (d = 0.70) and PCL-C (d = 0.66) outcomes. Overall, these findings suggest that exposure to traumatic memories activates arousal across sessions, with GSR being most associated with reductions in PTSD symptoms for participants in the PE group.

Verbal feedback enhances motor learning during post-stroke gait retraining

ABSTRACT Background Fast treadmill walking combined with functional electrical stimulation to ankle muscles (FastFES) is a well-studied gait intervention that improves post-stroke walking function. Although individualized verbal feedback is commonly incorporated during clinical gait training, and a variable practice structure is posited to enhance learning, the influence of these two factors on motor learning during locomotor interventions such as FastFES is poorly understood. Objectives To determine if the addition of individualized verbal feedback or variable practice to a FastFES training session enhances motor learning of targeted gait patterns. Methods Nine individuals with post-stroke hemiparesis completed a crossover study comprising exposure to 3 dose-matched types of gait training: (1) FastFES (FF), comprising five 6-minute bouts of training with intermittent FES, (2) FF with addition of individualized verbal instructions and faded feedback delivered by a physical therapist (FF+PT), (3) FF with variable gait speed and FES timing (FF+Var). Gait biomechanics data were collected before (Pre), immediately after (Post), and 24-h following (Retention) each training type. Within-session and retention change scores of 3 targeted gait variables were calculated to assess locomotor learning. Results FF+PT resulted in larger improvements within-session and at retention in trailing limb angle, and a trend for larger improvements in paretic pushoff compared to FF. FF+Var failed to show greater learning of biomechanical variables compared to FF. Conclusions Addition of individualized verbal feedback (FF+PT) to a single session of gait training may enhance within- and across-session learning of targeted gait variables in people post-stroke, and merits more investigation.

Individualizing Evidence-Based Treatment of Neuropsychiatrically Complex Patients: Process-Based Targets for Change in Parkinson’s Depression

Providing evidence-based treatment always requires responding in the moment to apparent gaps between the protocol and the patient’s presenting needs and preferences. In the treatment of depression in Parkinson’s disease (PD), research has shown that providing PD-specialized, empirically supported interventions is paramount. However, given PD’s highly heterogeneous symptom presentations, adapting and individualizing treatment to address each patient’s unique constellation of neuropsychiatric symptoms and PD-related physical challenges is equally important. This Commentary on the article by Dr. Logan Durland (2020) focuses on the importance of attending to process-based factors to inform protocol adaptations in the treatment of Parkinson’s depression, guided by the framework of functional analytic psychotherapy (FAP). The FAP approach applies behavioral principles to in-session processes as a means of highlighting and therapeutically targeting clinically relevant behaviors in real time. Seeking such opportunities to foster within-session change may be especially important when providing evidence-based treatment to individuals with co-occurring mental health issues and chronic, functionally limiting medical problems like PD. As these patients manage the interactions between the complex demands of illness self-management and the burden of mental health symptoms, they must respond adaptively to unpredictable daily challenges. Harnessing moments of clinically relevant struggle during sessions in order to support and reinforce new responses—including new ways of approaching the learning process itself—can help patients consolidate both the coping skills themselves and flexibility and confidence to apply them.

Examining motivational interviewing’s effect on confidence and commitment using daily data

Mechanisms of behavior change (MOBC) within Motivational Interviewing (MI) are thought to operate via both relational and technical elements. These elements are hypothesized to increase client motivation and self-efficacy for change and subsequently decrease drinking. Only partial support for this causal chain exists, particularly when using within-session change talk as the primary intervening variable. This study explored whether commitment to moderate or abstain from drinking and confidence to moderate drinking in the next day measured via ecological momentary assessment (EMA) provided alternative support for the theory. Data were from a pilot randomized controlled trial testing active ingredients of MI. Problem drinkers (N = 89) seeking to moderate their drinking were randomly assigned to one of the three conditions: 1) MI; 2) Spirit only MI (SOMI), consisting of non-directive elements of MI, e.g., reflective listening; and 3) a non-therapy control. Participants completed daily EMA that measured confidence, both types of commitment, and drinks per day for a week prior to and during seven weeks of treatment. Hypotheses were not supported, and results were unexpected. Participants in SOMI were more likely to have higher daily confidence than those in MI; there were no condition differences for either type of commitment. All daily measures significantly predicted drinking; however, the MI group did not demonstrate a stronger relationship between the intervening variables and drinking, as hypothesized. Instead, participants in SOMI yielded the strongest relationship between daily commitment to abstain and drinking compared to the other two conditions. Multiple possible explanations for the unexpected findings are discussed.

Immediate symptom response to manual therapy treatment for neck pain is related to rate and extent of recovery

Background:Manual therapies are commonly used in the management of neck pain to relieve symptoms, restoremobility and hasten recovery. Common practice in manual therapy is using immediate treatment responses to inform both treatment progression and prognosis. Within-session changes in symptoms have been shown to correlate with self-reported recovery rate. This study sought a detailed profile of the trajectory of recovery of neck pain treated with manual therapy and further information about the predictive value of withinsession improvements. Purpose:The aim of this studywas to describe the clinical course of a new episode of neck pain during a course of manual therapy treatment and to explore whether the early responses to treatment were related to longer term outcomes. Methods:Analysis of treatment responses and recovery in participants from two arms of a manual therapy randomised controlled trial. Participants were 181 people with a new episode of neck pain, treated with a course of mobilisation or manipulation of the neck on four occasions over two weeks. The clinical course during the episode of care was described using average preand post-treatment pain scores (numerical rating scale 0–10) for each occasion of treatment. Repeated measures t-test was used to compare scores within and between sessions. The relationships between immediate treatment effects and time taken to recover and the Global Perceived Effect (GPE) of treatment at 3 months were explored using multivariate regression analyses. Results: On each occasion of treatment, pain scores significantly decreased with the smallest average withinsession change 1.4 (95%CI 1.2 to 1.5). There was also small but statistically significant increases in average pain scores of up to 0.7 (95%CI 0.4 to 1.0) between treatment sessions without regression to the preceding pre-treatment level. The change in pain scores after the first treatment session was independently associated with high GPE scores at three months (B= 0.2, 95%CI 0.01 to 0.4). There were also significant univariate associations between the within-session changes in pain and the time taken to recover from the episode of neck pain. However, these associations were not independent of duration of symptoms, self-rated general health, or the presence of headache. Conclusion(s): These results indicate that people with neck pain who are treated with manual therapy experience a pattern of recovery of symptoms that coincides with the occasions of treatment and features improvement within sessions and slight relapse between sessions. These results also demonstrate that improvements in symptoms within a treatment session are associatedwith a faster rate of recovery from an episode of neck pain and with patient’s overall perception of the benefits of treatment at 3-month follow up. Implications:Manual therapists can use the information in this study to assist their patients’ understanding of the trajectory of their recovery from a new episode of neck pain. In particular, it is helpful for patients to understand that slight relapses between treatment sessions are the normand not necessarily an indicator of poor outcome.These results also assist clinical reasoning in manual therapy practice by demonstrating a predictive value of short term treatment responses.

The Effects of Cognitive Control and Time on Frontal Beta Oscillations.

Frontal beta oscillations are associated with top-down control mechanisms but also change over time during a task. It is unclear whether change over time represents another control function or a neural instantiation of vigilance decrements over time, the time-on-task effect. We investigated how frontal beta oscillations are modulated by cognitive control and time. We used frontal chronic electrocorticography in monkeys performing a trial-and-error task, comprising search and repetition phases. Specific beta oscillations in the delay period of each trial were modulated by task phase and adaptation to feedback. Beta oscillations in this same period showed a significant within-session change. These separate modulations of beta oscillations did not interact. Crucially, and in contrast to previous investigations, we examined modulations of beta around spontaneous pauses in work. After pauses, the beta power modulation was reset and the cognitive control effect was maintained. Cognitive performance was also maintained whereas behavioral signs of fatigue continued to increase. We propose that these beta oscillations reflect multiple factors contributing to the regulation of cognitive control. Due to the effect of pauses, the time-sensitive factor cannot be a neural correlate of time-on-task but may reflect attentional effort.

The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1

Single-group, prospective, repeated-measures design with responder analysis. To determine differences in the changes in diffusion of water within the lumbar intervertebral discs between participants with low back pain who reported a within-session reduction in pain intensity following a single treatment of spinal manipulative therapy and those who did not. There is a paucity of research that describes the physiologic events associated with analgesia following intervention for low back pain. Postintervention increases in the diffusion of water within various soft tissues of the spine may be one of many potential mechanisms linked to pain reduction. Nineteen adults between 20 and 45 years of age participated in this study. All participants reported low back pain of at least 2 on an 11-point (0-10) verbally administered numeric pain rating scale at the time of enrollment. Participants underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans immediately before and after receiving a single treatment of spinal manipulative therapy. Individuals who reported a decrease in current pain intensity of more than 2 following treatment were classified as "within-session responders," and the remainder were classified as "not-within-session responders." The apparent diffusion coefficient (ADC), representing the diffusion of water in the nucleus pulposus, was calculated from ADC maps derived from the midsagittal diffusion-weighted images. Two-way, repeated-measures analyses of variance indicated significant group-by-time interactions. Participants in the within-session-responder group (n = 12) had a postintervention increase in ADC at L1-2 (P = .001), L2-3 (P = .002), and L5-S1 (P = .01) compared to those in the not-within-session-responder group (n = 7). Large effect sizes in ADC between responder groups were observed at L1-2 (d = 1.74), L2-3 (d = 1.83), and L5-S1 (d = 1.49). No significant group-by-time interactions were observed at the L3-4 and L4-5 levels. Changes in the diffusion of water within the lumbar intervertebral discs at the L1-2, L2-3, and L5-S1 levels appear to be related to differences in within-session pain reports following a single treatment of spinal manipulative therapy.

A Comparison of Attachment Outcomes in Enactment-Based Versus Therapist-Centered Therapy Process Modalities in Couple Therapy

Attachment issues are viewed by many therapists as lying at the heart of couple distress. It is critical to empirically validate therapy processes that facilitate couples in responding to each other's attachment needs. This study examined enactments as a therapy process and change mechanism to promote secure attachment in couple therapy. Sixteen couples were randomly assigned to 1 of 2 experimental groups--1 group received 3 therapist-centered sessions followed by 3 enactment-based sessions, and a second group received 3 enactment-based sessions followed by 3 therapist-centered sessions. To measure between-session and within-session change, each spouse completed presession and postsession measures of attachment security each week. Results showed that couples who received enactment-based sessions first reported greater increases in attachment security than those receiving therapist-centered sessions first. These same couples continued to show improvement after switching to the therapist-centered sessions. Conversely, couples who received therapist-centered sessions first did not increase attachment after switching to enactment-based sessions. For wives, enactment-based sessions produced the greatest improvement in attachment, yet both therapy process modalities led to some improvement. Conversely, for husbands, attachment improved only when they received enactment-based sessions first. Enactment-based sessions may therefore be more important for husbands than wives. Overall, with some qualification it appears that enactment-based therapy process may improve attachment more than a therapist-centered process. These observed trends and findings are generally consistent with previous research supporting use of enactments in couple therapy.

The ability of a sustained within-session finding of pain reduction during traction to dictate improved outcomes from a manual therapy approach on patients with osteoarthritis of the hip

Objectives: The objectives of this study were to: (1) determine the association of a within-session finding after traction of the hip with self-report of well-being, pain, and self-report of function at 9 weeks; and (2) to determine if the interactions between the within-session finding and the outcome measure are different between groups of patients with hip OA who receive and who do not receive manual therapy.Methods: Data were retrospectively analysed in 70 subjects who were part of a randomized control trial. Correlation analyses of within-session findings from the initial visit after traction of a concordantly painful hip were compared to self-report measures for function, pain, and well-being at 9 weeks. A comparison of slope coefficients between manual therapy and non-manual therapy groups was performed to determine the interactive aspects of the within-session finding.Results: Although the correlations for the manual therapy group were higher than for the supervised neglect group, none of the correlational analyses for both groups was strong or significant. Significant differences in the slope coefficients for well-being and pain were found, suggesting that the interactions between the within-session findings and the targeted outcomes were different in the manual therapy group versus supervised neglect group.Discussion: These findings suggest that within-session findings during the initial evaluation are not strongly related to a positive outcome after manual therapy, although the interaction of the finding of a within-session change and the use of manual therapy is more compelling than the finding in a sample of patients who did not receive manual therapy.

Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

How Collaborative Is Structural Family Therapy?

In response to the charge by “collaborative” therapies, such as solution focused and narrative, that structural family therapy is an aggressive, confrontational, and impositional approach, this investigation examines the role of therapist empathy in creating a collaborative partnership in structural family therapy. Twenty-four videotaped therapy sessions were used to correlate therapists' empathic response to family members and in-session change in the family's core problem dynamic. Findings suggest that empathy is not only evident in structural family therapy, but may be an essential ingredient in establishing a collaborative relationship and facilitating within-session change.

Do changes within a manual therapy treatment session predict between-session changes for patients with cervical spine pain?

Physiotherapists often use within-session changes to provide a guide for refining treatment application. This study tested the validity of within-session changes as predictors of between-session changes for patients with neck pain receiving manual therapy treatment. A total of 70 pairs of treatments from 29 patients with sub-acute non-specific neck pain receiving manual therapy were assessed to determine the relationship between within-session and between-session changes in range of motion (ROM), pain intensity, and centralisation. Measurements were taken of ROM of the more limited direction on each axis of flexion, extension, lateral-flexion and rotation, and pain (intensity and location) before and after treatment. The same measurements were repeated before the following treatment. Regression analysis demonstrated that within-session change accounted for 26% to 48% of the variability in between-session change for ROM and six per cent for pain intensity. The proportion of the within-session change for ROM maintained between sessions ranged from 42% to 63% (95% CI 25% to 88%). The odds ratios for within-session improved/not improved categorisation to predict between-session category for ROM ranged from 2.5 (95% CI 0.6 to 4.3) to 21.3 (95% CI 10.1 to 96.1), for pain intensity 4.5 (95% CI 1.2 to 14.4) and for pain centralisation 9.2 (95% CI 2.2 to 38.7) indicating greater likelihood of between-session improvement after within-session improvement. The between-session results for most patients (71% to 83%) could be classified correctly by their within-session category. The results support the use of within-session changes in ROM, centralisation, and possibly pain intensity as predictors of between-session changes for musculoskeletal disorders of the cervical spine.

Can cognitive restructuring reduce the disruption associated with perfectionistic concerns?

We investigated the utility of a brief cognitive restructuring intervention in inoculating perfectionists from their typical negative responses to evaluative threat. In particular, we wanted to examine whether cognitive restructuring could reduce perfectionists' negative affect and cognitions about a speech task. We were also interested in analyzing the pattern of within-session change across a variety of affective and cognitive measures as a function of this cognitive intervention. Sixty female undergraduate students delivered a speech before a small audience. We used a 2 (Group) × 2 (Condition) design to investigate the effects of perfectionism and intervention type on subjects' negative affect and cognitions related to the evaluative task. Participants high and low in perfectionistic concern over mistakes (CM; group) were randomly assigned to receive either a cognitive restructuring or distraction intervention (Condition) prior to the speech task. Individuals high in CM reported significantly more negative cognitive and affective responses to the evaluative task than low CM subjects; however, cognitive restructuring was successful in reducing cost and probability estimates for all subjects' most feared predictions for the impending speech. Moreover, these cognitive changes were associated with lower ratings of self-reported anxiety in comparison to subjects in the distraction condition. Interestingly, cognitive restructuring did not affect subjects' more global ratings of negative affect or negative thoughts about the speech. Our results provide some preliminary but encouraging implications for the effectiveness of cognitive restructuring in the treatment of perfectionism.

Studies of wheel-running reinforcement: parameters of Herrnstein's (1970) response-strength equation vary with schedule order.

Six male Wistar rats were exposed to different orders of reinforcement schedules to investigate if estimates from Herrnstein's (1970) single-operant matching law equation would vary systematically with schedule order. Reinforcement schedules were arranged in orders of increasing and decreasing reinforcement rate. Subsequently, all rats were exposed to a single reinforcement schedule within a session to determine within-session changes in responding. For each condition, the operant was lever pressing and the reinforcing consequence was the opportunity to run for 15 s. Estimates of k and R(O) were higher when reinforcement schedules were arranged in order of increasing reinforcement rate. Within a session on a single reinforcement schedule, response rates increased between the beginning and the end of a session. A positive correlation between the difference in parameters between schedule orders and the difference in response rates within a session suggests that the within-session change in response rates may be related to the difference in the asymptotes. These results call into question the validity of parameter estimates from Herrnstein's (1970) equation when reinforcer efficacy changes within a session.