Memory updating through aging: different patterns for socially meaningful (and not) stimuli

Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series

Introduction

Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective.

Methods

In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast.

Results

The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy.

Discussion

These results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

The role of metacognition and schematic support in younger and older adults' episodic memory

Older adults experience deficits in associative memory. However, age-related differences are reduced when information is consistent with prior knowledge (i.e., schematic support), suggesting that episodic and semantic memory are interrelated. It is unclear what role metacognitive processes play in schematic support. Prior knowledge may reduce encoding demands, but older adults may allocate cognitive resources to schema-consistent information because it is more meaningful. We examined metacognitive awareness of and control over associative information that was consistent or inconsistent with prior knowledge. In Experiment 1, participants self-paced their study of grocery items paired with either market prices or unusually high prices and were tested on the exact price of each item over four study-test lists with new items on each list. In Experiment 2, participants studied items for a fixed time but made judgments of learning (JOLs) at encoding. Older adults better remembered the prices of market-value items than overpriced items. In Experiment 1, younger and older adults studied overpriced items longer than market-priced items, consistent with a discrepancy reduction model of self-regulated learning, but study time did not relate to later recall accuracy, suggesting a labor-in-vain effect. In Experiment 2, participants gave higher JOLs to market-priced items than overpriced items and were generally metacognitively aware of the benefits of schematic support. Together, these results suggest that the benefits of schematic support may not be dependent on or influenced by metacognitive control processes, supporting the hypothesis that episodic memory may be less distinct from semantic memory in younger and older adults.