Mental threat rehearsal increases fear generalization

BACKGROUND AND OBJECTIVES

Fear generalization to harmless stimuli characterizes anxiety-related disorders, but much remains unknown about its determinants. Based on studies showing that mental imagery of threat can increase conditioned fear responding, we tested whether it also facilitates fear generalization, and whether threat inflation moderates this effect.

METHODS

In a fear conditioning study, 120 participants first completed an acquisition phase, in which one of two pictures was followed by an aversive sound (human scream). Then, the sound was presented 11 times at an increasing (threat inflation) or constant volume (no threat inflation). Finally, a generalization stimulus was presented, and some participants were asked to imagine the last sound (threat rehearsal) and others were not (no threat rehearsal).

RESULTS

Bayesian informative hypotheses tests indicated that imagery-based threat rehearsal increased generalization of threat expectancy, and, combined with threat inflation, it also resulted in stronger generalized distress.

LIMITATIONS

due to the absence of a test phase, it is unclear whether our effects would transfer to other GSs and whether they would persist beyond the manipulation phase.

CONCLUSIONS

Mental imagery of threat may put individuals at risk for fear generalization. Future studies should examine whether modulating imagery may prevent clinical anxiety.

Self-generated strategies in the phonological similarity effect

Strategy use is an important source of individual differences during immediate serial reconstruction. However, not all strategies are equally suited for all tasks. Therefore, assessing participants' dynamic strategy selection across contexts is an important next step for reliable interpretation of individual differences in short-term memory span - in both experimental and clinical settings. Strategy use during reconstruction of phonologically similar and phonologically distinct word sets was directly assessed using a self-report questionnaire. In two experiments, participants reported consistent use of phonological strategies across word sets; however, participants reported additionally using non-phonological strategies (i.e., mental imagery and sentence generation) when tasked with remembering phonologically similar words. In particular, strategy selection was most impacted when the phonologically similar word set was either the only word set or the first word set participants received. When the phonologically similar lists were presented after a classic list of phonologically distinct words, participants continued using the phonological strategies that had been effective for the distinct lists. Moreover, in both experiments, accuracy of phonologically similar lists was better predicted by use of non-phonological strategies than use of phonological strategies. Specifically, reported use of verbalization or rehearsal did not predict accuracy, but participants who reported regularly using mental imagery and/or sentence generation (typically in conjunction with rehearsal) displayed greater serial memory for similar words. These results do not undermine the general assumptions of the phonological similarity effect, but they do indicate that its interpretation is less straightforward than previously thought.

Negative recency effects in delayed recognition: Spacing, consolidation, and retrieval strategy processes

While items learned immediately before testing are generally remembered better than prior items in a study list, in delayed testing this relationship is reversed, yielding a negative recency effect. To adjudicate between the strategic rehearsal and spacing accounts of this phenomenon, we examined performance of 169 participants on a delayed recognition test following multiple sessions requiring the study and immediate free recall testing of 16 lists of 16 words. This revealed a strong effect of the amount of spacing between initial study position and initial free recall position on the degree of negative recency, supporting the spacing account. Furthermore, these spacing effects were nonmonotonic, suggesting that they are mediated by consolidation processes. Additional analyses indicate that strategies and rehearsal opportunities may also contribute to the effects of within-list encoding position on subsequent long-term memory, but for recall more than for recognition.

Medical education videos as a tool for rehearsal: efficiency and the cases of background music and difficulty

This study reports a field experiment investigating how instructional videos with and without background music contribute to the learning of examination techniques within a formal curriculum of medical teaching. Following a classroom teaching unit on the techniques for examining the knee and the shoulder joint, our participants (N = 175) rehearsed the studied techniques for either the knee or the shoulder joint with an instructional video with or without background music. As dependent measures, we collected a general questionnaire, a prediction of test performance, as well as performance on an exam-like knowledge test covering both joints. For both videos, the participants who had watched the particular video during rehearsal were more accurate in answering the corresponding questions than the participants who had seen the other video, signaling that instructional videos provide a useful tool for rehearsal (i.e., both groups reciprocally served as control groups). For the knee video (less difficult), we observed a detrimental effect of the background music, whereas we observed no such effect for the shoulder video (more difficult). Further explorations revealed that background music might be detrimental for learning, as it reduces the perceived demand characteristics. Because the impact of the demand characteristics might be more pronounced in less difficult instructional videos, we discuss video difficulty as a potential moderating factor. Overall, our study provides evidence that instructional videos could be usefully implemented in formal teaching curricula and that such instructional videos probably should be designed without background music.

The "STARS-CASCADE" Study: Virtual Reality Simulation as a New Training Approach in Vascular Neurosurgery

OBJECTIVE

Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery.

METHODS

We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed.

RESULTS

There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P < 0.005).

CONCLUSIONS

Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.

Immersive 3-Dimensional Virtual Reality Modeling for Case-Specific Presurgical Discussions in Cerebrovascular Neurosurgery

BACKGROUND

Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display.

OBJECTIVE

To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery.

METHODS

A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons' hand-drawn presurgical illustrations.

RESULTS

The VR session effectively enhanced surgeons' understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons' presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts.

CONCLUSION

Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons' understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.

The "STARS-CT-MADE" Study: Advanced Rehearsal and Intraoperative Navigation for Skull Base Tumors

BACKGROUND

Skull base meningiomas represent a challenge for neurosurgeons, and the procedures are typically performed by experienced neurosurgeons, thus limiting resident training. A new simulation and rehearsal device can be used as an aid for senior surgeons during these operations and serve as a training tool for junior surgeons.

METHODS

Forty patients harboring an anterior/middle fossa meningioma were recruited. Surgical Theater, a rehearsal/simulation platform, was used for preoperative planning and intraoperative 3D navigation on 20 patients (CT-MADE group), while the remaining (control group) underwent a traditional navigation. Qualitative comparisons between the 2 groups were made with regard to surgical procedure and patient outcome. Satisfaction questionnaires were completed by expert neurosurgeons and residents to assess the overall usefulness of the platform. Furthermore, the surface of the simulated craniotomy performed during the planning was compared with the one actually performed during surgery in order to evaluate the reliability of the planning.

RESULTS

No differences between the 2 groups were found (surgery duration: P = 0.4; visual impairment: P = 0.56). Both residents and senior neurosurgeons enjoyed using the platform for intraoperative navigation and planning; simulated craniotomies were significantly smaller as compared with the real ones (P = 0.009), probably because it was not intuitive to depict the exact margins of the operculum with the platform.

CONCLUSION

Surgical Theater helped residents to improve their anatomic and procedural comprehension and was deemed as a useful aid to safely perform some demanding neurosurgical procedures, by both senior and junior surgeons.

Does rehearsal matter? Left anterior temporal alpha and theta band changes correlate with the beneficial effects of rehearsal on working memory

Rehearsal during working memory (WM) maintenance is assumed to facilitate retrieval. Less is known about how rehearsal modulates WM delay activity. In the present study, 44 participants completed a Sternberg Task with either intact novel scenes or phase-scrambled scenes, which had similar color and spatial frequency but lacked semantic content. During the rehearsal condition participants generated a descriptive label during encoding and covertly rehearsed during the delay period. During the suppression condition participants did not generate a label during encoding and suppressed (repeated "the") during the delay period. This was easy in the former (novel scenes) but more difficult in the later condition (phase-scrambled scenes) where scenes lacked semantic content. Behavioral performance and EEG delay activity was analyzed as a function of maintenance strategy. Performance during WM revealed a benefit of rehearsal for phase-scrambled but not intact scenes. Examination of the absolute amplitude revealed three underlying sources of activity for rehearsal, including the left anterior temporal (ATL) and left and midline parietal regions. Increases in alpha and theta activity in ATL were correlated with improvement in performance on WM with rehearsal only when labeling was not automatic (e.g., phase-scrambled scenes), which may reflect differences in labeling and rehearsal (i.e., semantic associations vs. shallow labels). We conclude that rehearsal only benefits memory for visual stimuli that lack semantic information, and that this is correlated with changes in alpha and theta rhythms.

Cognitive control of working memory but not familiarity in rhesus monkeys (Macaca mulatta)

Directed forgetting paradigms assess cognitive control by determining whether memory accuracy is superior in trials on which subjects were instructed to remember compared with accuracy in trials on which they were instructed to forget. We used a directed forgetting paradigm to compare the extent to which working memory and familiarity are subject to rehearsal-like cognitive control in rhesus monkeys. Monkeys studied a sample image, then saw one of two distinctive cues during a retention interval. The remember cue typically predicted a four-choice match to sample test, for which memory of the sample was critical. The forget cue typically predicted one of five perceptual discrimination tests, matched for accuracy to the memory tests, for which memory of the sample was irrelevant. On rare probe trials, the test type other than the type typically predicted by the cue was presented. When cognitive control of memory was possible, accuracy should have been higher on memory tests following the remember cue than on those following the forget cue. We found that accuracy was higher following the remember cue under conditions that favored working memory (small image set) but was not higher under conditions that favored matching on the basis of relative familiarity (large image set). Working memory, but not familiarity, is subject to cognitive control in rhesus monkeys.

Decomposing the role of rehearsal in auditory distraction during serial recall

According to the interference-by-process mechanism of auditory distraction, irrelevant changing sounds interfere with subvocal articulatory-motor sequencing during rehearsal. However, previous attempts to limit rehearsal with concurrent articulation and examine the residual irrelevant sound effect have limited both cumulative rehearsal as well as the initial assembly of articulatory-phonological labels. The current research decomposed rehearsal into these two levels of articulatory-phonological sequencing: silent concurrent articulation limits the availability of both serial repetition and articulatory-phonological recoding; rapid serial visual presentation allows for articulatory-phonological recoding but presents items too quickly for cumulative serial repetition. As predicted by the interference-by-process account, concurrent articulation -- but not rapid serial visual presentation -- reduced the irrelevant sound effect. Not only did the irrelevant sound effect persist in the face of rapid serial visual presentation, a steady-state effect also emerged. These findings indicate that irrelevant sounds interfere with both serial processing at the level of articulatory-motor planning at the word level as well as in the formation of item-to-item associations created via serial repetition of complete items. Moreover, these findings highlight the benefits of articulatory-phonological recoding - independent of pure rehearsal -- within serial recall.

Robotic Surgical Assistant (ROSA™) Rehearsal: Using 3-Dimensional Printing Technology to Facilitate the Introduction of Stereotactic Robotic Neurosurgical Equipment

BACKGROUND

The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA™) in 2012. Although the safety and accuracy of the ROSA platform has been well-established, the introduction of complex robotic technology into an existing surgical practice poses technical and logistical challenges particular to a given institution.

OBJECTIVES

To better facilitate the integration of new surgical equipment into the armamentarium of a thriving pediatric neurosurgery practice by describing the use of a three-dimensional (3D)-printed patient model with in situ 3D-printed tumor for presurgical positioning and trajectory optimization in the stereotactic biopsy of a pontine lesion in a pediatric patient.

METHODS

A 3D model was created with an added silicone mock tumor at the anatomical position of the lesion. In a preoperative rehearsal session, the patient model was pinned and registered using the ROSA platform, and a mock biopsy was performed targeting the in Situ silicone tumor.

RESULTS

Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology. Biopsy trajectory successfully reached intralesional tissue on the 3D-printed model. The rehearsal maneuvers decreased operative and intubation time for the patient and improved operative staff familiarity with the robotic setup.

CONCLUSION

Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the biopsy of a difficult to reach pontine lesion in a pediatric patient. The ROSA rehearsal decreased operative time and increased staff familiarity with a new complex surgical equipment.

Do reminders of the crime reverse the memory-undermining effect of simulating amnesia?

Research shows that simulating amnesia impairs actual memory for a mock crime. Lack of rehearsal has been suggested as the most likely explanation for this finding because feigning amnesia is linked to reduced thinking about the offence. We investigated whether reminders about the crime could reverse the memory-undermining effect of simulation. In two studies, participants watched a video of a violent crime. After, they were asked to either simulate amnesia or confess the crime. During the week between the first and second memory test phase, participants were provided with reminders of the crime in two different modalities. In Study 1 (pilot), participants received frames of the mock crime video via WhatsApp. Findings showed that such reminders did not enhance ex-simulators' memory. In Study 2, participants were asked to put sequences of the mock crime in the right order. This latter modality led to enhanced memory for the offence in simulating participants. Theoretical and practical implications of our findings for the legal field are discussed.

Auditory distraction does more than disrupt rehearsal processes in children's serial recall

As children mature, their ability to remember information improves. This improvement has been linked to changes in verbal control processes such as rehearsal. Rehearsal processes are thought to undergo a quantitative shift around 7 years of age; however, direct measurement of rehearsal is difficult. We investigated a measure of rehearsal ability in children and compared this measurement to serial recall performance in the presence of auditory distractors. Theories of auditory distraction effects in children rely upon a combination of attentionally based and serial-order-based processes (Elliott et al. in Journal of Memory and Language, 88, 39-50, 2016); the present work contributes to the understanding of auditory distraction effects by measuring both types of processes within one study. Children completed an individually adjusted serial-recall task with auditory distractors. To assess rehearsal, each child's proportionalized articulatory difference (PAD) score was calculated from performance on adaptive digit span tasks performed in quiet and under articulatory suppression (see also Jarrold & Citroën in Developmental Psychology, 49, 837-847, 2013). Attentional processes were measured in two ways: first, by using complex span tasks, and second, by children's vulnerability to disruption in the context of irrelevant sound. The results indicated that the rehearsal measure was significantly related to the auditory distraction effect, but this relation was isolated to the attentional-diversion component of the irrelevant-sound effect. The results provide preliminary evidence that children consume attentional resources during rehearsal. Moreover, irrelevant sound disrupts children's rehearsal not solely through automatic, obligatory conflict. Rather, irrelevant sound diverts children's attention, which prevents attentional resources from supporting rehearsal processes.

Examining the role of rehearsal in old-old adults' working memory

We investigated the role of rehearsal in verbal working memory (WM) and whether WM capacity can be improved by a rehearsal instruction in very old age. In two experiments, we tested a total of 78 old-old adults (75 years and above) in one experimental session consisting of three assessment phases. First, participants worked on three different WM span tasks to assess their baseline performance. In the next phase, half of the participants received a rehearsal instruction to practice on two of the WM tasks, whereas the other half received no strategy instruction (Experiment 1) or worked on a filler task (Experiment 2). In the final phase, participants again worked on the three WM tasks. In Experiment 1, we found significant improvements for the WM tasks over time in both groups. However, we could not find a specific improvement for the rehearsal instruction due to a high spontaneous strategy use in the control group. When minimizing spontaneous strategy use in Experiment 2 by changing the task material, we found larger improvements in the instruction compared to the control group. However, we still found substantial spontaneous strategy use in the control group. The results indicate that rehearsal, as an essential component of verbal WM, is still intact and efficient in old-old adults. Furthermore, the spontaneous strategy use indicates that old-olds use their existing skills to cope with increasing WM demands. Finally, old-old adults benefited from an explicit rehearsal instruction showing potentials to boost WM capacity in this age group.

Preoperative surgical rehearsal using cadaveric fresh tissue surgical simulation increases resident operative confidence

BACKGROUND

Rehearsal is an essential part of mastering any technical skill. The efficacy of surgical rehearsal is currently limited by low fidelity simulation models. Fresh cadaver models, however, offer maximal surgical simulation. We hypothesize that preoperative surgical rehearsal using fresh tissue surgical simulation will improve resident confidence and serve as an important adjunct to current training methods.

METHODS

Preoperative rehearsal of surgical procedures was performed by plastic surgery residents using fresh cadavers in a simulated operative environment. Rehearsal was designed to mimic the clinical operation, complete with a surgical technician to assist. A retrospective, web-based survey was used to assess resident perception of pre- and post-procedure confidence, preparation, technique, speed, safety, and anatomical knowledge on a 5-point scale (1= not confident, 5= very confident).

RESULTS

Twenty-six rehearsals were performed by 9 residents (PGY 1-7) an average of 4.7±2.1 days prior to performance of the scheduled operation. Surveys demonstrated a median pre-simulation confidence score of 2 and a post-rehearsal score of 4 (P<0.01). The perceived improvement in confidence and performance was greatest when simulation was performed within 3 days of the scheduled case. All residents felt that cadaveric simulation was better than standard preparation methods of self-directed reading or discussion with other surgeons. All residents believed that their technique, speed, safety, and anatomical knowledge improved as a result of simulation.

CONCLUSIONS

Fresh tissue-based preoperative surgical rehearsal was effectively implemented in the residency program. Resident confidence and perception of technique improved. Survey results suggest that cadaveric simulation is beneficial for all levels of residents. We believe that implementation of preoperative surgical rehearsal is an effective adjunct to surgical training at all skill levels in the current environment of decreased work hours.

The fading affect bias shows positive outcomes at the general but not the individual level of analysis in the context of social media

Unpleasant affect fades faster than pleasant affect (e.g., Walker, Vogl, & Thompson, 1997); this effect is referred to as the Fading Affect Bias (FAB; Walker, Skowronski, Gibbons, Vogl, & Thompson, 2003a). Research shows that the FAB is consistently related to positive/healthy outcomes at a general but not at a specific level of analysis based on event types and individual differences (e.g., Gibbons et al., 2013). Based on the positive outcomes for FAB and negative outcomes for social media (Bolton et al., 2013; Huang, 2010), the current study examined FAB in the context of social media events along with related individual differences. General positive outcomes were shown in the form of robust FAB effects across social media and non-social media events, a larger FAB for non-social media events than for social media events, negative correlations of FAB with depression, anxiety, and stress as well as a positive correlation of FAB with self-esteem. However, the lack of a negative correlation between FAB and anxiety for social media events in a 3-way interaction did not show positive outcomes at a specific level of analysis. Rehearsal ratings mediated the 3-way interaction. Implications are discussed.

The Mid-Career Award

Working memory is an extremely influential concept within experimental psychology, with, at the time of writing, over 90 papers with this term in their title published in this journal alone since 2000. One reason for this interest is that measures of working memory tend to be strong correlates of important indices of real-world function. In addition, at first sight working memory appears to be a relatively simple concept to understand. However, despite this apparent simplicity, explaining working memory performance is not straightforward. In this paper I address this challenge, with a particular focus on the development of working memory performance in children; both children developing typically and those experiencing atypical development. I specifically highlight the multiple constraints on working memory performance, and how these constraints inter-relate. I then consider the broader theoretical implications of each of these constraints for current accounts of working memory and its development.

Dissociating the effects of semantic grouping and rehearsal strategies on event-related brain potentials

The application of elaborative encoding strategies during learning, such as grouping items on similar semantic categories, increases the likelihood of later recall. Previous studies have suggested that stimuli that encourage semantic grouping strategies had modulating effects on specific ERP components. However, these studies did not differentiate between ERP activation patterns evoked by elaborative working memory strategies like semantic grouping and more simple strategies like rote rehearsal. Identification of neurocognitive correlates underlying successful use of elaborative strategies is important to understand better why certain populations, like children or elderly people, have problems applying such strategies. To compare ERP activation during the application of elaborative versus more simple strategies subjects had to encode either four semantically related or unrelated pictures by respectively applying a semantic category grouping or a simple rehearsal strategy. Another goal was to investigate if maintenance of semantically grouped vs. ungrouped pictures modulated ERP-slow waves differently. At the behavioral level there was only a semantic grouping benefit in terms of faster responding on correct rejections (i.e. when the memory probe stimulus was not part of the memory set). At the neural level, during encoding semantic grouping only had a modest specific modulatory effect on a fronto-central Late Positive Component (LPC), emerging around 650 ms. Other ERP components (i.e. P200, N400 and a second Late Positive Component) that had been earlier related to semantic grouping encoding processes now showed stronger modulation by rehearsal than by semantic grouping. During maintenance semantic grouping had specific modulatory effects on left and right frontal slow wave activity. These results stress the importance of careful control of strategy use when investigating the neural correlates of elaborative encoding.