Patrick E. McKnight

Purpose in life as a system that creates and sustains health and well-being: An integrative, testable theory.

Purpose—a cognitive process that defines life goals and provides personal meaning—may help explain disparate empirical social science findings. Devoting effort and making progress toward life goals provides a significant, renewable source of engagement and meaning. Purpose offers a testable, causal system that synthesizes outcomes including life expectancy, satisfaction, and mental and physical health. These outcomes may be explained best by considering the motivation of the individual—a motivation that comes from having a purpose. We provide a detailed definition with specific hypotheses derived from a synthesis of relevant findings from social, behavioral, biological, and cognitive literatures. To illustrate the uniqueness of the purpose model, we compared purpose with competing contemporary models that offer similar predictions. Addressing the structural features unique to purpose opens opportunities to build upon existing causal models of “how and why” health and well-being develop and change over time.

A capability model of individual differences in frontal EEG asymmetry

Researchers interested in measuring individual differences in affective style via asymmetries in frontal brain activity have depended almost exclusively upon the resting state for EEG recording. This reflects an implicit conceptualization of affective style as a response predisposition that is manifest in frontal EEG asymmetry, with the goal to describe individuals in terms of their general approach or withdrawal tendencies. Alternatively, the response capability conceptualization seeks to identify individual capabilities for approach versus withdrawal responses during emotionally salient events. The capability approach confers a variety of advantages to the study of affective style and personality, and suggests new possibilities for the approach/withdrawal motivational model of frontal EEG asymmetry and emotion. Logical as well as empirical arguments supportive of this conclusion are presented.

The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research

Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.

When social anxiety disorder co-exists with risk-prone, approach behavior: Investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication

Little is known about people with social anxiety disorder (SAD) who are not behaviorally inhibited. To advance knowledge on phenomenology, functional impairment, and treatment seeking, we investigated whether engaging in risk-prone behaviors accounts for heterogeneous outcomes in people with SAD. Using the National Comorbidity Survey-Replication (NCS-R) dataset, our analyses focused on people with current (N = 679) or lifetime (N = 1143) SAD diagnoses. Using latent class analysis on NCS-R risk-prone behavior items, results supported two SAD classes: (1) a pattern of behavioral inhibition and risk aversion and (2) an atypical pattern of high anger and aggression, and moderate/high sexual impulsivity and substance use problems. An atypical pattern of risk-prone behaviors was associated with greater functional impairment, less education and income, younger age, and particular psychiatric comorbidities. Results could not be subsumed by the severity, type, or number of social fears, or comorbid anxiety or mood disorders. Conclusions about the nature, course, and treatment of SAD may be compromised by not attending to heterogeneity in behavior patterns.

Progressive Resistance Training Improves Overall Physical Activity Levels in Patients With Early Osteoarthritis of the Knee: A Randomized Controlled Trial

Background Prescription of resistance training (RT) exercises is an essential aspect of management for knee osteoarthritis (OA). However, whether patients with knee OA who are randomly assigned to receive RT simply substitute RT for other modes of physical activity remains unclear. Objective The aim of this study was to determine the effect of a structured RT intervention on overall levels of moderate- and vigorous-intensity physical activity (MVPA) in patients with early-onset knee OA. The study compared patients with early-onset OA who participated in an RT program, those who participated in a self-management (SM) program, and those who participated in both RT and SM. Because participants randomly assigned to receive the RT intervention may simply switch activity modes, resulting in little net effect, we assessed total MVPA in addition to tracking changes in strength (force-generating capacity). Design and Intervention This study was a randomized controlled trial comparing the effectiveness of SM alone, RT alone, and combined RT+SM on MVPA in patients with early OA of the knee. Setting The study was conducted on a university campus, with patient recruitment from the local community. Participants The participants in this study were 171 patients (74% women, 26% men) with knee OA. They had a mean age of 55.1 (SD=7.1) years, a mean body mass index of 27.6 (SD=4.2) kg/m2, and radiographic status of grade II OA (and no higher) in at least one knee, as defined by the Kellgren and Lawrence classification. They wore an accelerometer while awake (X̄=14.2 [SD=2.2] hours) for 5 to 7 contiguous days (X̄=6.8 [SD=0.5] days) at baseline and at 3 and 9 months of intervention. Results The participants engaged in MVPA a mean of 26.2 (SD=19.3) minutes per day at baseline. Both groups significantly increased their MVPA from baseline to 3 months (RT group by 18% [effect size (d)=0.26]; SM group by 22% [effect size (d)=0.25]), but only the RT group sustained those changes at 9 months (RT group maintained a 10% increase [effect size (d)=0.15]; SM group maintained a 2% increase [effect size (d)=0.03]). A significant group × time interaction for MVPA indicated that the RT group maintained higher MVPA levels than the SM group. Limitations. Lack of direct measures of energy expenditure and physical function was a limitation of the study. Conclusions Patients with early-onset OA of the knee can engage in an RT program without sacrificing their overall MVPA levels. These results support the value of RT for management of knee OA.

A comparison of strength training, self-management, and the combination for early osteoarthritis of the knee

To assess the relative effectiveness of combining self‐management and strength training for improving functional outcomes in patients with early knee osteoarthritis.

Unpacking Emotion Differentiation: Transforming Unpleasant Experience by Perceiving Distinctions in Negativity

Being able to carefully perceive and distinguish the rich complexity in emotional experiences is a key component of psychological interventions. We review research in clinical, social, and health psychology that offers insights into the adaptive value of putting feelings into words with a high degree of complexity (i.e., emotion differentiation or emotional granularity). According to recent research, upon experiencing intense distress, individuals who experience their emotions with more granularity are less likely to resort to maladaptive self-regulatory strategies such as binge drinking, aggression, and self-injurious behavior; show less neural reactivity to rejection; and experience less severe anxiety and depressive disorders. These findings shed light on how negative emotions and stressful experiences can be transformed by people’s emotion-differentiation skill. Besides basic research suggesting that emotion differentiation is an important developmental process, evidence suggests that interventions designed to improve emotion differentiation can both reduce psychological problems and increase various strands of well-being.

The Darker Side of Social Anxiety: When Aggressive Impulsivity Prevails Over Shy Inhibition

The majority of definitions, research studies, and treatment programs that focus on social anxiety characterize the prototypical person with the disorder as shy, submissive, inhibited, and risk averse. This stereotype, however, has been challenged recently. Specifically, a subset of people with social anxiety who are aggressive, impulsive novelty seekers deviate from that prototype. People with this atypical profile show greater functional impairment and are less likely to complete or fare well in treatment compared with inhibited socially anxious people. The difference between these two groups of people with social anxiety cannot be explained by the severity, type, or number of social fears, nor by co-occurring anxiety and mood disorders. Conclusions about the nature, course, and treatment of social anxiety may be compromised by not attending to diverse behaviors and self-regulatory styles. These concerns may be compounded in neurobiological and clinical studies of people with social anxiety problems that rely on smaller samples to make claims about brain patterns and the efficacy of particular treatments.

Distinguishing Healthy Adults From People With Social Anxiety Disorder: Evidence for the Value of Experiential Avoidance and Positive Emotions in Everyday Social Interactions

Despite the increased attention that researchers have paid to social anxiety disorder (SAD), compared with other anxiety and mood disorders, relatively little is known about the emotional and social factors that distinguish individuals who meet diagnostic criteria from those who do not. In this study, participants with and without a diagnosis of SAD (generalized subtype) described their daily face-to-face social interactions for 2 weeks using handheld computers. We hypothesized that, compared with healthy controls, individuals diagnosed with SAD would experience fewer positive emotions, rely more on experiential avoidance (of anxiety), and have greater self-control depletion (feeling mentally and physically exhausted after socializing), after accounting for social anxiety, negative emotions, and feelings of belonging during social interactions. We found that compared with healthy controls, individuals with SAD experienced weaker positive emotions and greater experiential avoidance, but there were no differences in self-control depletion between groups. Moreover, the differences we found could not be attributed to comorbid anxiety or depressive disorders. Our results suggest that negative emotions alone do not fully distinguish normal from pathological social anxiety, and that assessing social anxiety disorder should include impairments in positive emotional experiences and dysfunctional emotion regulation (in the form of experiential avoidance) in social situations.

Placebo effects in cognitive training

Significance Placebo effects pose problems for some intervention studies, particularly those with no clearly identified mechanism. Cognitive training falls into that category, and yet the role of placebos in cognitive interventions has not yet been critically evaluated. Here, we show clear evidence of placebo effects after a brief cognitive training routine that led to significant fluid intelligence gains. Our goal is to emphasize the importance of ruling out alternative explanations before attributing the effect to interventions. Based on our findings, we recommend that researchers account for placebo effects before claiming treatment effects. Although a large body of research shows that general cognitive ability is heritable and stable in young adults, there is recent evidence that fluid intelligence can be heightened with cognitive training. Many researchers, however, have questioned the methodology of the cognitive-training studies reporting improvements in fluid intelligence: specifically, the role of placebo effects. We designed a procedure to intentionally induce a placebo effect via overt recruitment in an effort to evaluate the role of placebo effects in fluid intelligence gains from cognitive training. Individuals who self-selected into the placebo group by responding to a suggestive flyer showed improvements after a single, 1-h session of cognitive training that equates to a 5- to 10-point increase on a standard IQ test. Controls responding to a nonsuggestive flyer showed no improvement. These findings provide an alternative explanation for effects observed in the cognitive-training literature and the brain-training industry, revealing the need to account for confounds in future research.