Recent neuroimaging studies demonstrate that remembering the past and imagining the future rely on the same core brain network. However, findings of common core network activity during remembering and imagining events and increased activity during future event simulation could reflect the recasting of past events as future events. We experimentally recombined event details from participants' own past experiences, thus preventing the recasting of past events as imagined events. Moreover, we instructed participants to imagine both future and past events in order to disambiguate whether future-event-specific activity found in previous studies is related specifically to prospection or a general demand of imagining episodic events. Using spatiotemporal partial-least-squares (PLS), a conjunction contrast confirmed that even when subjects are required to recombine details into imagined events (and prevented from recasting events), significant neural overlap between remembering and imagining events is evident throughout the core network. However, the PLS analysis identified two subsystems within the core network. One extensive subsystem was preferentially associated with imagining both future and past events. This finding suggests that regions previously associated with future events, such as anterior hippocampus, medial prefrontal cortex and inferior frontal gyrus, support processes general to imagining events rather than specific to prospection. This PLS analysis also identified a subsystem, including hippocampus, parahippocampal gyrus and extensive regions of posterior visual cortex that was preferentially engaged when remembering past events rich in contextual and visuospatial detail.

Thinking about the future is an integral component of human cognition - one that has been claimed to distinguish us from other species. Building on the construct of episodic memory, we introduce the concept of 'episodic future thinking': a projection of the self into the future to pre-experience an event. We argue that episodic future thinking has explanatory value when considering recent work in many areas of psychology: cognitive, social and personality, developmental, clinical and neuropsychology. Episodic future thinking can serve as a unifying concept, connecting aspects of diverse research findings and identifying key questions requiring further reflection and study.

The somatic marker hypothesis provides a systems-level neuroanatomical and cognitive framework for decision making and the influence on it by emotion. The key idea of this hypothesis is that decision making is a process that is influenced by marker signals that arise in bioregulatory processes, including those that express themselves in emotions and feelings. This influence can occur at multiple levels of operation, some of which occur consciously and some of which occur non-consciously. Here we review studies that confirm various predictions from the hypothesis. The orbitofrontal cortex represents one critical structure in a neural system subserving decision making. Decision making is not mediated by the orbitofrontal cortex alone, but arises from large-scale systems that include other cortical and subcortical components. Such structures include the amygdala, the somatosensory/insular cortices and the peripheral nervous system. Here we focus only on the role of the orbitofrontal cortex in decision making and emotional processing, and the relationship between emotion, decision making and other cognitive functions of the frontal lobe, namely working memory.

Self-control is often conceived as a battle between "hot" impulsive processes and "cold" deliberative ones. Heeding the angel on one shoulder leads to success; following the demon on the other leads to failure. Self-control like a duality. What if that sensation is misleading, and, despite how they feel, self-control decisions are just like any other choice? We argue that self-control is a form of wherein options are assigned a subjective value and a decision is made through a dynamic integration process. We articulate how a value-based choice model of self-control can capture its phenomenology and account for relevant behavioral and neuroscientific data. This conceptualization of self-control links divergent scientific approaches, allows for more robust and precise hypothesis testing, and suggests novel pathways to improve self-control.

Both resting state functional magnetic resonance imaging (fcMRI) and transcranial magnetic stimulation (TMS) are increasingly popular techniques that can be used to non-invasively measure brain connectivity in human subjects. TMS shows additional promise as a method to manipulate brain connectivity. In this review we discuss how these two complimentary tools can be combined to optimally study brain connectivity and manipulate distributed brain networks. Important clinical applications include using resting state fcMRI to guide target selection for TMS and using TMS to modulate pathological network interactions identified with resting state fcMRI. The combination of TMS and resting state fcMRI has the potential to accelerate the translation of both techniques into the clinical realm and promises a new approach to the diagnosis and treatment of neurological and psychiatric diseases that demonstrate network pathology.Copyright © 2012 Elsevier Inc. All rights reserved.

Five studies tested two general hypotheses: Individuals differ in their use of emotion regulation strategies such as reappraisal and suppression, and these individual differences have implications for affect, well-being, and social relationships. Study 1 presents new measures of the habitual use of reappraisal and suppression. Study 2 examines convergent and discriminant validity. Study 3 shows that reappraisers experience and express greater positive emotion and lesser negative emotion, whereas suppressors experience and express lesser positive emotion, yet experience greater negative emotion. Study 4 indicates that using reappraisal is associated with better interpersonal functioning, whereas using suppression is associated with worse interpersonal functioning. Study 5 shows that using reappraisal is related positively to well-being, whereas using suppression is related negatively.

Over the past 60 years, human intracranial electrophysiology (HIE) has been used to characterize seizures in patients with epilepsy. Secondary to the clinical objectives, electrodes implanted intracranially have been used to investigate mechanisms of human cognition. In addition to studies of memory and language, HIE methods have been used to investigate emotions. The aim of this review is to outline the contribution of HIE (electrocorticography, single-unit recording and electrical brain stimulation) to our understanding of the neural representations of emotions. We identified 64 papers dating back to the mid-1950s which used HIE techniques to study emotional states. Evidence from HIE studies supports the existence of widely distributed networks in the neocortex, limbic/paralimbic regions and subcortical nuclei which contribute to the representation of emotional states. In addition, evidence from HIE supports hemispheric dominance for emotional valence. Furthermore, evidence from HIE supports the existence of overlapping neural areas for emotion perception, experience and expression. Lastly, HIE provides unique insights into the temporal dynamics of neural activation during perception, experience and expression of emotional states. In conclusion, we propose that HIE techniques offer important evidence which must be incorporated into our current models of emotion representation in the human brain. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Obsessive-compulsive disorder (OCD) has been associated with abnormal cognitive and emotional functions and these dysfunctions may be dependent on the disruption of dynamic interactions within neuronal circuits associated with emotion regulation. Although several studies have shown the aberrant cognitive-affective processing in OCD patients, little is known about how to characterize effective connectivity of the disrupted neural interactions. In the present study, we applied effective connectivity analysis using dynamic causal modeling to explore the disturbed neural interactions in OCD patients.A total of 20 patients and 21 matched healthy controls performed a delayed-response working memory task under emotional or non-emotional distraction while undergoing functional magnetic resonance imaging.During the delay interval under negative emotional distraction, both groups showed similar patterns of activations in the amygdala. However, under negative emotional distraction, the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) exhibited significant differences between groups. Bayesian model averaging indicated that the connection from the DLPFC to the OFC was negatively modulated by negative emotional distraction in patients, when compared with healthy controls (p < 0.05, Bonferroni-corrected).Exaggerated recruitment of the DLPFC may induce the reduction of top-down prefrontal control input over the OFC, leading to abnormal cortico-cortical interaction. This disrupted cortico-cortical interaction under negative emotional distraction may be responsible for dysfunctions of cognitive and emotional processing in OCD patients and may be a component of the pathophysiology associated with OCD.

A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term "contextual behavioral science." We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy.Copyright © 2011. Published by Elsevier Ltd.

We investigated the self-regulatory strategies people spontaneously use in their everyday lives to regulate their persistence during aversive activities. In pilot studies (pooled N = 794), we identified self-regulatory strategies from self-reports and generated hypotheses about individual differences in trait self-control predicting their use. Next, deploying ambulatory assessment (N = 264, 1940 reports of aversive/challenging activities), we investigated predictors of the strategies' self-reported use and effectiveness (trait self-control and demand types). The popularity of strategies varied across demands. In addition, people higher in trait self-control were more likely to focus on the positive consequences of a given activity, set goals, and use emotion regulation. Focusing on positive consequences, focusing on negative consequences (of not performing the activity), thinking of the near finish, and emotion regulation increased perceived self-regulatory success across demands, whereas distracting oneself from the aversive activity decreased it. None of these strategies, however, accounted for the beneficial effects of trait self-control on perceived self-regulatory success. Hence, trait self-control and strategy use appear to represent separate routes to good self-regulation. By considering trait- and process-approaches these findings promote a more comprehensive understanding of self-regulatory success and failure during people's daily attempts to regulate their persistence. (c) 2018 European Association of Personality Psychology

Inter-individual variability in perception, thought and action is frequently treated as a source of 'noise' in scientific investigations of the neural mechanisms that underlie these processes, and discarded by averaging data from a group of participants. However, recent MRI studies in the human brain show that inter-individual variability in a wide range of basic and higher cognitive functions - including perception, motor control, memory, aspects of consciousness and the ability to introspect - can be predicted from the local structure of grey and white matter as assessed by voxel-based morphometry or diffusion tensor imaging. We propose that inter-individual differences can be used as a source of information to link human behaviour and cognition to brain anatomy.

Procrastination is a prevalent problematic behavior that brings serious consequences, such as lower levels of health, wealth, and well-being. Previous research has verified that impulsivity is one of the traits most strongly correlated with procrastination. However, little is known about why there is a tight behavioral relationship between them. To address this question, we used voxel-based morphometry (VBM) to explore the common neural substrates between procrastination and impulsivity. In line with previous findings, the behavioral results showed a strong behavioral correlation between procrastination and impulsivity. Neuroimaging results showed impulsivity and procrastination shared the common neurobiological underpinnings in the dorsolateral prefrontal cortex (DLPFC) based on the data from 85 participants (sample 1). Furthermore, the mediation analysis revealed that impulsivity mediated the impact of gray matter (GM) volumes of this overlapping region in the DLPFC on procrastination on another independent 84 participants' data (sample 2). In conclusion, the overlapping brain region in the DLPFC would be responsible for the close relationship between procrastination and impulsivity. As a whole, the present study extends our knowledge on procrastination, and provides a novel perspective to explain the tight impulsivity - procrastination relationship.Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

Humans discount the value of future rewards following a hyperbolic function and thus may prefer a smaller immediate reward over a larger delayed reward. Marked interindividual differences in the steepness of this discounting function can be observed which can be quantified by the parameter k of the discount function. Here, we asked how differences in delay discounting behaviour are reflected by brain activation patterns. Sixteen healthy participants were studied in a slow event-related functional magnetic resonance imaging experiment at 3T. In each trial, participants had to decide between a smaller but immediately available monetary reward (ranging between 14 and 84 Euro) and a larger delayed reward (26 to 89 Euro; delay 5 to 169days) by button press. Participants had the chance to receive the reward corresponding to one of their decisions at the end of the experiment. As expected, participants differed widely with respect to the steepness of their discount function. By contrasting decisions at or near the individual participant's indifference point (as determined by parameter k) with trials either well below or well above this point two different brain networks with opposing activation patterns were revealed: Trials below or above the indifference point were associated with activation in the ventral striatum and ventromedial prefrontal cortex, whereas decisions at the indifference point gave rise to activation in medial prefrontal cortex. The opposite effects in the two systems at individual indifference point were interpreted as a reflection of response conflict.Copyright 2010 Elsevier B.V. All rights reserved.

Uncertainty is a ubiquitous feature of our daily lives. Although previous studies have identified a number of neural and peripheral physiological changes associated with uncertainty, there are limited data on the causal mechanisms underlying these responses in humans. In this study, we address this empirical gap through a novel application of fMRI in neurosurgical patients with focal, bilateral ventromedial prefrontal cortex (vmPFC) damage. The fMRI task involved cued anticipation of aversive and neutral picture stimuli; "certain" cues unambiguously indicated the upcoming picture valence, whereas "ambiguous" cues could precede either picture type. Healthy subjects exhibited robust bilateral insula responses to ambiguous cues, and this cue-related insula activity significantly correlated with heart rate variability during the task. By contrast, the vmPFC lesion patients exhibited altered cue-related insula activity and reduced heart rate variability. These findings suggest a role for vmPFC in coordinating neural and physiological responses during anticipation. Copyright © 2014 the authors 0270-6474/14/3410430-08$15.00/0.

Decision-making and impulse control (both cognitive and motor) are complex interrelated processes which rely on a distributed neural network that includes multiple cortical and subcortical regions. Among them, the orbitofrontal cortex (OFC) seems to be particularly relevant as demonstrated by several neuropsychological and neuroimaging investigations.In the present study we assessed whether transcranial direct current stimulation (tDCS) applied bilaterally over the OFC is able to modulate decision-making and cognitive impulse control. More specifically, 45 healthy subjects were randomized to receive a single 30-min session of active or sham anodal tDCS (1.5 mA) applied over either the left or the right OFC (coupled with contralateral cathodal tDCS). They were also assessed pre- and post-tDCS with a battery of computerized tasks.Our results show that participants who received active anodal tDCS (irrespective of laterality), vs. those who received sham tDCS, displayed more advantageous decision-making (i.e., increased Iowa Gambling Task "net scores" [p = 0.04]), as well as improved cognitive impulse control (i.e., decreased "interference" in the Stroop Word-Colour Task [p = 0.007]). However, we did not observe tDCS-related effects on mood (assessed by visual analogue scales), attentional levels (assessed by the Continuous Performance Task) or motor impulse control (assessed by the Stop-Signal Task).Our study potentially serves as a key translational step towards the development of novel non-invasive neuromodulation-based therapeutic interventions directly targeting vulnerability factors for psychiatric conditions such as suicidal behaviour and addiction.Copyright © 2015 Elsevier Ltd. All rights reserved.

The traditional concept of 'categorical' psychiatric disorders has been challenged as many of the symptoms display a continuous distribution in the general population. We suggest that this is the case for emotional dysregulation, a key component in several categorical psychiatric disorder constructs. We used voxel-based magnetic resonance imaging morphometry in healthy human subjects (n = 87) to study how self-reported subclinical symptoms associated with emotional dysregulation relate to brain regions assumed to be critical for emotion regulation. To measure a pure emotional dysregulation, we also corrected for subclinical symptoms of non-emotional attentional dysregulation. We show that such subclinical emotional symptoms correlate negatively with the grey matter volume of lateral orbitofrontal cortex bilaterally-a region assumed to be critical for emotion regulation and dysfunctional in psychiatric disorders involving emotional dysregulation. Importantly, this effect is mediated both by a decrease in volume associated with emotional dysregulation and an increase in volume due to non-emotional attentional dysregulation. Exploratory analysis suggests that other regions involved in emotional processing such as insula and ventral striatum also show a similar reduction in grey matter volume mirroring clinical disorders associated with emotional dysregulation. Our findings support the concept of continuous properties in psychiatric symptomatology.© The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Attention may reflexively shift towards the location of perceived threats, but it is still unclear how these spatial biases recruit the distributed fronto-parietal cortical networks involved in other aspects of selective attention. We used event-related fMRI to determine how brain responses to a neutral visual target are influenced by the emotional expression of faces appearing at the same location during a covert orienting task. On each trial, two faces were briefly presented, one in each upper visual field (one neutral and one emotional, fearful or happy), followed by a unilateral target (a small horizontal or vertical bar) replacing one of the faces. Participants had to discriminate the target orientation, shown on the same (valid) or opposite (invalid) side as the emotional face. Trials with faces but no subsequent target (cue-only trials) were included to disentangle activation due to emotional cues from their effects on target detection. We found increased responses in bilateral temporo-parietal areas and right occipito-parietal cortex for fearful faces relative to happy faces, unrelated to the subsequent target and cueing validity. More critically, we found a selective modulation of intraparietal and orbitofrontal cortex for targets following an invalid fearful face, as well as an increased visual response in right lateral occipital cortex for targets following a valid fearful face. No such effects were observed with happy faces. These results demonstrate that fearful faces can act as exogenous cues by increasing sensory processing in extrastriate cortex for a subsequent target presented at the same location, but also produce a cost in disengaging towards another location by altering the response of IPS to invalidly cued targets. Neural mechanisms responsible for orienting attention towards emotional vs. non-emotional stimuli are thus partly shared in parietal and visual areas, but also partly distinct.

The orbitofrontal cortex contains the secondary taste cortex, in which the reward value of taste is represented. It also contains the secondary and tertiary olfactory cortical areas, in which information about the identity and also about the reward value of odours is represented. The orbitofrontal cortex also receives information about the sight of objects from the temporal lobe cortical visual areas, and neurons in it learn and reverse the visual stimulus to which they respond when the association of the visual stimulus with a primary reinforcing stimulus (such as taste) is reversed. This is an example of stimulus-reinforcement association learning, and is a type of stimulus-stimulus association learning. More generally, the stimulus might be a visual or olfactory stimulus, and the primary (unlearned) positive or negative reinforcer a taste or touch. A somatosensory input is revealed by neurons that respond to the texture of food in the mouth, including a population that responds to the mouth feel of fat. In complementary neuroimaging studies in humans, it is being found that areas of the orbitofrontal cortex are activated by pleasant touch, by painful touch, by taste, by smell, and by more abstract reinforcers such as winning or losing money. Damage to the orbitofrontal cortex can impair the learning and reversal of stimulus-reinforcement associations, and thus the correction of behavioural responses when there are no longer appropriate because previous reinforcement contingencies change. The information which reaches the orbitofrontal cortex for these functions includes information about faces, and damage to the orbitofrontal cortex can impair face (and voice) expression identification. This evidence thus shows that the orbitofrontal cortex is involved in decoding and representing some primary reinforcers such as taste and touch; in learning and reversing associations of visual and other stimuli to these primary reinforcers; and in controlling and correcting reward-related and punishment-related behavior, and thus in emotion. The approach described here is aimed at providing a fundamental understanding of how the orbitofrontal cortex actually functions, and thus in how it is involved in motivational behavior such as feeding and drinking, in emotional behavior, and in social behavior.

The orbitofrontal cortex represents the reward or affective value of primary reinforcers including taste, touch, texture, and face expression. It learns to associate other stimuli with these to produce representations of the expected reward value for visual, auditory, and abstract stimuli including monetary reward value. The orbitofrontal cortex thus plays a key role in emotion, by representing the goals for action. The learning process is stimulus-reinforcer association learning. Negative reward prediction error neurons are related to this affective learning. Activations in the orbitofrontal cortex correlate with the subjective emotional experience of affective stimuli, and damage to the orbitofrontal cortex impairs emotion-related learning, emotional behaviour, and subjective affective state. With an origin from beyond the orbitofrontal cortex, top-down attention to affect modulates orbitofrontal cortex representations, and attention to intensity modulates representations in earlier cortical areas of the physical properties of stimuli. Top-down word-level cognitive inputs can bias affective representations in the orbitofrontal cortex, providing a mechanism for cognition to influence emotion. Whereas the orbitofrontal cortex provides a representation of reward or affective value on a continuous scale, areas beyond the orbitofrontal cortex such as the medial prefrontal cortex area 10 are involved in binary decision-making when a choice must be made. For this decision-making, the orbitofrontal cortex provides a representation of each specific reward in a common currency.

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis.

Personality is an important epidemiological factor for understanding health outcomes. This study investigated the associations of trait procrastination with hypertension and cardiovascular disease (HT/CVD) and maladaptive coping by testing an extension of the procrastination-health model among individuals with and without HT/CVD. Individuals with self-reported HT/CVD (N = 182) and healthy controls (N = 564), from a community sample, completed an online survey including measures of personality, coping, and health outcomes. Logistic regression analysis controlling for demographic and higher order personality factors found that older age, lower education level and higher procrastination scores were associated with HT/CVD. Moderated mediation analyses with bootstrapping revealed that procrastination was more strongly associated with maladaptive coping behaviours in participants with HT/CVD than the healthy controls, and the indirect effects on stress through maladaptive coping were larger for the HT/CVD sample. Results suggest procrastination is a vulnerability factor for poor adjustment to and management of HT/CVD.

Theories on procrastination have proposed that the trade-off between the episodic future thinking (EFT) of positive outcome and negative engagement determines whether to procrastinate. Yet, the neural substrates underlying EFT affects procrastination remain poorly understood. Thus, we adopt a free construction method to obtain individuals' EFT thoughts toward procrastination tasks, and coded these thoughts based on the 2 (emotional valence: positive vs negative) × 2 (imaginary direction: outcome vs engagement) model of EFT (2 × 2 model). Next, a regression analysis was utilized to test the relationship between each dimension in the 2 × 2 model and execution willingness. To explore the neuroanatomical structures underlying EFT, the voxel-based morphometry (VBM) analysis was conducted to find out brain regions responsible for EFT. In addition, the resting-state functional connectivity (RSFC) analysis was also utilized to examine the neural pathways underlying EFT affects procrastination. Behavioral results showed combine the anticipated positive outcome with anticipated negative engagement can best predict execution willingness. The VBM analysis revealed that the left dorsolateral prefrontal cortex (DLPFC) was positively correlated with anticipated positive outcome, while the right hippocampus was positively correlated with anticipated negative engagement. The RSFC results indicated that DLPFC functional connectivity with the right inferior frontal gyrus (RIFG) and left precuneus were positively associated with anticipated positive outcome, whereas the hippocampus connectivity with the left insula was positively associated with anticipated negative engagement. Structural equation model results suggest that EFT affects procrastination through the cognitive control pathway (DLPFC-IFG, DLPFC-precuneus) and emotional processing pathway (hippocampus-insula). Collectively, these findings suggest that task procrastination can be predicted by the interaction of the top-down cognitive control pathway and bottom-up emotional processing pathway.Copyright © 2021 Elsevier Ltd. All rights reserved.

Theories on procrastination propose that associating tasks with higher valued incentive outcomes results in less task procrastination. However, it remains unknown how representation of incentive outcomes and task-outcome association are mediated by the human brain. Using event-related functional magnetic resonance imaging, we scanned human participants while they were thinking about both tasks and the incentive outcomes each task can yield in an unconstrained way. Results showed that tasks that are more likely to be procrastinated are associated with less value in incentive outcomes. Interestingly, procrastination was more likely if it was more difficult for participants to associate a task with its valued incentives when thinking about the task (i.e., the decreased task-outcome association). On the neural level, higher value of rewarding outcomes was correlated with increased putamen activations, which further negatively predicted task procrastination. On the other hand, when participants were associating tasks with the incentive outcomes, the decreasing task-outcome association corresponded to decreasing activation in putamen, and a decreasing hippocampus-putamen coupling which further mediated the effect of the insufficient task-outcome association on procrastination. In particular, the current findings show that procrastination is more likely when people are less able to associate tasks with highly valued incentives, which is accompanied by reduced hippocampal-striatal interactions during task construction.© 2018 Wiley Periodicals, Inc.

The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, self-report scale designed to screen for the most common DSM-IV Axis I disorders encountered in outpatient mental health settings. In the present report, we describe the diagnostic performance (sensitivity, specificity, and positive and negative predictive values) of the PDSQ in an outpatient setting.Six hundred thirty psychiatric outpatients presenting for treatment were evaluated with the Structured Clinical Interview for DSM-IV after completing the PDSQ. Patients arrived approximately 20 minutes before the scheduled time of the appointment to complete the scale. Diagnostic raters were blind to responses on the scale.The PDSQ's subscales' diagnostic performance varied in a predictable manner according to the cutoff score-as the threshold for case identification increased, subscale sensitivity decreased and specificity increased. Mean subscale sensitivities of 80%, 85%, and 90% resulted in mean subscale specificities of 78%, 73%, and 66%, respectively, and negative predictive values of 95%, 96%, and 97%. Receiver operating curves were determined for each subscale and all areas under the curve were significant.The PDSQ is a diagnostic aid designed to be used in clinical practice to facilitate the efficiency of conducting initial diagnostic evaluations. From a clinical perspective, it is most important that a diagnostic aid have good sensitivity, so that most cases are detected, and high negative predictive value, so that most noncases on the measure are indeed noncases. Our results indicate that most of the PDSQ subscales were able to achieve this goal.