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    ABSTRACT: Maternal depression and contextual risks (e.g. poverty) are known to impact children's cognitive and social functioning. However, few published studies have examined how stress in the social environment (i.e. interpersonal stress) might developmentally inter-relate with maternal depression and contextual risks to negatively affect a child in these domains. This was the purpose of the current study. Mother-child pairs (n = 6979) from the Avon Longitudinal Study of Parents were the study participants. Mothers reported on depression, contextual risks, and interpersonal stress between pregnancy and 33 months child age. At age 8, the children underwent cognitive assessments and the mothers reported on the children's social cognitive skills. Maternal depression, contextual risks, and interpersonal stress showed strong continuity and developmental inter-relatedness. Maternal depression and contextual risks directly predicted a range of child outcomes, including executive functions and social cognitive skills. Interpersonal stress worked indirectly via maternal depression and contextual risks to negatively affect child outcomes. Maternal depression and contextual risks each increased interpersonal stress in the household, which, in turn, contributed to reduced child cognitive and social functioning.
    Depression and Anxiety 07/2014; 31(7). DOI:10.1002/da.22147
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    ABSTRACT: Individuals with an eating disorder experience the rubber hand illusion (RHI) significantly more strongly than healthy controls on both perceptual (proprioceptive drift) and subjective (self-report embodiment questionnaire) measures. This heightened sensitivity to visual information about the body, and/or reduced somatosensory information processing about the body, suggest an increased malleability of the bodily self. The aim of the present study was to explore whether this is a state phenomenon or a persisting individual trait that outlasts the period of acute eating disorder. The RHI and self-report measures of eating disorder psychopathology (EDI-3 subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; DASS-21; and the Self-Objectification Questionnaire) were administered to 78 individuals with an eating disorder, 28 individuals recovered from an eating disorder, and 61 healthy controls. Proprioceptive drift in recovered individuals was intermediate between the acutely ill and HC groups. Subjective report of the strength of the illusion in recovered individuals was similar to acutely ill individuals. These results suggest that increased malleability of the bodily self persists, at least partially, following recovery and may be a trait phenomenon in people with eating disorders. Those with a lifetime history of an eating disorder may have heightened sensitivity to visual information about the body and reduced somatosensory information processing of the body. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
    International Journal of Eating Disorders 05/2014; 47(4). DOI:10.1002/eat.22219
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    ABSTRACT: Studies have long reported that aging is associated with declines in several functions modulated by the prefrontal cortex, including executive functions like working memory, set shifting, and inhibitory control. The neurochemical basis to this is poorly understood, but may include the serotonergic system. We investigated the modulatory effect of serotonin using acute tryptophan depletion (ATD) during a cognitive switching task involving visual-spatial set shifting modified for a functional MRI environment. Ten healthy women over 55 years were tested on two separate occasions in this within-group double-blind sham-controlled crossover study to compare behavioral and physiological brain functioning following ATD and following a ("placebo") sham depletion condition. ATD did not significantly affect task performance. It did modulate brain functional recruitment. During sham depletion women significantly activated the expected task-relevant brain regions associated with the Switch task including prefrontal and anterior cingulate cortices. In contrast, following ATD participants activated posterior regions of brain more during switch than repeat trials. In addition to the main effects of depletion condition, a comparison of the ATD relative to the sham condition confirmed this anterior-to-posterior shift in activation. The posterior (increased) activation clusters significantly and negatively correlated with the reduced prefrontal activation clusters suggesting a compensation mechanism for reduced prefrontal activation during ATD. Thus, serotonin modulates an anterior-to-posterior shift of activation during cognitive switching in older adults. Neural adaptation to serotonin challenge during cognitive control may prove useful in determining cognitive vulnerability in older adults with a predisposition for serontonergic down-regulation (e.g., in vascular or late life depression). Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc.
    Human Brain Mapping 02/2014; 35(2). DOI:10.1002/hbm.22187
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    ABSTRACT: Unawareness of deficits caused by brain damage or neurodegeneration, termed anosognosia, has been demonstrated in a number of different neurological conditions. Clinical observation suggests that unawareness paradoxically can be accompanied by signs of understanding or representation of deficit, but not explicitly expressed. Such "implicit awareness," an apparent oxymoron, is implied by or inferred from actions or statements of the person with neurological disorder. In the current paper, we review clinical observations and experimental evidence which suggest the occurrence of implicit awareness in dementia and hemiplegia, and explore the clinical and theoretical implications of this phenomenon. We present a theoretical framework to understand implicit awareness in these two conditions.
    Cognitive neuroscience 12/2013; 4(3-4):181-197. DOI:10.1080/17588928.2013.833899
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    ABSTRACT: Acceptance and Commitment Therapy (ACT) and the psychological flexibility model on which it is based are growing interests for those researching and treating chronic pain. One part of this model is a therapeutic process called cognitive defusion. Cognitive defusion is a process of experiencing a distinction between thoughts and the events or people they describe. This process is intended to reduce the dominating psychological influence of thoughts without necessarily changing the content or frequency of the thoughts. There are recently developed measures of this process but little study of it in people with chronic pain. This study explored the reliability and validity of the Cognitive Fusion Questionnaire (CFQ) within a chronic pain population. Three hundred twenty-six adults with chronic pain completed this measure and a set of other standard clinical measures at the start of treatment in a specialty chronic pain service in the UK. An exploratory factor analysis revealed an interpretable two-factor structure within the items of the CFQ. Internal consistency reliability was good (α=0.87). In analyses of validity the CFQ significantly correlated with general psychological acceptance and pain related acceptance as expected. In multiple regression analyses, which included relevant patient background variables, pain, and acceptance of pain, cognitive fusion contributed significantly to the explained variance in the prediction of five out of six dependent variables tested. The CFQ may be a useful measure for further research and treatment development.
    The Clinical journal of pain 11/2013; 30(10). DOI:10.1097/AJP.0000000000000047
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    ABSTRACT: Throughout the past 50 years mental health services have aimed to provide and improve high quality inpatient care. It is not clear whether there has been improvement as service users and nursing staff have both expressed frustration at the lack of therapeutic activities. In particular, it may be that the changing levels of symptoms over the past 50 years may affect engagement with ward activities. Eight wards in a health care trust in London serving an inner city and urban populations participated. Data were collected on participation in activities and 116 service users' perceptions of acute care as well as clinical factors. Less time was spent participating in activities today than 50 years ago, while one quarter of service users reported taking part in no activities at all. Uptake of activities was related to more positive service user perceptions of the wards. Symptom severity did not impact the frequency of participation in activities, although those who took part in no activities at all had higher negative symptoms scores. Service users' uptake of activities was not related to the severity of their illness. This belies the belief that the acutely ill cannot take part in meaningful activities. This study supports the view that more therapeutic activities could be taken up by the acutely ill and are in fact appreciated.
    Social Psychiatry 11/2013; 49(4). DOI:10.1007/s00127-013-0788-6
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    ABSTRACT: Objective: Converging research suggests that individuals with schizophrenia show a marked impairment in reinforcement learning, particularly in tasks requiring flexibility and adaptation. The problem has been associated with dopamine reward systems. This study explores, for the first time, the characteristics of this impairment and how it is affected by a behavioral intervention-cognitive remediation. Method: Using computational modelling, 3 reinforcement learning parameters based on the Wisconsin Card Sorting Test (WCST) trial-by-trial performance were estimated: R (reward sensitivity), P (punishment sensitivity), and D (choice consistency). In Study 1 the parameters were compared between a group of individuals with schizophrenia (n = 100) and a healthy control group (n = 50). In Study 2 the effect of cognitive remediation therapy (CRT) on these parameters was assessed in 2 groups of individuals with schizophrenia, one receiving CRT (n = 37) and the other receiving treatment as usual (TAU, n = 34). Results: In Study 1 individuals with schizophrenia showed impairment in the R and P parameters compared with healthy controls. Study 2 demonstrated that sensitivity to negative feedback (P) and reward (R) improved in the CRT group after therapy compared with the TAU group. R and P parameter change correlated with WCST outputs. Improvements in R and P after CRT were associated with working memory gains and reduction of negative symptoms, respectively. Conclusion: Schizophrenia reinforcement learning difficulties negatively influence performance in shift learning tasks. CRT can improve sensitivity to reward and punishment. Identifying parameters that show change may be useful in experimental medicine studies to identify cognitive domains susceptible to improvement.
    Schizophrenia Bulletin 11/2013; 40(6). DOI:10.1093/schbul/sbt152
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    ABSTRACT: What is already known? Adapting to chronic illness is a phrase commonly used in health psychology. Common operationalizations include presence or absence of psychopathology, or low negative affect and good functional status. A variety of models are currently used to study adaptation to chronic illness. Each explain some variance in adjustment outcomes. What does this editorial add? An argument for a consistent overarching theory that is specific to the process of adaptation to chronic illness. Adaptation is characterized as a return to equilibrium after critical illness events or stressors. A new working model of adapting to chronic illness.
    British Journal of Health Psychology 11/2013; 18(4):681-686. DOI:10.1111/bjhp.12072
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    ABSTRACT: Aims. For people with psychosis, contact with informal caregivers is an important source of social support, associated with recovery, and with better outcomes following individual cognitive therapy (CBTp). In this study, we tested whether increased flexibility in delusional thinking, an established predictor of positive outcome following CBTp, was a possible mechanism underlying this effect. Methods. 219 participants with delusions (mean age 38 years; 71% male; 75% White) were grouped according to the presence of a caregiver (37% with a caregiver) and caregiver level of expressed emotion (High/Low EE, 64% Low). Delusional belief flexibility was compared between groups, controlling for interpersonal functioning, severity of psychotic symptoms, and other hypothesised outcome predictors. Results. Participants with caregivers were nearly three times more likely than those without to show flexibility (OR = 2.7, 95% CI 1.5 to 5.0, p = 0.001), and five times more likely if the caregiving relationship was Low EE (OR = 5.0, 95% CI 2.0-13.0, p = 0.001). ORs remained consistent irrespective of controlling for interpersonal functioning and other predictors of outcome. Conclusions. This is the first evidence that having supportive caregiving relationships is associated with a specific cognitive attribute in people with psychosis, suggesting a potential cognitive mechanism by which outcomes following CBTp, and perhaps more generally, are improved by social support.
    Epidemiology and Psychiatric Sciences 10/2013; DOI:10.1017/S2045796013000553
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