Compassion Focused Group Psychotherapy for attachment and relational trauma: Engaging people with a diagnosis of personality disorder.

OBJECTIVES: The research aimed to evaluate an exploratory Compassion Focused Group Psychotherapy Programme and the impact on participants' experiences of self-criticism, usage of services and general wellbeing. Participants included patients with a history of complex attachment and relational trauma (A&RT), who might attract a diagnosis of personality disorder. DESIGN: This study utilised a quasi-experimental non-randomised within subject controlled design for the evaluation of the efficacy of the programme. METHODS: Participants were recruited from tertiary care services. The programme consisted of a 12-week Preparation and Engagement intervention (PEG) which was Compassionate Mind Training and Psychoeducation, followed by a 40-week Compassion Focused Trauma Group intervention. The cohort was then followed up after 12 months during which period they received treatment as usual. A comprehensive selection of self-report measures was administered at various points during the therapeutic process and following completion of the group interventions. RESULTS: The results of the research showed that the provision of a long-term, slow-paced, Compassion Focused Group Psychotherapy intervention, resulted in significant changes across all measures which were maintained at 12-month follow-up. These significant results were maintained following intention to treat and reliable change analyses. These data were supported by a significant reduction in service usage and a significant increase in engagement in employment and education. CONCLUSIONS: This study has identified that within Compassion Focused Group Psychotherapy, there is a therapeutic process of establishing group-based safeness as a necessary precursor to cultivating compassion and reworking early shame-based trauma memories.

Vividness of positive mental imagery predicts positive emotional response to visually presented Project Soothe pictures.

Lang's bioinformational theory of mental imagery proposes that mental imagery and external stimuli engage emotional information-processing systems in similar ways. However, the positive and negative systems are thought to be distinct, so this similarity is likely to show a valence-specific effect. Therefore, we hypothesized that an individual's ability to construct vivid positive, but not negative, mental imagery would predict positive emotional responding to positive visual stimuli, independently of depressive symptoms. Our stimuli were pictures collected through Project Soothe for possible use in psychotherapy (www.projectsoothe.com); as these pictures were intended to induce soothing emotion, we hypothesized that theoretically linked variables Self-compassion and Self-criticism would also predict positive responding to the stimuli. A total of 214 participants completed an online study including validated questionnaire measures, mental imagery tasks, and a picture-rating exercise. Only Positive Imagery Vividness and Self-compassion were significant predictors of positive responding to the soothing pictures, even controlling for depressive symptoms, and Negative and General Imagery Vividness. These findings support Lang's theory and provide evidence for individual differences in a positive processing tendency shared across mental imagery-based and perceptual representations. As this relationship is distinct from depressive symptoms, future imagery-based psychotherapies might aim to influence this positive processing tendency.

TD: The case of Diogenes Syndrome-deficit or denial?

Diogenes Syndrome (DS) is characterised by extreme self-neglect, domestic squalor, hoarding, social withdrawal, and lack of concern and shame for the individual's residential situation. This paper describes TD who was unable to identify emotional expressions of disgust and was borderline-impaired for facial recognition associated with perceptual difficulties. Problems interpreting expressions of disgust were interesting as TD was living in squalor, neglecting himself, and lacked concern for his circumstances. This led us to question whether the basis of his difficulties were neuropsychological or psychological in nature, which became the objective of this study, with a focus on shame and disgust. TD completed neuropsychological and psychological assessments alongside an experimental task investigating processing of disgust and his living situation. Results highlighted executive dysfunction but understanding of living with the consequences of squalor was spared as was emotion based decision-making. Assessment indicated difficulties with olfactory processing and aspects of interoceptive awareness. TD showed poor awareness of his living conditions and a lack of shame. Disgust sensitivity was unimpaired. It is unclear if TD's difficulties were caused by psychological or neuropsychological impairments, although both likely play a part. Further research is required to understand processes underpinning DS, particularly disgust and shame.

An exploration of compassion focused therapy following acquired brain injury.

BACKGROUND: People with acquired brain injuries (ABI) frequently experience psychological difficulties such as anxiety and depression, which may be underpinned and maintained by high self-criticism and shame alongside an inability to self-soothe. Compassionate focused therapy (CFT) was developed to address shame and self-criticism and foster the ability to self-soothe. OBJECTIVES: This is a naturalistic evaluation with the aim of assessing the feasibility, safety, and potential value of CFT for ABI patients with emotional difficulties receiving neuropsychological rehabilitation. METHODS: This study employed a mixed methods design combining self-report measures and qualitative interviews. Twelve patients received a combination of CFT group and individual intervention. Self-report measures of self-criticism, self-reassurance, and symptoms of anxiety and depression were collected pre and post programme and analysed using Wilcoxon signed rank test (N=12; five female, seven males). Follow-up data were analysed in the same manner (N=9). Interviews were conducted with six patients and analysed using interpretative phenomenological analysis. RESULTS: CFT was associated with significant reductions in measures of self-criticism, anxiety, and depression and an increase in the ability to reassure the self. No adverse effects were reported. Three superordinate themes emerged from the interviews: psychological difficulties; developing trust and finding safeness; and a new approach. CONCLUSIONS: This study suggests that CFT is well accepted in ABI survivors within the context of neuropsychological rehabilitation. Furthermore, the results indicate that further research into CFT for psychological problems after ABI is needed and that there may be key aspects, which are specific to CFT intervention, which could reduce psychological difficulties after ABI. PRACTITIONER POINTS: CFT appears to be a feasible intervention for psychological problems after ABI. CFT was associated with a reduction in symptoms of anxiety and depression and associated self-criticism, as well as enhanced self-reassurance for ABI survivors. These ABI survivors reported that CFT provided them with tools to manage continued psychological difficulties.

An exploration of the experience of self in the social world for men following traumatic brain injury.

This study explores the lived experience of male survivors of traumatic brain injury (TBI) in relation to perceived changes in their personal and social identity. The aim was to provide an understanding of the individuals' sense of self and sources of emotional distress and growth following injury. Semi-structured interviews were conducted with nine male survivors of TBI (aged 22-59 years). These men were 17 months to 21 years post-injury and were recruited through a UK holistic neuropsychological rehabilitation centre. Transcripts of their accounts were analysed using thematic analysis. Identified dominant themes related to the men's described experience of changes in self relating to their social world, were titled: "abnormality", "hidden", "the old-me-new-me" and "others treat me differently". In response to these emotional experiences the themes of "self-criticism", "need to be as others want me to be" and "withdrawal" emerged. The identified themes are considered alongside the alternative narrative of "positive growth" in relation to current understanding of identity and "self-conscious" emotions. Future research and clinical implications are suggested.

Reduction in occipital cortex gamma-aminobutyric acid concentrations in medication-free recovered unipolar depressed and bipolar subjects.

BACKGROUND: Studies using proton magnetic resonance spectroscopy (MRS) have indicated that unmedicated, acutely depressed patients have decreased levels of gamma-aminobutyric acid (GABA) in occipital cortex. Cortical levels of glutamate (Glu) may be increased, although these data are less consistent. The aim of this study was to use MRS to determine whether changes in GABA and Glu levels were present in patients with mood disorders who had recovered and were no longer taking medication. METHODS: An [1H]-MRS was used to measure levels of GABA, of the combined concentration of Glu and glutamine (Gln), and of N-acetylaspartate (NAA) in occipital cortex in medication-free, fully recovered subjects with a history of recurrent unipolar depression (n = 15), bipolar disorder (n = 16), and a group of healthy controls (n = 18). RESULTS: Occipital levels of GABA and NAA were significantly lower in recovered depressed and bipolar subjects than in healthy controls, whereas Glu +Gln concentrations were higher. CONCLUSIONS: Our data suggest that recovered unmedicated subjects with a history of mood disorder have changes in cortical concentrations of GABA, NAA, and Glu +Gln. These biochemical abnormalities may be markers of a trait vulnerability to mood disorder, rather than neurochemical correlates of an abnormal mood state.