Social isolation after acquired brain injury: Exploring the relationship between network size, functional support, loneliness and mental health.

Social isolation can be a consequence of acquired brain injury (ABI). Few studies have examined the relationship between social isolation and mental health after ABI. In this cross-sectional and case-control study, we compared 51 ABI survivors and 51 matched healthy controls on measures of social isolation (network size, social support and loneliness) mental health and mental health problems. We explored the relationship between structural, functional and subjective components of social isolation and examined whether they were associated with mental health outcomes. No group differences were found on size of the network and perceived social support. The ABI group exhibited marginally higher levels of loneliness. The ABI group presented higher levels of depression, lower levels of quality of life and emotional wellbeing. In both groups, perception of social support was inversely related to subjective experience of loneliness. The relationship between network size and loneliness was only significant in the ABI group. Only loneliness significantly predicted quality of life, emotional wellbeing, depression and anxiety in people with brain injury. The relationship between social isolation variables in ABI is discussed, as well as the theoretical and clinical implications of focusing on loneliness to improve mental health after brain injury.

When technology cares for people with dementia: A critical review using neuropsychological rehabilitation as a conceptual framework.

Clinicians and researchers have become increasingly interested in the potential of technology in assisting persons with dementia (PwD). However, several issues have emerged in relation to how studies have conceptualized who the main technology user is (PwD/carer), how technology is used (as compensatory, environment modification, monitoring or retraining tool), why it is used (i.e., what impairments and/or disabilities are supported) and what variables have been considered as relevant to support engagement with technology. In this review we adopted a Neuropsychological Rehabilitation perspective to analyse 253 studies reporting on technological solutions for PwD. We analysed purposes/uses, supported impairments and disabilities and how engagement was considered. Findings showed that the most frequent purposes of technology use were compensation and monitoring, supporting orientation, sequencing complex actions and memory impairments in a wide range of activities. The few studies that addressed the issue of engagement with technology considered how the ease of use, social appropriateness, level of personalization, dynamic adaptation and carers' mediation allowed technology to adapt to PWD's and carers' preferences and performance. Conceptual and methodological tools emerged as outcomes of the analytical process, representing an important contribution to understanding the role of technologies to increase PwD's wellbeing and orient future research.

The Role of Inner Speech in Emotion Dysregulation and Emotion Regulation Strategy Use / El Rol del Habla Interna en la Desregulación Emocional y el uso de Estrategias de Regulación Emocional

Abstract Recent studies have suggested that emotion regulation (ER) strategies, such as reappraisal and suppression, rely on the use of verbal thinking. Outside the field of ER, verbal thinking, particularly in the form of inner speech, has been largely linked to behavior and cognitive regulation. However, no article has yet directly addressed the potential role of inner speech in ER. In this study, 180 participants completed a survey that included measures of inner speech usage (Inner Speech Questionnaire), ER difficulties (Difficulties in Emotion Regulation Scale), ER strategy use (Emotion Regulation Questionnaire) and symptoms (HADS). Correlational analyses and hierarchical linear regression models were used to explore the potential relationship between inner speech and ER variables. A positive relationship was found between Inner Speech usage and the Difficulties in Emotion Regulation Scale overall score. This relationship was, however, heavily mediated by level of symptomatology. As for the ER strategies, only reappraisal presented a significant positive relationship, of medium size, with inner speech usage, which was independent of the level of symptoms. The results of this study are discussed in relation to the current conceptualization of reappraisal as well as its implications for clinical practice.

Resumen Estudios recientes han sugerido que estrategias de regulación emocional (RE) como la re-interpretación y supresión dependen del pensamiento verbal. Fuera del campo de la RE, el pensamiento verbal, como habla interna, ha sido vinculado con la regulación cognitivo/conductual. Sin embargo, a la fecha ningún estudio ha explorado el rol del habla interna en la RE. En esta investigación, 180 sujetos completaron cuestionarios de uso de habla interna (Inner Speech Questionnaire, ISQ), dificultades en la RE (Difficulties in Emotion Regulation Scale, DERS), uso de estrategias de RE (Emotion Regulation Questionnaire, ERQ) y sintomatología (HADS). Se realizaron análisis correlacionales y modelos de regresión lineal para explorar la relación entre habla interna y variables de RE. Una relación positiva fue encontrada entre frecuencia de uso de habla interna y la puntuación global de la escala de dificultades en RE -relación altamente mediada por el nivel de sintomatología. Respecto a las estrategias de RE, solo la reinterpretación presentó una relación positiva y significativa, de tamaño medio, con la frecuencia de uso de habla interna -con independencia del nivel de síntomas. Los resultados de este estudio son discutidos en relación a la conceptualización actual de la re-interpretación así como su relevancia para la práctica clínica.

'Just can't hide it': a behavioral and lesion study on emotional response modulation after right prefrontal damage.

INTRODUCTION: Historically, emotion regulation problems have been reported as a common consequence of right prefrontal cortex (rPFC) damage. It has been proposed that the rPFC, particularly the rIFG, has a key role inhibiting prepotent reflexive actions, thus contributing to emotion regulation and self-regulation. This study is the first to directly explore this hypothesis, by testing whether damage to the rIFG compromises the voluntary modulation of emotional responses, and whether performance on inhibition tasks is associated with emotion regulation. METHOD: 10 individuals with unilateral right prefrontal damage and 15 matched healthy controls were compared on a well-known response modulation task. During the task participants had to amplify and suppress their facial emotional expressions, while watching film clips eliciting amusement. Measures of executive control, emotion regulation strategies usage and symptomatology were also collected. RESULTS: As a group, individuals with rPFC damage presented a significantly reduced range of response modulation compared with controls. In addition, performance in the suppression task was associated with measures of cognitive inhibition and suppression usage. Interestingly, these effects were driven primarily by a subgroup of individuals with rPFC damage, all of whom also had damage to the right posterior insula, and who presented a marked impairment in suppressing facial emotional expressions.

Internally and externally generated emotions in people with acquired brain injury: preservation of emotional experience after right hemisphere lesions.

The study of emotional changes after brain injury has contributed enormously to the understanding of the neural basis of emotion. However, little attention has been placed on the methods used to elicit emotional responses in people with brain damage. Of particular interest are subjects with right hemisphere [RH] cortical lesions, who have been described as presenting impairment in emotional processing. In this article, an internal and external mood induction procedure [MIP] was used to trigger positive and negative emotions, in a sample of 10 participants with RH damage, and 15 healthy controls. Emotional experience was registered by using a self-report questionnaire. As observed in previous studies, internal and external MIPs were equally effective in eliciting the target emotion, but the internal procedure generated higher levels of intensity. Remarkably, participants with RH lesions were equally able to experience both positive and negative affect. The results are discussed in relation to the role of the RH in the capacity to experience negative emotions.

"Opening an emotional dimension in me": changes in emotional reactivity and emotion regulation in a case of executive impairment after left fronto-parietal damage.

Dysexecutive impairment is a common problem after brain injury, particularly after damage to the lateral surface of the frontal lobes. There is a large literature describing the cognitive deficits associated with executive impairment after dorsolateral damage; however, little is known about its impact on emotional functioning. This case study describes changes in a 72-year-old man (Professor F) who became markedly dysexecutive after a left fron-to-parietal stroke. Professor F's case is remarkable in that, despite exhibiting typical executive impairments, abstraction and working memory capacities were spared. Such preservation of insight-related capacities allowed him to offer a detailed account of his emotional changes. Quantitative and qualitative tools were used to explore changes in several well-known emotional processes. The results suggest that Professor F's two main emotional changes were in the domain of emotional reactivity (increased experience of both positive and negative emotions) and emotion regulation (down-regulation of sadness). Professor F related both changes to difficulties in his thinking process, especially a difficulty generating and manipulating thoughts during moments of negative arousal. These results are discussed in relation to the literature on executive function and emotion regulation. The relevance of these findings for neuropsychological rehabilitation and for the debate on the neural basis of emotional processes is addressed.

Inside-out: comparing internally generated and externally generated basic emotions.

A considerable number of mood induction (MI) procedures have been developed to elicit emotion in normal and clinical populations. Although external procedures (e.g., film clips, pictures) are widely used, a number of experiments elicit emotion by using self-generated procedures (e.g., recalling an emotional personal episode). However, no study has directly compared the effectiveness of two types of internal versus external MI across multiple discrete emotions. In the present experiment, 40 undergraduate students watched film clips (external procedure) and recalled personal events (internal procedure) inducing 4 basic emotions (fear, anger, joy, sadness) and later completed a self-report questionnaire. Remarkably, both internal and external procedures elicited target emotions selectively, compared with nontarget emotions. When contrasting the intensity of target emotions, both techniques showed no significant differences, with the exception of Joy, which was more intensely elicited by the internal procedure. Importantly, when considering the overall level of intensity, it was always greater in the internal procedure, for each stimulus. A more detailed investigation of the data suggest that recalling personal events (a type of internal procedure) generates more negative and mixed blends of emotions, which might account for the overall higher intensity of the internal mood induction.