Metacognitive beliefs in depressed in-patients: adaptation and validation of the short version of the Metacognitions Questionnaire (MCQ-30) for French clinical and non-clinical samples.

BACKGROUND: The short form of the Metacognitions Questionnaire (MCQ-30) is a brief multi-dimensional measure which explores the metacognitive processes and beliefs about worry and cognition that are central to the vulnerability and maintenance of emotional disorders. AIMS: The first aim of the study was to create and validate a French version of the MCQ-30 in a non-clinical and a clinical sample of depressed in-patients. METHOD: A French adaptation of the MCQ-30 was administered to a sample of 467 individuals from the general population and 73 hospitalized patients with major depressive disorder. Internal consistency was measured by Cronbach's alpha reliability coefficients. Factor structure was assessed using a confirmatory factor analysis on the non-clinical group and a multi-trait-multi-method analysis on the psychiatric group. Criterion validity was explored by comparing the scores of the two samples. Measures of rumination, worry and depression were used to explore convergent validity. RESULTS: Confirmatory factor analysis in the non-clinical sample indicated that the French version of the MCQ-30 has the same factor structure as the MCQ-30's original five-factor solution. In the clinical sample, the multi-trait-multi-method analysis revealed discrepancies with the original factor structure, and the MCQ-30 and its subscales were less reliable. Our results provide evidence of a convergent validity. The MCQ-30 scores were also able to discriminate between psychiatric and non-clinical samples. CONCLUSIONS: Our results show that the French version of the MCQ-30 is a valid instrument for measuring metacognitive beliefs in non-clinical population. Further research is needed to support its use among depressed in-patients.

[Virtual reality therapy in the care management of anxiety disorders]. / La terapia por realidad virtual en el tratamiento de los trastornos de ansiedad.

Virtual reality involves the creation of an interactive three-dimensional virtual world which the user can navigate. This technology is proposed for anxiety disorders as an alternative to the in vivo and imaginative exposure provided in cognitive behavioral therapy, the gold standard psychoterapeutic treatment for this pathology. According to a signifcant number of publications including meta-analysis, virtual reality therapy exposure is at least equivalent to in vivo exposure in specifc phobias, panic disorder with agoraphobia, post-traumatic stress disorder and social phobia. A fundamental feature of the virtual experience is presence, which is commonly defned as the mental experience of "being there", in the virtual world. This concept prompts us to consider virtual reality a therapy beyond exposition, more like an embodied therapy.

Fear of falling: efficacy of virtual reality associated with serious games in elderly people.

OBJECTIVE: Fear of falling is defined as an ongoing concern about falling that is not explained by physical examination. Focusing on the psychological dimension of this pathology (phobic reaction to walking), we looked at how virtual reality associated with serious games can be used to treat this pathology. METHODS: Participants with fear of falling were randomly assigned to either a treatment group or a waiting list. The therapy consisted of 12 weekly sessions of virtual reality exposure therapy associated with serious games. RESULTS: Sixteen participants were included. The mean age of the treatment group was 72 years and that of the control group was 69 years. Participants' scores on the fear of falling measure improved after treatment with virtual reality associated with serious games, leading to a significant difference between the two groups. CONCLUSION: Virtual reality exposure therapy associated with serious games can be used in the treatment of fear of falling. The two techniques are complementary (top-down and bottom-up processes). To our knowledge, this is the first time that a combination of the two has been assessed. There was a specific effect of this therapy on the phobic reaction. Further studies are needed to confirm its efficacy and identify its underlying mechanism.

[Therapeutic education for recurrent depressive disorder]. / Éducation thérapeutique du trouble dépressif récurrent.

Depression is a serious and recurrent condition which can become chronic. As a complement to other therapeutic approaches, therapeutic patient education (TPE) or psychoeducation is effective. TPE groups led by a multidisciplinary hospitalisation team in a psychiatric department are thereby integrated into the global care in order to reduce relapses and improve patients' quality of life.

E-virtual reality exposure therapy in acrophobia: A pilot study.

Virtual reality therapy is already used for anxiety disorders as an alternative to in vivo and in imagino exposure. To our knowledge, however, no one has yet proposed using remote virtual reality (e-virtual reality). The aim of the present study was to assess e-virtual reality in an acrophobic population. Six individuals with acrophobia each underwent six sessions (two sessions per week) of virtual reality exposure therapy. The first three were remote sessions, while the last three were traditional sessions in the physical presence of the therapist. Anxiety (STAI form Y-A, visual analog scale, heart rate), presence, technical difficulties and therapeutic alliance (Working Alliance Inventory) were measured. In order to control the conditions in which these measures were made, all the sessions were conducted in hospital. None of the participants dropped out. The remote sessions were well accepted. None of the participants verbalized reluctance. No major technical problems were reported. None of the sessions were cancelled or interrupted because of software incidents. Measures (anxiety, presence, therapeutic alliance) were comparable across the two conditions. e-Virtual reality can therefore be used to treat acrophobic disorders. However, control studies are needed to assess online feasibility, therapeutic effects and the mechanisms behind online presence.

Gait control and executive dysfunction in early schizophrenia.

Dysexecutive functioning, which is described as an enduring core feature of schizophrenia, has been associated with gait disorders. However, few studies have reported gait disorders in schizophrenia patients. The objective of this study was to examine the association between executive dysfunction and gait performance in recent-onset schizophrenia patients using the dual task paradigm. Thirty-two subjects participated to the study: 17 with recent-onset schizophrenia and 15 healthy age-matched controls. Executive functions were evaluated using the Frontal Assessment Battery, Stroop and Trail-Making tests. Mean values and coefficients of variation (CV) of the temporal gait parameters while single tasking (just walking) and while dual tasking (walking and forward counting, walking and backward counting, walking and verbal fluency) were measured using the SMTEC(®)-footswitch system. We focused on the CV of stride time as this measure has been shown to be the most representative parameter of higher gait control. A strong effect of the stride time was found in the group factor for the verbal fluency dual-task when compared to controls (Cohen's d mean = 1.28 and CV = 1.05). The effect was lower in the other dual tasks, and insignificant in the single task of walking. This study shows that patients exhibit higher stride-to-stride variability while dual tasking than controls. It also shows a stronger impact of verbal fluency on gait regularity compared to the other dual tasks revealing a relationship between the executive dysfunction and gait modification. Those results are in line with the idea that schizophrenia implies not only cognitive but also motor functioning and coordination impairment.

MEG evidence for dynamic amygdala modulations by gaze and facial emotions.

BACKGROUND: Amygdala is a key brain region for face perception. While the role of amygdala in the perception of facial emotion and gaze has been extensively highlighted with fMRI, the unfolding in time of amydgala responses to emotional versus neutral faces with different gaze directions is scarcely known. METHODOLOGY/PRINCIPAL FINDINGS: Here we addressed this question in healthy subjects using MEG combined with an original source imaging method based on individual amygdala volume segmentation and the localization of sources in the amygdala volume. We found an early peak of amygdala activity that was enhanced for fearful relative to neutral faces between 130 and 170 ms. The effect of emotion was again significant in a later time range (310-350 ms). Moreover, the amygdala response was greater for direct relative averted gaze between 190 and 350 ms, and this effect was selective of fearful faces in the right amygdala. CONCLUSION: Altogether, our results show that the amygdala is involved in the processing and integration of emotion and gaze cues from faces in different time ranges, thus underlining its role in multiple stages of face perception.

Gaze behaviour in social blushers.

Gaze aversion could be a central component of social phobia. Fear of blushing is a symptom of social anxiety disorder (SAD) but is not yet described as a specific diagnosis in psychiatric classifications. Our research consists of comparing gaze aversion in SAD participants with or without fear of blushing in front of pictures of different emotional faces using an eye tracker. Twenty-six participants with DSM-IV SAD and expressed fear of blushing (SAD+FB) were recruited in addition to twenty-five participants with social phobia and no fear of blushing (SAD-FB). Twenty-four healthy participants aged and sex matched constituted the control group. We studied the number of fixations and the dwell time in the eyes area on the pictures. The results showed gaze avoidance in the SAD-FB group when compared to controls and when compared to the SAD+FB group. However we found no significant difference between SAD+FB and controls. We also observed a correlation between the severity of the phobia and the degree of gaze avoidance across groups. These findings seem to support the claim that social phobia is a heterogeneous disorder. Further research is advised to decide whether fear of blushing can constitute a subtype with specific behavioral characteristics.

Gait and motor imagery of gait in early schizophrenia.

Although gait disorders were described in schizophrenia, motor imagery of gait has not yet been studied in this pathology. We compared gait, motor imagery of gait and the difference between these two conditions in patients with schizophrenia and healthy age-matched controls. The mean ± standard deviation (S.D.) of Timed Up and Go (TUG), imagined TUG (iTUG) and delta time (i.e.; difference between TUG and iTUG), was used as outcomes. Covariables include Mini Mental State Examination, the Frontal Assessment Battery (FAB), FAB's subitems, the Positive and Negative Syndrome Scale and the Unified Parkinson's Disease Rating Scale (UPDRS). Seventeen patients with early schizophrenia and 15 healthy age-matched controls were assessed. Schizophrenia patients performed the TUG and the iTUG slower than the controls. Multivariate linear regressions showed that iTUG and delta time were associated with the conflicting instruction of the FAB. The present study provides the first evidence that patients with schizophrenia performed gait and motor imagery of gait slower than healthy controls. These deficits could be in part explained by impaired executive function and specifically by a disturbance in the sensitivity to interference.

Human brain spots emotion in non humanoid robots.

The computation by which our brain elaborates fast responses to emotional expressions is currently an active field of brain studies. Previous studies have focused on stimuli taken from everyday life. Here, we investigated event-related potentials in response to happy vs neutral stimuli of human and non-humanoid robots. At the behavioural level, emotion shortened reaction times similarly for robotic and human stimuli. Early P1 wave was enhanced in response to happy compared to neutral expressions for robotic as well as for human stimuli, suggesting that emotion from robots is encoded as early as human emotion expression. Congruent with their lower faceness properties compared to human stimuli, robots elicited a later and lower N170 component than human stimuli. These findings challenge the claim that robots need to present an anthropomorphic aspect to interact with humans. Taken together, such results suggest that the early brain processing of emotional expressions is not bounded to human-like arrangements embodying emotion.

Visual modulation of pleasure in subjects with physical and social anhedonia.

Anhedonia is a personality trait associated with a decrease in the ability to feel pleasure. We investigated the experience of pleasure in individuals with physical and social anhedonia for positive pictures with varying levels of luminance contrast. Photographs with either a sensory or a social content were modified with a contrast-gradation procedure. Participants had to report the intensity of the pleasure they experienced in response to these pictures. Twenty-six subjects with physical anhedonia, 18 with social anhedonia and 34 control subjects completed the task. In controls, high-contrast pictures elicited an intense feeling of pleasure, whereas low contrast pictures elicited little pleasure. Although they were also sensitive to the modulation of contrast, subjects with physical and social anhedonia reported less pleasure than controls, across a larger range of contrast levels for sensory and social pictures, respectively. The findings suggest that the deficit in the experience of positive emotion in anhedonia is associated with a diminished pleasure intensity, fairly selective for the sensory or the social emotion dimension. This study encourages further investigation of the interaction between perceptual encoding and emotional processing in anhedonia.

Gaze avoidance in social phobia: objective measure and correlates.

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder.

The experience of pleasure before and after hearing rehabilitation.

Hearing loss may lead to major changes in the social and emotional aspects of daily life. This follow-up study investigated the effect of hearing-aid use on emotional experience in adults with hearing impairment. Thirteen individuals with impaired hearing were tested before and after 6 months of hearing-aid use, and were compared with 19 individuals who had worn hearing aids for many years. The participants reported their daily emotional experiences, by completing questionnaires relating to sensory and social pleasure. After 6 months of hearing-aid use, individuals experienced more physical and social pleasure, whereas individuals using hearing aids for long periods of time reported similar levels of pleasure at the beginning and at the end of a 6-month interval. The participants also performed a visual task, in which they rated the intensity of pleasure they experienced in response to emotionally positive and neutral pictures differing in luminance contrast. In this task, pleasure typically decreases with decreasing contrast of the positive images displayed. Once they had been fitted with hearing aids, the participants reported lower levels of pleasure, especially at low contrast. These findings highlight that the anhedonia scales provide a measure sensitive to emotional improvements that accompany the partial restoration of hearing function, although these scales were not specifically designed for hearing-impaired populations. In contrast, the surprising decrease in pleasure ratings for pictures after the introduction of hearing-aid use may be because of the compensation of hearing loss by changes in visual attention functions.

Schizotypy, depression, and anxiety in physical and social anhedonia.

Social anhedonia is a more promising indicator of vulnerability to schizophrenia than physical anhedonia, both as assessed by Chapman scales. More broadly, the populations identified by these scales would have a propensity to different psychiatric disorders. This cross-sectional study examined the respective profiles of schizotypy, anxiety, and depression in French students with physical and social anhedonia, using psychometric and interview-based measures. Compared to controls (n=46), subjects with social anhedonia (n=19) reported higher schizotypal scores for interpersonal, paranoid, disorganization, and cognitive/perceptual dimensions, whereas subjects with physical anhedonia (n=35) had more extensive interpersonal deficits and paranoia. Both groups had more depressive and anxiety symptoms than controls, in particular subjects with social anhedonia.

Agency, the sense of presence, and schizophrenia.

The objective of this work is to evaluate the impact of agency deficiency on presence. We hypothesize that a deficit in agency, such as occurs in schizophrenia, has repercussions on the sense of presence as well as on performance in a sensorimotor test involving the body. Nineteen healthy controls and 19 stable patients with schizophrenia, matched by age and gender, participated in the study. We used new interactive technologies that enable the users to physically interact with a virtual environment and simultaneously sees themselves performing the actions. Two conditions were balanced: the control condition in which the participant see himself or herself doing the test, and the mask condition, in which the central part of the participant's body is hidden. At the end of the test, all participants completed a questionnaire on presence. The results show that control participants performed better than those with schizophrenia in the control condition. On the contrary, in the mask condition, their performance was significantly lower, whereas participants with schizophrenia obtained the same score as in the control condition. Controls also rated higher in the scale of presence than did participants with schizophrenia. Those results seem to corroborate a relationship between agency and presence. The body awareness and the self in schizophrenia are discussed in the light of agency.

Cognitive avoidance of intrusive memories and autobiographical memory: specificity, autonoetic consciousness, and self-perspective.

Autobiographical memory (AM) specificity is impaired in depression and post-traumatic stress disorder. Previous studies emphasised the role of cognitive avoidance of intrusive memories in this impairment. This study aimed to examine the association of cognitive avoidance of intrusive memories with specificity, autonoetic consciousness, and self-perspective. A total of 38 healthy participants were given the revised Impact of Event Scale (IES-R) and an AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness (remember/know procedure), and self-perspective (field/observer procedure). Taking into account age, verbal IQ, mood, harm avoidance, and executive resources, the IES-R avoidance subscale was negatively correlated with specificity and remember responses for positive memories, and with remember and field responses for negative memories. These findings suggest that cognitive avoidance of intrusive memories is associated with a decrease of the episodic components of AM retrieval.

Spontaneous appetence for wheel-running: a model of dependency on physical activity in rat.

According to human observations of a syndrome of physical activity dependence and its consequences, we tried to examine if running activity in a free activity paradigm, where rats had a free access to activity wheel, may present a valuable animal model for physical activity dependence and most generally to behavioral dependence. The pertinence of reactivity to novelty, a well-known pharmacological dependence predictor was also tested. Given the close linkage observed in human between physical activity and drugs use and abuse, the influence of free activity in activity wheels on reactivity to amphetamine injection and reactivity to novelty were also assessed. It appeared that (1) free access to wheel may be used as a valuable model for physical activity addiction, (2) two populations differing in activity amount also differed in dependence to wheel-running. (3) Reactivity to novelty did not appeared as a predictive factor for physical activity dependence (4) activity modified novelty reactivity and (5) subjects who exhibited a high appetence to wheel-running, presented a strong reactivity to amphetamine. These results propose a model of dependency on physical activity without any pharmacological intervention, and demonstrate the existence of individual differences in the development of this addiction. In addition, these data highlight the development of a likely vulnerability to pharmacological addiction after intense and sustained physical activity, as also described in man. This model could therefore prove pertinent for studying behavioral dependencies and the underlying neurobiological mechanisms. These results may influence the way psychiatrists view behavioral dependencies and phenomena such as doping in sport or addiction to sport itself.

High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.

The primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory-visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use.