Transitions from child and adolescent to adult mental health services for eating disorders: an in-depth systematic review and development of a transition framework.

BACKGROUND: Eating disorders (EDs) peak in mid-to-late adolescence and often persist into adulthood. Given their early onset and chronicity, many patients transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) for ongoing, speciality ED care. This transition typically occurs at 18 years of age, when important biological, psychosocial, and vocational changes take place. Thus, smooth and effective transitions are paramount for ensuring service continuity, as well as reducing the risk of ED relapse and premature death. Here, we synthesized evidence on transitions from CAMHS to AMHS for young people with EDs, aiming to inform future research, clinical practice, and healthcare policy. METHODS: A systematic review of the literature was conducted. This adhered to PRISMA guidelines. PubMed, Embase, and Scopus electronic databases were queried from inception to December 3, 2023. Leveraging the PICOS framework, study eligibility was evaluated in the qualitative synthesis. Data regarding methodology, analytic approach, and associated outcomes were then extracted. The quality of evidence was examined using critical appraisal tools. Finally, concept mapping was applied to organize findings into a transition framework. RESULTS: The search returned 76 articles. Of these, 14 were included in the final review. Articles were grouped into 'qualitative' (n = 10), 'cross-sectional' (n = 2), and 'longitudinal cohort' (n = 2) studies based on research design. Overall, ED transitions were complex, multifaceted, and challenging for patients, caregivers, and providers alike. This resulted from an interplay of temporal- (e.g., timing of ED onset and transition), stakeholder- (e.g., patient ambivalence towards recovery) and systemic- (e.g., differences between services) related factors. Most studies were of moderate-to-high quality. Findings informed the development of five transition strategies designed to facilitate effective transfers across ED care: Timely talks, Readiness, Inclusion, Preparation, and Synergy (TRIPS). CONCLUSIONS: Transitions from CAMHS to AMHS appear problematic for young people with EDs and other involved stakeholders. The field stands to benefit from TRIPS, an actionable, evidence-based framework that aims to alleviate challenges of transitioning and subsequently improve ED trajectories. As a logical next step, future work should empirically test the TRIPS framework, exploring its predictive utility and clinical value.

Eating disorders often develop in youth and persist into adulthood. Given this, many young people transition from pediatric to adult care for ongoing treatment. This usually occurs at 18 years of age, when important life changes take place, such as leaving home or pursuing higher education. Hence, smooth and effective transitions are critical for mental health. The present review summarized studies investigating transitions from pediatric to adult care for young people with eating disorders, and subsequently developed an evidence-informed transition framework (TRIPS). Based on the 14 studies included in the review, transitions from pediatric to adult care are challenging for young people with eating disorders, as well as for caregivers and providers. This is due to several factors related to the timing of transitions, the types of stakeholders involved, and the differences between care. Looking ahead, the field may benefit from the TRIPS framework that aims to improve transitions and clinical outcomes.

Keeping the promise: a critique of the current state of microdosing research.

Introduction: The practice of taking small, sub-hallucinogenic doses of psychedelics, known as microdosing, has exploded in popularity over the last decade. Users claim benefits ranging from improved mood and enhanced creativity to an increased sense of meaning and connectedness in life. While research on microdosing is still lagging behind the shift in public opinion, several papers have been published in the last five years which attempted to assess the effects of microdosing. Methods: This review paper aimed to critically analyze the research practices used in the recent wave of microdosing research: We reviewed 15 papers published before the closing date of this review in March 2022. Results: Our review concludes that it is premature to draw any conclusions about the efficacy or safety of microdosing since the research quality cannot be considered confirmatory. Discussion: We propose some potential causes for the current state of the literature and some suggestions for how these causes may be ameliorated.

5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study.

Psychedelic therapy is, arguably, the next frontier in psychiatry. It offers a radical alternative to longstanding, mainstays of treatment, while exciting a paradigm shift in translational science and drug discovery. There is particular interest in 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT)-a serotonergic psychedelic-as a novel, fast-acting therapeutic. Yet, few studies have directly examined 5-MeO-DMT for trauma- or stress-related psychopathology, including post-traumatic stress disorder (PTSD). Herein, we present the first longitudinal case study on 5-MeO-DMT for chronic refractory PTSD, in a 23-year-old female. A single dose of vaporized bufotoxin of the Sonoran Desert Toad (Incilius alvarius), containing an estimated 10-15 mg of 5-MeO-DMT, led to clinically significant improvements in PTSD, with next-day effects. This was accompanied by marked reductions in hopelessness and related suicide risk. Improvements, across all constructs, were sustained at 1-, 3-, 6-, and 12-months follow-up, as monitored by a supporting clinician. The subject further endorsed a complete mystical experience, hypothesized to underly 5-MeO-DMT's therapeutic activity. No drug-related, serious adverse events occurred. Together, results showed that 5-MeO-DMT was generally tolerable, safe to administer, and effective for PTSD; however, this was not without risk. The subject reported acute nausea, overwhelming subjective effects, and late onset of night terrors. Further research is warranted to replicate and extend these findings, which are inherently limited, non-generalizable, and rely on methods not clinically accepted.

Humans versus AI: whether and why we prefer human-created compared to AI-created artwork.

With the recent proliferation of advanced artificial intelligence (AI) models capable of mimicking human artworks, AI creations might soon replace products of human creativity, although skeptics argue that this outcome is unlikely. One possible reason this may be unlikely is that, independent of the physical properties of art, we place great value on the imbuement of the human experience in art. An interesting question, then, is whether and why people might prefer human-compared to AI-created artworks. To explore these questions, we manipulated the purported creator of pieces of art by randomly assigning a "Human-created" or "AI-created" label to paintings actually created by AI, and then assessed participants' judgements of the artworks across four rating criteria (Liking, Beauty, Profundity, and Worth). Study 1 found increased positive judgements for human- compared to AI-labelled art across all criteria. Study 2 aimed to replicate and extend Study 1 with additional ratings (Emotion, Story, Meaningful, Effort, and Time to create) intended to elucidate why people more-positively appraise Human-labelled artworks. The main findings from Study 1 were replicated, with narrativity (Story) and perceived effort behind artworks (Effort) moderating the label effects ("Human-created" vs. "AI-created"), but only for the sensory-level judgements (Liking, Beauty). Positive personal attitudes toward AI moderated label effects for more-communicative judgements (Profundity, Worth). These studies demonstrate that people tend to be negatively biased against AI-created artworks relative to purportedly human-created artwork, and suggest that knowledge of human engagement in the artistic process contributes positively to appraisals of art.

Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report.

Background: A dissociative subtype of posttraumatic stress disorder, known as "D-PTSD", has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In addition to meeting criteria for PTSD, patients endorse prominent dissociative symptoms, namely depersonalization and derealization, or detachment from one's self and surroundings. At present, this population is supported by a highly heterogeneous and undeveloped literature. Targeted interventions are therefore lacking, and those indicated for PTSD are limited by poor efficacy, delayed onset of action, and low patient engagement. Here, we introduce cannabis-assisted psychotherapy (CAP) as a novel treatment for D-PTSD, drawing parallels to psychedelic therapy. Case presentation: A 28-year-old female presented with complex D-PTSD. In a naturalistic setting, she underwent 10 sessions of CAP, scheduled twice monthly over 5 months, coupled with integrative cognitive behavioral therapy. An autonomic and relational approach to CAP was leveraged, specifically psychedelic somatic interactional psychotherapy. Acute effects included oceanic boundlessness, ego dissolution, and emotional breakthrough. From baseline to post-treatment, the patient showed a 98.5% reduction in pathological dissociation, as measured by the Multidimensional Inventory of Dissociation, no longer meeting criteria for D-PTSD. This was accompanied by decreased cognitive distractibility and emotional suffering, as well as increased psychosocial functioning. Anecdotally, the patient has sustained improvements for over 2 years to date. Conclusions: There is urgency to identify treatments for D-PTSD. The present case, while inherently limited, underscores the potential of CAP as a therapeutic option, leading to robust and sustained improvement. Subjective effects were comparable to those produced by classic and non-classic psychedelics, such as psilocybin and ketamine. Further research is warranted to explore, establish, and optimize CAP in D-PTSD, and to characterize its role in the pharmacological landscape.

Fixation, flexibility, and creativity: The dynamics of mind wandering.

The mind-wandering literature is long on results and short on theory. One notable exception is the Dynamic Framework, a theoretical framework that characterizes mind wandering as thoughts that are relatively unconstrained from deliberate and automatic sources, or "freely moving." Critically, this framework makes numerous testable predictions, including (a) a positive association between freely moving thought and ADHD, (b) negative associations between freely moving thought and depression, anxiety, and OCD, and (c) a positive association between freely moving thought and divergent thinking ability. In Study 1, to test these predictions, we measured participants' reports of freely moving thoughts during a cognitive task and assessed divergent thinking and various psychopathological symptoms. Results failed to support any of the Dynamic Framework's predictions. In Study 2, we assessed the predicted relations between freely moving thought and divergent-thinking performance by manipulating thought constraint during a creative-incubation interval that preceded a divergent-thinking task. Here, we found some evidence (albeit very weak) to support the Dynamic Framework's prediction. Finally, in Study 3, we examined the possibility that indexing freely moving thought during a divergent-thinking task would yield the predicted associations but failed to find support for these associations. These results, most of which are at odds with the predictions of the Dynamic Framework, suggest either the need to revise the framework and/or that current methods are inadequate to properly test these predictions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prior exposure increases judged truth even during periods of mind wandering.

Much of our day is spent mind-wandering-periods of inattention characterized by a lack of awareness of external stimuli and information. Whether we are paying attention or not, information surrounds us constantly-some true and some false. The proliferation of false information in news and social media highlights the critical need to understand the psychological mechanisms underlying our beliefs about what is true. People often rely on heuristics to judge the truth of information. For example, repeated information is more likely to be judged as true than new information (i.e., the illusory truth effect). However, despite the prevalence of mind wandering in our daily lives, current research on the contributing factors to the illusory truth effect have largely ignored periods of inattention as experimentally informative. Here, we aim to address this gap in our knowledge, investigating whether mind wandering during initial exposure to information has an effect on later belief in the truth of that information. That is, does the illusory truth effect occur even when people report not paying attention to the information at hand. Across three studies we demonstrate that even during periods of mind wandering, the repetition of information increases truth judgments. Further, our results suggest that the severity of mind wandering moderated truth ratings, such that greater levels of mind wandering decreased truth judgements for previously presented information.

Creativity, Boredom Proneness and Well-Being in the Pandemic.

Throughout the course of the pandemic, it has become clear that the strictures of social isolation and various levels of lockdown constraints have impacted people's well-being. Here, our aim was to explore relations between trait dispositions associated with boredom proneness, self-regulation and well-being using data collected early in the pandemic. Specifically, we explored whether the tendency to engage in everyday creative pursuits (e.g., making your own greeting cards) would act as a prophylactic against poor well-being. Results showed that well-being was higher for those individuals who increased engagement with creative pursuits during the early stages of the pandemic. That is, people who engaged more in everyday creative activities also reported higher levels of self-esteem, optimism, and positive affect. In contrast, those who pursued fewer creative outlets had higher levels of depression and anxiety, were higher in boredom proneness, and reported experiencing more negative affect. As we emerge from the pandemic, these data provide a clue as to how people might plan to cope adaptively with the restrictive circumstances this extreme world event engendered. More generally, these data provide support for the notion that everyday creativity (and not necessarily creative expertise) has positive associations for well-being.

Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions.

Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive-compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.

On the relation between mind wandering, PTSD symptomology, and self-control.

Here we examined the association between mind wandering, post-traumatic stress disorder (PTSD) symptomology, and self-control. In a large undergraduate sample (N = 5,387), we assessed trait-levels of spontaneous and deliberate mind wandering, self-control, and PTSD symptomology. Results indicated that, while PTSD symptomology was uniquely positively associated with spontaneous mind wandering, it was negatively associated with deliberate mind wandering and self-control. These findings suggest that the mechanism(s) underlying everyday mind wandering may also underlie PTSD symptomology and traumatic intrusions. Moreover, the unique negative association between PTSD symptomatology and self-control suggests that PTSD is characterized not only by impairments in inhibiting unwanted thoughts (as indexed by mind wandering), but also by impairments in inhibiting other unwanted behaviors.

Re-examining the effect of motivation on intentional and unintentional task-unrelated thought: accounting for thought constraint produces novel results.

It has been proposed that motivating participants to perform well on a cognitive task ought to lead to decreases in rates of intentional, but not unintentional, task-unrelated thought (TUT; a commonly studied variety of mind wandering). However, at odds with this prediction, research has found that increasing motivation results in decreases in both intentional and unintentional TUTs. One possible explanation for this surprising finding is that standard assessments of TUT may inadvertently conflate TUTs with another variety of mind wandering: unconstrained thought. If so, then deconfounding task-unrelated and unconstrained varieties of mind wandering might produce the predicted effect of a decrease in intentional, but not unintentional, TUT when motivation is increased. To explore this possibility, in the present study, participants completed a sustained-attention task after receiving standard instructions (normal-motivation condition) or instructions informing them that they could leave the study early if they achieved a certain level of performance (motivated condition). Throughout the task, we assessed rates of TUT (both intentional and unintentional) and unconstrained thoughts. Consistent with prior work, the results indicated that motivated participants reported being on-task significantly more frequently than non-motivated participants. However, unlike previous work, we found that when deconfounding TUTs and unconstrained thoughts, participants in the motivation condition reported significantly fewer bouts of intentional TUT than those in the non-motivation condition, but no differences in rates of unintentional TUT were observed between groups. These results suggest that (a) motivation specifically targets intentional TUT and (b) standard assessments of TUT conflate task-relatedness and thought constraint.

Thought dynamics under task demands: Evaluating the influence of task difficulty on unconstrained thought.

As research on mind wandering has accelerated, the construct's defining features have expanded and researchers have begun to examine different dimensions of mind wandering. Recently, Christoff and colleagues have argued for the importance of investigating a hitherto neglected variety of mind wandering: "unconstrained thought," or, thought that is relatively unguided by executive-control processes. To date, with only a few studies investigating unconstrained thought, little is known about this intriguing type of mind wandering. Across 2 experiments, we examined, for the first time, whether changes in task demand influence rates of constrained versus unconstrained thoughts. In both experiments, participants completed either an easy (0-back) or hard (2-back) task and responded to intermittently presented thought probes that gauged thought constraint throughout the task. In Experiment 1, we found that participants completing the easy task engaged in unconstrained thoughts more frequently than those completing the difficult task. In Experiment 2, we replicated this result and further demonstrated manipulations of unconstrained thought while also measuring task-relatedness (a common dimension of mind wandering). Finally, exploratory analyses showed associations between constrained thought and age, verbal intelligence, and an assessment of flow ('deep effortless concentration'), thereby adding further evidence to indicate a dissociation between task-relatedness and constraint. We discuss the methodological and theoretical applications of our findings to the burgeoning field of research on unconstrained thought. All data, analysis, article, and experiment code can be found at https://osf.io/wr2vk/ (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mind wandering at encoding, but not at retrieval, disrupts one-shot stimulus-control learning.

The one-shot pairing of a stimulus with a specific cognitive control process, such as task switching, can bind the two together in memory. The episodic control-binding hypothesis posits that the formation of temporary stimulus-control bindings, which are held in event-files supported by episodic memory, can guide the contextually appropriate application of cognitive control. Across two experiments, we sought to examine the role of task-focused attention in the encoding and implementation of stimulus-control bindings in episodic event-files. In Experiment 1, we obtained self-reports of mind wandering during encoding and implementation of stimulus-control bindings. Results indicated that, whereas mind wandering during the implementation of stimulus-control bindings does not decrease their efficacy, mind wandering during the encoding of these control-state associations interferes with their successful deployment at a later point. In Experiment 2, we complemented these results by using trial-by-trial pupillometry to measure attention, again demonstrating that attention levels at encoding predict the subsequent implementation of stimulus-control bindings better than attention levels at implementation. These results suggest that, although encoding stimulus-control bindings in episodic memory requires active attention and engagement, once encoded, these bindings are automatically deployed to guide behavior when the stimulus recurs. These findings expand our understanding of how cognitive control processes are integrated into episodic event files.

Boredom proneness, political orientation and adherence to social-distancing in the pandemic.

Research recently showed that boredom proneness was associated with increased social distancing rule-breaking in a sample collected early in the COVID-19 pandemic. Here we explore data collected early in the pandemic to examine what factors might drive this relation. We focus on political affiliation. Given the functional account of boredom as a call to action, we hypothesized that this urge to act may drive individuals towards outlets replete with symbolic value (e.g., ideology, identity). In addition, given the politicization of some social distancing rules (e.g., mask wearing), we explored whether those who adhere to strong political ideologies-particularly conservative ideologies-would be more likely to rule-break. Moderation analyses indicated that boredom proneness and social (but not fiscal) conservatism were indeed predictive of rule-breaking. These results highlight the need for both clear messaging emphasizing the strength of communal identity and action (i.e., that "We are all in this together") and for interventions that emphasize shared collective values in contexts that appeal directly to social conservatives.

The neural correlates of ongoing conscious thought.

A core goal in cognitive neuroscience is identifying the physical substrates of the patterns of thought that occupy our daily lives. Contemporary views suggest that the landscape of ongoing experience is heterogeneous and can be influenced by features of both the person and the context. This perspective piece considers recent work that explicitly accounts for both the heterogeneity of the experience and context dependence of patterns of ongoing thought. These studies reveal that systems linked to attention and control are important for organizing experience in response to changing environmental demands. These studies also establish a role of the default mode network beyond task-negative or purely episodic content, for example, implicating it in the level of vivid detail in experience in both task contexts and in spontaneous self-generated experiential states. Together, this work demonstrates that the landscape of ongoing thought is reflected in the activity of multiple neural systems, and it is important to distinguish between processes contributing to how the experience unfolds from those linked to how these experiences are regulated.

Boredom in the COVID-19 pandemic: Trait boredom proneness, the desire to act, and rule-breaking.

The state of boredom presents a conundrum: When bored, we want to engage with an activity, but we don't want to engage with whatever is currently available. This conflict is exacerbated when external factors impose restrictions on the range of behaviors we can engage in, which is precisely the scenario we are currently facing, at a global level, during this period of social isolation in response to the COVID-19 pandemic. We collected data from 924 North American participants (530 Male, Mean age = 37.7 years) using the internet-based Mturk platform to examine the relation between self-reports of boredom proneness (using the Short Boredom-Proneness Scale) and individual responses to questions about compliance with social-distancing requirements during the COVID-19 pandemic. Our sample replicated recent findings in boredom research, including a negative correlation between boredom proneness and self-control. We also provide novel evidence that highly boredom prone people have been more likely to break the rules of social isolation in a variety of ways (e.g., fewer hours spent in social isolation, poor adherence to social distancing as evidenced by increased likelihood of holding a social gathering and coming into proximity with more people than recommended). We further demonstrated that boredom proneness substantially mediates the association between self-control and rule-breaking. These results indicate that boredom proneness is a critical factor to consider when encouraging adherence to social isolation.

Attention need not always apply: Mind wandering impedes explicit but not implicit sequence learning.

According to the attentional resources account, mind wandering (or "task-unrelated thought") is thought to compete with a focal task for attentional resources. Here, we tested two key predictions of this account: First, that mind wandering should not interfere with performance on a task that does not require attentional resources; second, that as task requirements become automatized, performance should improve and depth of mind wandering should increase. Here, we used a serial reaction time task with implicit- and explicit-learning groups to test these predictions. Providing novel evidence for the attentional resource account's first prediction, results indicated that depth of mind wandering was negatively associated with learning in the explicit, but not the implicit, group, indicating that mind wandering is associated with impaired explicit, but not implicit, learning. Corroborating the attention resource account's second prediction, we also found that, overall, performance improved while at the same time depth of mind wandering increased. From an implicit-learning perspective, these results are consistent with the claim that explicit learning is impaired under attentional load, but implicit learning is not. Data, analysis code, manuscript preparation code, and pre-print available at osf.io/qzry7/.

The relation between task-unrelated media multitasking and task-related motivation.

In two experiments, we explored the relation between participants' (a) levels of motivation to complete a task and (b) task-unrelated media multitasking. In Experiment 1, we examined the extent to which participants' levels of motivation to complete a task influenced their tendency to engage in task-unrelated media multitasking. Participants completed a 1-back task, while having the opportunity to turn on and off an unrelated, optional video. Results showed that participants who were told they would finish the experiment early if they achieved a sufficient level of performance (the motivated group) were significantly less likely to play the optional video during the 1-back task than those who were not given the opportunity to finish early (control condition). In Experiment 2, we examined the extent to which engaging in task-unrelated media multitasking affected task-related motivation. Three groups of participants completed a 1-back task, while (a) no video was presented, (b) a video was continuously played, or (c) participants could turn on and off a video at their leisure (as in Experiment 1). At both the beginning and the end of Experiment 2, participants were asked to indicate their level of motivation to complete the task. Interestingly, results revealed that continuously having the video playing helped sustain task-related motivation. Thus, although greater motivation to perform a task reduces the likelihood of engaging in task-unrelated media multitasking, such media multitasking also appears to increase levels of motivation.

Dissociating the freely-moving thought dimension of mind-wandering from the intentionality and task-unrelated thought dimensions.

The recently forwarded family-resemblances framework of mind-wandering argues that mind-wandering is a multidimensional construct consisting of a variety of exemplars. On this view, membership in the mind-wandering family is graded along various dimensions that define more or less prototypical instances of mind-wandering. In recent work, three dimensions that have played a prominent role in defining prototypicality within the mind-wandering family include: (a) task-relatedness (i.e., how related the content of a thought is to an ongoing task), (b) intentionality (i.e., whether thought is deliberately or spontaneously engaged), and (c) thought constraint (i.e., how much attention constrains thought dynamics). One concern, however, is that these dimensions may be redundant with each other. The utility of distinguishing among these different dimensions of mind-wandering rests upon a demonstration that they are dissociable. To shed light on this issue, we indexed the task-relatedness, intentionality, and constraint dimensions of thought during the completion of a laboratory task to evaluate how these dimensions relate to each other. We found that 56% of unconstrained thoughts were "on-task" and that 23% of constrained thoughts were "off-task." Moreover, we found that rates of off-task thought, but not "freely-moving" (i.e., unconstrained) thought, varied as a function of expected changes in task demands, confirming that task-relatedness and thought constraint are separable dimensions. Participants also reported 21% of intentional off-task thoughts that were freely moving and 9% of unintentional off-task thoughts that were constrained. Finally, off-task thoughts were more likely to be freely-moving than unintentional. Taken together, the results suggest that these three dimensions of mind-wandering are not redundant with one another.