Feasibility, acceptability and clinical benefit of a trauma-focused stabilisation group for post-traumatic stress disorder patients with complex presentations on primary care waitlists.

BACKGROUND: Large numbers of people showing complex presentations of post-traumatic stress disorder (PTSD) in the NHS Talking Therapies services routinely require multi-faceted and extended one-to-one National Institute of Clinical Excellence (NICE) recommended treatment approaches. This can lead to longer waits for therapy and prolong patient suffering. We therefore evaluated whether a group stabilisation intervention delivered to patients on the waitlist for individual trauma-focused psychological treatment could help address this burden. AIMS: The study aimed to ascertain a trauma-focused stabilisation group's acceptability, feasibility, and preliminary clinical benefit. METHOD AND RESULTS: Fifty-eight patients with PTSD waiting for trauma-focused individual treatment were included in the study. Two therapists delivered six 5-session groups. The stabilisation group was found to be feasible and acceptable. Overall, PTSD symptom reduction was medium to large, with a Cohen's d of .77 for intent-to-treat and 1.05 for per protocol analyses. Additionally, for depression and anxiety, there was minimal symptom deterioration. CONCLUSIONS: The study provided preliminary evidence for the acceptability, feasibility and clinical benefit of attending a psychoeducational group therapy whilst waiting for one-to-one trauma therapy.

Developmental pathways of depressive symptoms via parenting, self-evaluation and peer relationships in young people from 3 to 17 years old: evidence from ALSPAC.

PURPOSE: Self-evaluation and interpersonal factors are theoretically and empirically linked to depression in young people. An improved understanding of the multifactorial developmental pathways that explain how these factors predict depression could inform intervention strategies. METHODS: Using structural equation modeling, this study explored whether self-evaluation and interpersonal factors were associated with adolescent depressive symptoms in a population-based sample (n = 11,921; Avon Longitudinal Study of Parents and Children, ALSPAC), across four development stages: early and late childhood plus early and middle adolescence from 3 to 17 years old. RESULTS: Early good parenting practices predicted self-esteem, fewer peer difficulties, good friendships and fewer depressive symptoms in late childhood development outcomes. Higher self-esteem and less negative self-concept mediated the effect of early good parenting practice on reduced depressive symptoms in middle adolescence. The hypothesized erosion pathway from depressive symptoms in late childhood via higher levels of negative self-concept in early adolescence to depressive symptoms in middle adolescence was also confirmed. Additionally, peer difficulties played a mediation role in developing depressive symptoms. Contrary to the hypothesis, poor friendships predicted fewer depressive symptoms. The analysis supported a developmental pathway in which good parenting practices in early childhood led to fewer peer difficulties in late childhood and to less negative self-concept in early adolescence, which in turn predicted fewer depressive symptoms in middle adolescence. CONCLUSION: The social-developmental origin of youth depressive symptoms was supported via the effect of peer relationships in late childhood on self-evaluation in early adolescence.

Pain and suicidality in children and adolescents: a longitudinal population-based study.

Suicidality is a common public health concern in young people. Previous research has highlighted pain as a key correlate of suicidality in young people. However, the long-term experience of pain may vary between individuals, and the relationship between distinct pain trajectories and suicidality is poorly understood. This study aims to describe the number and nature of distinct pain trajectories, their demographic and clinical correlates, including baseline suicidality, and whether identified pain trajectories may predict future suicidality. Secondary data analyses were performed, using longitudinal data from the British Child and Adolescent Mental Health Survey (N = 7977), collected at five timepoints between 2004 and 2007 on a population-based sample of UK youth (5-16 years). Data were collected from up to three respondents (parents, teachers, and 11 + year-olds). Latent Class Growth Analysis was used to identify distinct pain trajectories, explore predictors of these trajectories, and establish whether trajectories predicted future suicidality. We identified the following four pain trajectories: increasing (33.6%), decreasing (4.5%), persistent/recurrent probability of pain (15.7%), and no pain (46.2%). Pain trajectories were associated with unique demographic and clinical correlates. Only the persistent/recurrent (vs. no-pain) trajectory was predicted by baseline suicidality (aOR = 2.24; 95% bootstrap-CI = 1.59-3.26). Furthermore, the persistent/recurrent trajectory predicted future suicidality (aOR = 1.03, 95% bootstrap-CI = 1.01-1.06), after controlling for baseline suicidality, psychiatric disorder, age, and gender. Findings provide a better understanding of correlates associated with distinct pain trajectories and long-term risk of suicidality in young people, suggesting a bidirectional pain-suicidality association and emphasising the need of targeted support for young people with persistent/recurrent pain.

Multisensory processing of emotional cues predicts intrusive memories after virtual reality trauma.

Research has shown that high trait anxiety can alter multisensory processing of threat cues (by amplifying integration of angry faces and voices); however, it remains unknown whether differences in multisensory processing play a role in the psychological response to trauma. This study examined the relationship between multisensory emotion processing and intrusive memories over seven days following exposure to an analogue trauma in a sample of 55 healthy young adults. We used an adapted version of the trauma film paradigm, where scenes showing a car accident trauma were presented using virtual reality, rather than a conventional 2D film. Multisensory processing was assessed prior to the trauma simulation using a forced choice emotion recognition paradigm with happy, sad and angry voice-only, face-only, audiovisual congruent (face and voice expressed matching emotions) and audiovisual incongruent expressions (face and voice expressed different emotions). We found that increased accuracy in recognising anger (but not happiness and sadness) in the audiovisual condition relative to the voice- and face-only conditions was associated with more intrusions following VR trauma. Despite previous results linking trait anxiety and intrusion development, no significant influence of trait anxiety on intrusion frequency was observed. Enhanced integration of threat-related information (i.e. angry faces and voices) could lead to overly threatening appraisals of stressful life events and result in greater intrusion development after trauma. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-023-00784-1.

What are people's experiences of orthorexia nervosa? A qualitative study of online blogs.

PURPOSE: Orthorexia nervosa (ON) is a proposed new eating disorder, used to describe a pathological obsession with healthy or 'clean' eating. Although some quantitative research has been carried out in ON, very little qualitative work has been published to date to explore individual experiences of ON. Thus, this study aimed to explore individuals' personal experiences of ON, as described in online blogs. METHODS: Fifteen women bloggers, who self-identified as having ON, consented for their blog entries to be analysed in this study. Forty pre-existing blog entries describing the first-person experiences of ON were analysed using thematic analysis. RESULTS: Three key themes were discussed: (1) initial motivations for a healthier lifestyle, (2) fuelling the problem-social influences, and: (3) when healthy becomes unhealthy. Bloggers described the role of social messages, comparison with others around ideas of 'healthiness', as well as confusion around diagnosis as factors influencing their disordered eating. They also described the exacerbating impact of perfectionism and perceived control, as well as a confirmatory cycle of fear and avoidance. For some bloggers, increased physical symptoms in response to feared foods provided confirmation for these fears, further exacerbating food avoidance. CONCLUSION: Whilst the debate around the diagnosis of ON continues, these bloggers' accounts suggest that ON is experienced as a legitimate, debilitating disorder, worthy of clinical and research investigation. This study provides evidence of some of the potential triggers and maintaining factors for this disordered eating style. LEVEL OF EVIDENCE: Level V, qualitative descriptive study.

Dispositional self-compassion and responses to mood challenge in people at risk for depressive relapse/recurrence.

This paper explores the relationship between dispositional self-compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self-compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self-compassion, use of cognitive emotion regulation strategies, and changes in mood and self-devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self-compassion showed greater mood recovery after mood induction, and less self-devaluation across the experimental procedure, independent of their mood-repair condition or habitual forms of cognitive emotion regulation. These results suggest that self-compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.

Rumination in dysphoric mothers negatively affects mother-infant interactions.

BACKGROUND: Postnatal maternal depressive symptoms are consistently associated with reduced quality of mother-infant interaction. However, there is little research examining the role of maternal cognitive factors (e.g. rumination) in the relationship between depressive symptoms and mother-infant interaction quality. This study investigated the hypotheses that: dysphoric mothers would demonstrate less sensitive behaviour towards their infants compared with nondysphoric mothers; mothers induced to ruminate would be less sensitive towards infants; rumination would moderate the relationship between maternal depressive symptoms and maternal sensitivity and the impact of the rumination induction would increase following a stressor (still face) task. METHOD: Mothers (N = 79; 39 dysphoric and 40 nondysphoric) and their infants were randomised to either a rumination induction or a control condition. Maternal sensitivity in mother-infant interactions was assessed before and after the induction using the CARE Index. In the second interaction task, mothers also completed the still-face procedure as a stressor. RESULTS: Extending previous research, mixed measures ANOVAs demonstrated that dysphoric mothers had reduced quality of interaction with their infant compared with nondysphoric mothers and that mothers in the rumination condition exhibited reduced sensitivity towards their infants relative to mothers in the control condition. Further, maternal sensitivity worsened further after the still-face procedure in the rumination condition, but not in the control condition. CONCLUSIONS: This study suggests that the repetitive, internal focus of a ruminative state is causally implicated in mother-infant interaction quality, regardless of the level of depressive symptoms. This research extends understanding of specific mechanisms involved in the quality of the mother-infant relationship.

Examining the Factor Structure of the Self-Compassion Scale in Four Distinct Populations: Is the Use of a Total Scale Score Justified?

This study examined the factor structure of the Self-Compassion Scale (SCS) using a bifactor model, a higher order model, a 6-factor correlated model, a 2-factor correlated model, and a 1-factor model in 4 distinct populations: college undergraduates (N = 222), community adults (N = 1,394), individuals practicing Buddhist meditation (N = 215), and a clinical sample of individuals with a history of recurrent depression (N = 390). The 6-factor correlated model demonstrated the best fit across samples, whereas the 1- and 2-factor models had poor fit. The higher order model also showed relatively poor fit across samples, suggesting it is not representative of the relationship between subscale factors and a general self-compassion factor. The bifactor model, however, had acceptable fit in the student, community, and meditator samples. Although fit was suboptimal in the clinical sample, results suggested an overall self-compassion factor could still be interpreted with some confidence. Moreover, estimates suggested a general self-compassion factor accounted for at least 90% of the reliable variance in SCS scores across samples, and item factor loadings and intercepts were equivalent across samples. Results suggest that a total SCS score can be used as an overall mesure of self-compassion.

Pain can produce systematic distortions of autobiographical memory.

OBJECTIVES: Cognitive-behavioral models highlight the role of learning and memory biases in the development and maintenance of chronic pain. However, the extent to which a memory bias is a consequence of the clinical state of being a chronic pain subject is unknown. This article presents a study which delineates the influence of chronic and acute pain on autobiographical memory retrieval. METHODS: 16 healthy controls and 16 individuals with chronic pain participated in an autobiographical memory task during two sessions (a current pain and a pain-free session for the chronic pain subjects) and received neutral words that served as a cue for the retrieval of past life events. RESULTS: The valence of remembered life events in individuals with chronic pain was more negative when they were in pain compared to pain-free states. Conversely, both groups did not differ in their ratings of the reported memories during the pain-free condition. In addition, no significant relationship between mood and the valence of retrieved memories was found. CONCLUSIONS: The present data demonstrate that current pain but not chronic pain per se can exert specific influences on remembering in participants with chronic pain. This memory bias could be a predisposition for the development of chronic pain but could also be a pain-maintaining consequence of painful experiences. This should be addressed in longitudinal studies.

Self-Compassion in Chinese Young Adults: Its Measurement and Measurement Construct.

OBJECTIVES: Self-compassion is the ability to be kind to oneself in adversity. This multidimensional construct is typically assessed by the Self-Compassion Scale (SCS). In Chinese samples, there have been inconsistent psychometric findings that impede cross-cultural research. This study aimed to explore the factor structure of the Chinese version (SCS-C). METHODS: Two samples of young Chinese adults were recruited (Sample 1, N = 465, 141 men, Mean age [Mage] = 20.26; Sample 2, N = 392, 71 men; Mage = 18.97). Confirmatory factor analyses and exploratory structural equation modeling (ESEM) were used to examine previously reported four- and six-factor structures of SCS-C. RESULTS: Although ESEM supported the six-factor structure when a problematic item was omitted, we found stronger evidence for a novel four-factor structure of the SCS-C revealed with self-kindness, common humanity, mindfulness, and uncompassionate self-responding. This suggests that Chinese individuals have a different understanding of the negative components of the original self-compassion definition, which was based on the United States and other mostly Western samples. Omega coefficients of the bifactor models suggested that using the SCS total score in Chinese samples is inappropriate. However, high factor determinacy and construct replicability indicated that the general factor of SCS-C could be used in a structural equation modeling context for both four-factor and six-factor structures. CONCLUSIONS: When using the existing SCS-C in path models, researchers should use a latent variable approach and establish the measurement construct rather than sum scores of the scale or subscales without checking the factor structure in future empirical studies. Also, the SCS-C needs to be revised, and we proposed directions forward for future research.

Daily relationships among maternal rumination, mood and bonding with infant.

There is little research examining the association between maternal maladaptive emotion regulation strategies such as rumination and perceived maternal bonding and mood. This study investigated the concurrent and prospective relationship of both trait and daily rumination with daily perceived maternal bonding and mood. Ninety-three mothers of infants aged between 3 and 14 months completed a ten-day diary study investigating the relationship between daily and trait ruminative self-focus, negative affect and perceived maternal bonding, or her perceived feelings of closeness with her infant. The majority of mothers reported mild to moderate depressive symptoms. The data were analysed using Hierarchical Linear Modelling. Baseline depressive symptoms and trait rumination were each positively associated with mean levels of daily ruminative self-focus and mood over the ten-day sampling period. Bonding with infant at baseline was not associated with mean levels of daily rumination, mood or bonding over the sampling period. Concurrently, daily rumination and daily bonding were negatively correlated, after accounting for daily mood. Prospectively, lower levels of daily bonding predicted increases in daily rumination and depressive mood on the subsequent day. Interestingly, daily rumination did not predict increases in depressive mood or bonding on the subsequent day, suggesting that rumination occurred in response to perceived disruptions in feelings of closeness with the infant, but did not lead to prospective decreases in these feelings of closeness. These findings hold important implications for understanding the relationship between the mother-infant relationship, and maternal rumination and depressive mood, suggesting that disruptions in the way mothers perceive they are bonding to their infants may contribute to depressongenic processes.

The potential of digital behavioural tests as a diagnostic aid for psychosis.

Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests. To demonstrate that digital behavioural tests can be used to discriminate between the STEPs users (SU; n = 32) and controls (n = 32, age and sex matched), we compared performance of five different classifiers applied to objective, quantitative and interpretable features derived from the 'mirror game' (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. All classifiers had AUC in the range of 0.84-0.92. The best of the five classifiers (linear discriminant classifier) achieved an outstanding performance, AUC = 0.92 (95%CI 0.75-1), Sensitivity = 0.75 (95%CI 0.5-1), Specificity = 1 (95%CI 0.75-1), evaluated on 25% hold-out and 1000 folds. Performance of all analysed classifiers is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification what ensures generalisability of the results. We also found that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Our findings show that standardised batteries of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.

Rejection sensitivity and vulnerable attachment: associations with social support and PTSD symptoms in trauma survivors.

Background: Although social support has been consistently associated with recovery from psychological trauma and prevention of posttraumatic stress disorder (PTSD), individual differences in seeking or benefitting from social support in trauma survivors are not well understood. Factors associated with negative internal working models of self and others, emotion dysregulation, and interrupted bonds with an individual's social support groups such as vulnerable attachment and rejection sensitivity could contribute to lower experienced social support and higher levels of PTSD. Objective: The objective of this study was to test a theoretically informed model and investigate how psychosocial variables such as vulnerable attachment styles, rejection sensitivity, and social support are associated with PTSD. Method: Using a cross-sectional survey and path analyses in 141 survivors of trauma (aged 18-69, M = 25.20), the relationship between vulnerable attachment style, rejection sensitivity, and PTSD were investigated. Results: Higher vulnerable attachment, rejection sensitivity, and lower social support were found to be significant predictors of PTSD symptoms (f2 = 0.75). The relationships from vulnerable attachment to PTSD were mediated by rejection sensitivity and perceived social support. The results supported and extend theoretical models of PTSD that posit a role for predisposing factors in the development and maintenance of the disorder. Conclusion: The findings suggest a potential benefit of identifying vulnerable groups that could benefit from a refinement of existing PTSD interventions by targeting the maladaptive effects of vulnerable attachment and rejection sensitivity, thus allowing the individual to draw effectively on social support networks.

Antecedentes:Aunque el apoyo social se ha asociado consistentemente con la recuperación del trauma psicológico y la prevención del Trastorno de Estrés Postraumático (TEPT), las diferencias individuales en la búsqueda o beneficios del apoyo social en sobrevivientes del trauma no se comprenden bien. Factores asociados con modelos de trabajo internos negativos de sí mismo y de los otros, desregulación emocional, y vínculos interrumpidos con los grupos de apoyo social de un individuo; tal como el apego vulnerable y sensibilidad al rechazo pudiesen contribuir a un bajo apoyo social percibido y altos niveles de TEPT.Objetivo:el objetivo de este estudio fue probar un modelo informado teóricamente e investigar cómo las variables psicosociales tales como estilo de apegos vulnerables, sensibilidad al rechazo y apoyo social están asociados con el TEPT.Método:usando una encuesta transversal y Análisis de ruta en 141 sobrevivientes de trauma (edad 18­69, M = 25.20); se investigaron la relación entre estilo de apego vulnerable, sensibilidad al rechazo y TEPT.Resultados:Mayor apego vulnerable, sensibilidad al rechazo, y apoyo social bajo se encontraron que eran predictores significativos de síntomas de TEPT (f2 = 0.75). La relación entre apego vulnerable y TEPT fue mediada por la sensibilidad al rechazo y apoyo social percibido. Los resultados apoyan y amplían los modelos teóricos de TEPT que postulan un rol de los factores predisponentes en el desarrollo y la mantención del trastorno.Conclusión:Los hallazgos sugieren un potencial beneficio en identificar grupos vulnerables que pudiesen beneficiarse de un refinamiento de las intervenciones existentes de TEPT mediante focalización de los efectos desdaptativos del apego vulnerable y de la sensibilidad al rechazo, lo que permite que el individuo recurra de manera efectiva a las redes de apoyo social.

Brain Responses to a Self-Compassion Induction in Trauma Survivors With and Without Post-traumatic Stress Disorder.

Self-compassion (SC) is a mechanism of symptom improvement in post-traumatic stress disorder (PTSD), however, the underlying neurobiological processes are not well understood. High levels of self-compassion are associated with reduced activation of the threat response system. Physiological threat responses to trauma reminders and increased arousal are key symptoms which are maintained by negative appraisals of the self and self-blame. Moreover, PTSD has been consistently associated with functional changes implicated in the brain's saliency and the default mode networks. In this paper, we explore how trauma exposed individuals respond to a validated self-compassion exercise. We distinguish three groups using the PTSD checklist; those with full PTSD, those without PTSD, and those with subsyndromal PTSD. Subsyndromal PTSD is a clinically relevant subgroup in which individuals meet the criteria for reexperiencing along with one of either avoidance or hyperarousal. We use electroencephalography (EEG) alpha-asymmetry and EEG microstate analysis to characterize brain activity time series during the self-compassion exercise in the three groups. We contextualize our results with concurrently recorded autonomic measures of physiological arousal (heart rate and skin conductance), parasympathetic activation (heart rate variability) and self-reported changes in state mood and self-perception. We find that in all three groups directing self-compassion toward oneself activates the negative self and elicits a threat response during the SC exercise and that individuals with subsyndromal PTSD who have high levels of hyperarousal have the highest threat response. We find impaired activation of the EEG microstate associated with the saliency, attention and self-referential processing brain networks, distinguishes the three PTSD groups. Our findings provide evidence for potential neural biomarkers for quantitatively differentiating PTSD subgroups.

High trait anxiety enhances optimal integration of auditory and visual threat cues.

BACKGROUND: Emotion perception is essential to human interaction and relies on effective integration of emotional cues across sensory modalities. Despite initial evidence for anxiety-related biases in multisensory processing of emotional information, there is no research to date that directly addresses whether the mechanism of multisensory integration is altered by anxiety. Here, we compared audiovisual integration of emotional cues between individuals with low vs. high trait anxiety. METHODS: Participants were 62 young adults who were assessed on their ability to quickly and accurately identify happy, angry and sad emotions from dynamic visual-only, audio-only and audiovisual face and voice displays. RESULTS: The results revealed that individuals in the high anxiety group were more likely to integrate angry faces and voices in a statistically optimal fashion, as predicted by the Maximum Likelihood Estimation model, compared to low anxiety individuals. This means that high anxiety individuals achieved higher precision in correctly recognising anger from angry audiovisual stimuli compared to angry face or voice-only stimuli, and compared to low anxiety individuals. LIMITATIONS: We tested a higher proportion of females, and although this does reflect the higher prevalence of clinical anxiety among females in the general population, potential sex differences in multisensory mechanisms due to anxiety should be examined in future studies. CONCLUSIONS: Individuals with high trait anxiety have multisensory mechanisms that are especially fine-tuned for processing threat-related emotions. This bias may exhaust capacity for processing of other emotional stimuli and lead to overly negative evaluations of social interactions.

Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model.

Purpose/Objective: Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method: We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications: We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.

Study development and protocol for a cohort study examining the impact of baseline social cognition on response to treatment for people living with post-traumatic stress disorder.

Background: Social cognitive impairments, specifically in facial emotion processing and mental state attribution, are common in post-traumatic stress disorder. However few studies so far have examined whether social cognitive ability impacts on PTSD recovery. Objective: To examine whether baseline social cognitive abilities are associated with treatment outcomes following trauma-focused therapy for PTSD. Method: This is a cohort study that will relate treatment outcomes post-discharge to baseline measures of social cognition (five tasks: Emotion Odd-One-Out Task (Oddity), Reading the Mind in the Eyes Task (RMET), Social Shapes Test (SST), Spontaneous Theory of Mind Protocol (STOMP), and Reflective Functioning Questionnaire (RFQ-8)) in people starting a course of psychological therapy for PTSD (target N = 60). The primary outcome will be pre- to post-treatment change in PTSD symptom severity (assessed using the PTSD Checklist for DSM-5). Secondary outcomes include functional impairment (assessed using the Work and Social Adjustment Scale), drop-out rate, and analyses differentiating participants with DSM-5 PTSD and ICD-11 PTSD and CPTSD. Regression models will be used to examine associations between baseline social cognitive performance and outcome measures while adjusting for potential confounders. Two pilot studies informed the development of our study protocol. The first involved qualitative analysis of interviews with nine participants with lived experience of mental health problems to inform our research questions and study protocol. The second involved trialling social cognitive tasks on 20 non-clinical participants to refine our test battery. Discussion: This study will address a gap in the literature about whether abilities in social cognition in people living with PTSD are associated with treatment-related recovery. HIGHLIGHTS: Impairments in social cognition are recognised in people with PTSD.Few studies have examined whether social cognitive ability is associated with recovery from PTSD.We present a study protocol, developed after pilot testing, to address this question.

Antecedentes: Las deficiencias en la cognición social, específicamente en el procesamiento de las emociones faciales y de la atribución de estados mentales, son comunes en el trastorno de estrés postraumático (TEPT). Sin embargo, hasta el momento pocos estudios han evaluado si la habilidad cognitiva social tiene un impacto en la recuperación del TEPT.Objetivo: Evaluar si las habilidades de cognición social de base están asociadas con los resultados del tratamiento después de la terapia centrada en el trauma para el TEPT.Métodos: Este es un estudio de cohortes que relacionará los resultados posteriores al alta del tratamiento con las medidas de referencia de la cognición social mediante cinco pruebas: la tarea de la emoción no correspondiente ('Emotion Odd-One-Out Task (Oddity)'), la tarea de lectura de la mente a través de la mirada ('Reading the Mind in the Eyes Task (RMET)'), la prueba de las figuras sociales ('Social Shapes Test (SST)'), el protocolo para la teoría de la mente espontánea ('Spontaneous Theory of Mind Protocol (STOMP)'), y el cuestionario de funcionamiento reflexivo ('Reflective Functioning Questionnaire (RFQ-8)'. Estas pruebas fueron realizadas en personas al iniciar el transcurso de la terapia psicológica para el TEPT (N objetivo = 60). El resultado principal será el cambio en la severidad de los síntomas del TEPT antes y después del tratamiento (evaluado utilizando la lista de verificación de síntomas de TEPT del DSM-5). Los resultados secundarios incluyen al deterioro funcional (evaluado mediante el cuestionario de trabajo y ajuste social, 'Work and Social Adjustment Scale' en inglés), la tasa de abandono, así como los análisis que diferencien a los participantes con TEPT según el DSM-5, y diferencien el TEPT y el TEPT complejo (TEPT-C) según la CIE-11. Se utilizarán modelos de regresión para examinar las asociaciones entre el rendimiento cognitivo social de referencia y las medidas de resultado mientras se ajustan por posibles variables de confusión. Dos estudios piloto sustentaron el desarrollo del protocolo del estudio. El primero involucró un análisis cualitativo de las entrevistas realizadas a nueve participantes con experiencias de problemas de salud mental para sustentar nuestras preguntas de investigación y el protocolo de estudio. El segundo involucró evaluar las pruebas de cognición social en veinte participantes sin condiciones clínicas para refinar la batería de pruebas.Discusión: Este estudio busca estrechar la brecha en la literatura sobre si las habilidades en la cognición social en personas que viven con TEPT están asociadas con la recuperación vinculada al tratamiento.

Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse.

Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA + major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression.

Background: Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD. Methods: We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV. Results: As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses. Conclusion: The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.

Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design.

OBJECTIVE: Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees. DESIGN: In a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index. RESULTS: The CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group. CONCLUSION: Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need replication in a larger trial.