Obliviate! Reviewing Neural Fundamentals of Intentional Forgetting from a Meta-Analytic Perspective.

Intentional forgetting (IF) is an important adaptive mechanism necessary for correct memory functioning, optimal psychological wellbeing, and appropriate daily performance. Due to its complexity, the neuropsychological processes that give birth to successful intentional forgetting are not yet clearly known. In this study, we used two different meta-analytic algorithms, Activation Likelihood Estimation (ALE) & Latent Dirichlet Allocation (LDA) to quantitatively assess the neural correlates of IF and to evaluate the degree of compatibility between the proposed neurobiological models and the existing brain imaging data. We found that IF involves the interaction of two networks, the main "core regions" consisting of a primarily right-lateralized frontal-parietal circuit that is activated irrespective of the paradigm used and sample characteristics and a second less constrained "supportive network" that involves frontal-hippocampal interactions when IF takes place. Additionally, our results support the validity of the inhibitory or thought suppression hypothesis. The presence of a neural signature of IF that is stable regardless of experimental paradigms is a promising finding that may open new venues for the development of effective clinical interventions.

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

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

Couples extrinsic emotion regulation questionnaire: Psychometric validation in a Chilean population.

The way couples regulate their emotions affects the quality of their relationship. Despite this, no evidence-based scales of validity and reliability can measure the intention to regulate emotions in the romantic dyad. In order to address this gap, we developed the Couples Extrinsic Emotion Regulation (CEER) questionnaire. First, we adapted the "Others" subscale from the Emotion Regulation of Others and Self questionnaire (EROS) for any close relationship to measure the intention to regulate emotions in couples; second, the psychometric properties of the CEER questionnaire were studied. For the content validity assessment, 23 experts (47.8% of whom worked in social and health psychology and the psychology of emotions, 17.4% in couples' therapy, and 34.8% in social science methodologies) participated. A total of 528 Chileans completed the online CEER questionnaire, the relationship satisfaction scale (RAS) and dyadic adjustment scale (DAS): 27.8% were male, age M = 38.7, SD = 10.05, and time of the relationships M = 11.27, SD = 9.82. The content-based validity study made it possible to determine which items to include in the final version. Two unrelated first-order factors structure of the original test fit (RMSEA = .052, GFI = .97, AGFI = .95; CFI = .99; NFI = .98; and NNFI = .98). The CEER+ and CEER- factors presented adequate internal consistency (α = .79; ω = .80 and α = .85; ω = .85, respectively). The discrimination index of the factors were excellent (CEER+ = .55 and CEER- = .63). Validity evidence based on the relations to other variables showed a direct positive relation between CEER+, RAS and overall DAS, as well as their factors; and a negative relation between CEER-, RAS overall DAS, as well as their factors. The use of this instrument is recommended for the identification of Chilean couples where at least one of the partners has a less favorable opinion of their relationship, providing relevant data for couple's therapy.

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

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

From meaning to symptom reduction: contemporary approaches to psychotherapy after traumatic brain injury / Del sentido a la reducción de síntomas: enfoques contemporáneos de la psicoterapia después de un trauma cráneo encefálico

Introduction: During the last decades, psychological interventions have become central components of rehabilitation programs for Traumatic Brain Injury (TBI). Nevertheless, due to a wide variability of therapeutic approaches there is little agreement regarding which approach is more suitable, or whether key elements from different psychotherapies should be integrated. This article critically reviews several contemporary approaches that are dominant in the literature. Methods: In order to accomplish such goal, an all-time search on Web of Science and Google Scholar was carried, using TBI and Psychotherapy as key words (n = 72). Results: The main finding of this paper is that theoretical and technical variability among psychotherapies reflects differences in the 'level of care' that is targeted: symptom reduction, behavioral problem reduction, quality of life and meaning reconstruction. Four contemporary approaches to psychotherapy [cognitive behavioral, third wave cognitive behavioral, narrative and psychodynamic] are then briefly described, by presenting their main theoretical tenets, the level of care they target, and the existing evidence that supports their efficacy. Finally, the implications of using a 'levels of care' perspective when addressing the 'effectiveness' debate is considered, as well as the need to familiarize future clinicians with more integrative models of psychological support after TBI.

Introducción: Durante las últimas décadas, las intervenciones psicológicas se han convertido en un elemento central de los programas de rehabilitación para personas que han adquirido un Trauma Cráneo Encefálico (TEC). Este artículo revisa críticamente los enfoques contemporáneos predominantes en la literatura a la luz del concepto de "niveles de cuidado". Método: Se realizó una revisión bibliográfica entre los años 1985 y 2014 utilizando los motores de búsqueda Web of Science y Google Scholar, usando TEC y Psicoterapia como palabras claves. 72 artículos fueron seleecionados para revisión. Resultados: Existe una amplia variabilidad teórico/técnica en los enfoques utilizados en esta población, reflejando diferencias en los niveles de cuidado: reducción de síntomas, reducción de problemas conductuales, calidad de vida y reconstrucción de sentido vital. Cuatro enfoques psicoterapéuticos contemporáneos (cognitivo-conductual, cognitivo-conductual de tercera generación, narrativo y psicodinámico) son brevemente descritos, presentando sus supuestos teóricos, el nivel de cuidado que consideran como objetivo, y la evidencia existente que apoya su efectividad. Finalmente, se discuten las implicancias de utilizar una perspectiva de 'niveles de cuidado' en el debate sobre efectividad de la psicoterapia en personas con TEC, así como la necesidad de familiarizar futuros neuropsicólogos clínicos con modelos genéricos de apoyo psicológico para esta población.

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

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

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

"Relating through sameness": a qualitative study of friendship and social isolation in chronic traumatic brain injury.

Social isolation has been described as a common problem among traumatic brain injury (TBI) survivors during the chronic phase. Due to physical, cognitive and behavioural changes, survivors become less socially active and experience a marked decrease in the number of friends. The goal of this investigation is to explore TBI survivors' subjective account of the challenges encountered in sustaining friendships, as well as gaining insight into their particular understanding of such difficulties. Using a thematic analysis approach, 11 survivors of TBI were interviewed in relation to their experience of social isolation and friendship during the chronic stage. Four main themes emerged from the interviews: (1) The impact of long-term cognitive and behavioural problems on relationships; (2) Loss of old friends; (3) Difficulties making new friends, and (4) Relating to other survivors in order to fight social isolation (sameness). Clinical implications of these findings, as well as their relevance in the design of long-term rehabilitation programmes, are discussed. Particular emphasis is placed on the need to acknowledge the value of relating to other survivors, as a way of resisting cultural discourses about disability, and as a source of self-cohesion in the process of identity re-construction.

Observations on Working Psychoanalytically with a Profoundly Amnesic Patient.

Individuals with profound amnesia are markedly impaired in explicitly recalling new episodic events, but appear to preserve the capacity to use information from other sources. Amongst these preserved capacities is the ability to form new memories of an emotional nature - a skill at the heart of developing and sustaining interpersonal relationships. The psychoanalytic study of individuals with profound amnesia might contribute to the understanding the importance of each memory system, including effects on key analytic processes such as transference and countertransference. However, psychoanalytic work in the presence of profound amnesia might also require important technical modifications. In the first report of its kind, we describe observations from a long term psychoanalytic process (72 sessions) with an individual (JL) who has profound amnesia after an anoxic episode. The nature of therapy was shaped by JL's impairment in connecting elements that belong to distant (and even relatively close) moments in the therapeutic process. However, we were also able to document areas of preservation, in what appears to be a functioning therapeutic alliance. As regards transference, the relationship between JL and his analyst can be viewed as the evolution of a narcissistic transference, and case material is provided that maps this into three phases: (i) rejecting; (ii) starting to take in; and (iii) full use of the analytic space - where each phase exhibits differing degrees of permeability between JL and the analyst. This investigation appears to have important theoretical implications for psychoanalytic practice, and for psychotherapy in general - and not only with regard to brain injured populations. We especially note that it raises questions concerning the mechanism of therapeutic action in psychoanalysis and psychotherapy, and the apparent unimportance of episodic memory for many elements of therapeutic change.

Confabulation: Developing the 'emotion dysregulation' hypothesis.

Confabulations offer unique opportunities for establishing the neurobiological basis of delusional thinking. As regards causal factors, a review of the confabulation literature suggests that neither amnesia nor executive impairment can be the sole (or perhaps even the primary) cause of all delusional beliefs - though they may act in concert with other factors. A key perspective in the modern literature is that many delusions have an emotionally positive or 'wishful' element, that may serve to modulate or manage emotional experience. Some authors have referred to this perspective as the 'emotion dysregulation' hypothesis. In this article we review the theoretical underpinnings of this approach, and develop the idea by suggesting that the positive aspects of confabulatory states may have a role in perpetuating the imbalance between cognitive control and emotion. We draw on existing evidence from fields outside neuropsychology, to argue for three main causal factors: that positive emotions are related to more global or schematic forms of cognitive processing; that positive emotions influence the accuracy of memory recollection; and that positive emotions make people more susceptible to false memories. These findings suggest that the emotions that we want to feel (or do not want to feel) can influence the way we reconstruct past experiences and generate a sense of self - a proposition that bears on a unified theory of delusional belief states.

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

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

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

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

Reappraisal generation after acquired brain damage: The role of laterality and cognitive control.

In the past decade, there has been growing interest in the neuroanatomical and neuropsychological bases of reappraisal. Findings suggest that reappraisal activates a set of areas in the left hemisphere (LH), which are commonly associated with language abilities and verbally mediated cognitive control. The main goal of this study was to investigate whether individuals with focal damage to the LH (n = 8) were more markedly impaired on a reappraisal generation task than individuals with right hemisphere lesions (RH, n = 8), and healthy controls (HC, n = 14). The reappraisal generation task consisted of a set of ten pictures from the IAPS, depicting negative events of different sorts. Participants were asked to quickly generate as many positive reinterpretations as possible for each picture. Two scores were derived from this task, namely difficulty and productivity. A second goal of this study was to explore which cognitive control processes were associated with performance on the reappraisal task. For this purpose, participants were assessed on several measures of cognitive control. Findings indicated that reappraisal difficulty - defined as the time taken to generate a first reappraisal - did not differ between LH and RH groups. However, differences were found between patients with brain injury (LH + RH) and HC, suggesting that brain damage in either hemisphere influences reappraisal difficulty. No differences in reappraisal productivity were found across groups, suggesting that neurological groups and HC are equally productive when time constraints are not considered. Finally, only two cognitive control processes inhibition and verbal fluency- were inversely associated with reappraisal difficulty. Implications for the neuroanatomical and neuropsychological bases of reappraisal generation are discussed, and implications for neuro-rehabilitation are considered.

Thinking about neuropsychological rehabilitation: an interview with Barbara Wilson

Barbara Wilson is a psychologist and researcher in neuropsychological rehabilitation from U.K. She is the founder of the Oliver Zangwill Centre, a place that has strongly contributed to the development of theoretical and technical approaches to rehabilitate cognitive and socio-emotional problems after brain injury†. In this interview Barbara Wilson offers her personal perspective on the state of the art in neuropsychological rehabilitation, commenting on key topics such as the principles that guide holistic rehabilitation, the relevance of incorporating emotional problems after brain injury and the need to adopt research methodologies that are congruent with our object of study...

Mente desorganizada y reacción catastrófica: regulación emocional intrínseca y extrínseca en sobrevivientes de lesión cerebral adquirida / Disorganized mind and catastrophic reaction: intrinsic and extrinsic emotion regulation in acquired brain injury survivors

La experiencia de tener una mente desorganiza es un fenómeno común luego de lesiones a la corteza frontal. Si bien en las últimas décadas existe un mayor conocimiento respecto a los mecanismos neuropsicológicos que colapsan en una mente desorganizada, las consecuencias emocionales de dicho problema han sido escasamente descritas. Este artículo sugiere que uno de los resultados más importantes de experimentar una mente desorganizada es la imposibilidad de utilizar dicha mente como fuente de autorregulación emocional. Además, propone que en situaciones de desorganización mental, los sobrevivientes de lesión cerebral tienden a utilizar las mentes-cerebros de otros como fuente de regulación afectiva, proceso conocido como regulación extrínseca. Por medio de la descripción de un caso clínico se intenta además demostrar como los procesos de regulación intrínseca y extrínseca se encuentran íntimamente relacionados...

The experience of a disorganized mind is a common phenomenon after pre-frontal cortex lesions. Even though during the last decades there has been a better understanding of the neuropsychological mechanisms that are often compromised in a disorganized mind, its emotional consequences have been scarcely described. This article suggests that a main problem of having a disorganized mind is the difficulty of using that same mind to self-regulate emotional states. In addition, this paper also proposes that in situations where the mind is in a state of disorganization, patients tend to use other’s people’s minds-brains as a source of affective regulation, a process commonly known as extrinsic regulation. Finally, the relationship between intrinsic and extrinsic regulatory processes is addressed through the description of a clinical case...

Concrete behaviour and reappraisal deficits after a left frontal stroke: a case study.

Concrete behaviour, the inability to disengage from immediate experience in order to manipulate ideas and thoughts, has long been understood to be a common problem after frontal lobe lesions. However, there has been little consideration of the impact that concreteness may have on emotional functioning, specifically in the use of thinking to manipulate emotional responses. One widely studied emotion regulation strategy is reappraisal, which depends on several frontal lobe related cognitive control processes. While there have been numerous neuroimaging findings on reappraisal, no study has used brain injured patients to investigate this issue. The present case study is the first to describe the capacity to generate reappraisals in a patient (Mrs M), whose behaviour became concrete after a left prefrontal stroke. Using a picture-based reappraisal paradigm, her performance was compared to non-concrete brain-lesioned patients, and neurologically healthy controls. Although Mrs M showed relatively preserved overall cognitive function, she was completely unable to spontaneously generate reappraisals. In striking contrast, once external support was offered, in the form of prompts, her capacity to reappraise dramatically improved. The results are analysed in terms of three neuropsychological capacities - all compromised in Mrs M - previously proposed as reappraisal components: response inhibition, abstraction, and verbal fluency. A number of implications for rehabilitation are discussed, including how the use of prompting may facilitate reappraisal capacity.

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

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