Psychometric properties of the BIRT Motivation Questionnaire (BMQ), a self-measure of avolition in individuals with schizophrenia.

AIMS: Avolition defined as a lack of interest or engagement in goal-directed behavior plays a key role in everyday functioning in schizophrenia and is considered as one of the main contributors to the burden of disease. The aim of this study was to 1) validate the self-report BIRT Motivation Questionnaire (BMQ-S) seldom used before in schizophrenia 2) examine the degree of agreement between the BMQ-S and its informant-report version 3) to assess its ability to predict real-world outcome at 12 month follow-up. METHODS: One hundred and twenty-two (51.9% inpatients) adults with a diagnosis of schizophrenia were included. Exploratory Factor analysis was performed on the BMQ-S to identify the underlying structure. Real life functioning was measured with the Global Assessment of Functioning scale (GAF). Convergent validity was assessed with the Scale for Assessment of Negative Symptom (SANS) and the Lille Apathy Rating Scale (LARS). RESULTS: The main psychometric properties of the BMQ-S (internal consistency, test-retest reliability) were satisfactory. Exploratory factorial analysis revealed a 4-factor model which explained 76% of the overall variance. The BMQ-S correlated significantly with the LARS and the SANS avolition subscore suggesting adequate convergent validity. The correlation between the BMQ-S and the clinician-report version was 0.48. The global score and in particular the Initiation/disorganisation dimension was a significant predictor of global functioning at 12-months even when adjusted for age, chlorpromazine intake and depression. CONCLUSION: Our findings indicate that the BMQ-S has satisfactory psychometric properties and that schizophrenia patients can reliably assess their lack of motivation. Self-evaluation of avolition should be considered in the overall prediction of real-world functioning in schizophrenia.

Positive and negative urgency as a single coherent construct: Evidence from a large-scale network analysis in clinical and non-clinical samples.

AIMS: Negative and positive urgency are emotion-related impulsivity traits that are thought to be transdiagnostic factors in psychopathology. However, it has recently been claimed that these two traits are closely related to each other and that considering them separately might have limited conceptual and methodological value. The present study aimed to examine whether positive and negative urgency constructs constitute separate impulsivity traits. METHODS: In contrast to previous studies that have used latent variable approaches, this study employed an item-based network analysis conducted in two different samples: a large sample of non-clinical participants (N = 18,568) and a sample of clinical participants with psychiatric disorders (N = 385). RESULTS: The network analysis demonstrated that items denoting both positive and negative urgency cohere as a single cluster of items termed "general urgency" in both clinical and non-clinical samples, thereby suggesting that differentiating positive and negative urgency as separate constructs is not necessary. CONCLUSION: These findings have important implications for the conceptualization and assessment of urgency and, more broadly, for future research on impulsivity, personality, and psychopathology.

How to project oneself without positive and integrated memories? Exploration of self-defining memories and future projections in bipolar disorder.

Bipolar disorder (BD) is a disabling disorder with functional impact on everyday life. Recent studies suggest that autobiographical memory impairment may contribute to the maintenance of psychopathology, leading to enduring altered self-construct. Moreover, past personal experiences also support the ability to project oneself into the future to pre-experience an event, this capacity can be modified by psychiatric disorders. Self-defining memories and future projections by accessing highly significant events that are vivid and focused on central goals or enduring concerns can both provide a better understanding of the impact of disorders on self-perception and on the ability to project oneself into the future. Therefore we proposed to explore self-defining memories and future projections in BD patients (n = 25) compared to control participants (n = 25). BD patients' self-defining events were associated with more tension, life-threatening events, and negative emotion. BD patients also reported less integrated past but not less integrated future self-defining events. And their future projections were more closely related to leisure, and associated with positive emotions, compared to controls. For both groups, the future projections were less specific, integrated, and tense than the memories. These results question the self-coherence of patients' identity and should be confirmed to propose appropriate interventions to project oneself adaptively into the future and contribute to a better outcome.

Self-defining memories after severe traumatic brain injury: A preliminary study.

Autobiographical memory plays a major role in the (re)construction of sense of identity, a recurrent issue after a traumatic brain injury (TBI). Although the recall of specific autobiographical events is frequently impaired in patients with TBI, little is known about how these changes affect their sense of self and identity. Thus, we examined self-defining memories (SDMs), that is, the most significant personal memories supporting one's sense of identity, in 16 patients with severe TBI and in matched controls. To this end, participants recalled three SDMs and rated their emotions in response to memory retrieval. In addition, characteristics of SDMs such as specificity, meaning-making, self-connections that reflect identity stability or identity change, content (theme, presence of tension, and redemption sequences) were analysed by independent raters. The main results showed that patients' SDMs were less specific and contained fewer redemption sequences than did those of controls but did not significantly differ in thematic content, presence of tension, meaning-making, self-connections that reflect identity stability or identity change and affective responses to memory retrieval. Furthermore, among the patients' memories that refer to the TBI-related event itself, only one contained an explicit meaning. Despite the lack of specificity in memories, patients with severe TBI were able to extract meaning from personal memories although they could struggle with integrating the TBI-related event into their sense of identity. These characteristics of SDMs may contribute to disturbances in sense of self and continuity in patients with severe TBI, as well as difficulties in personal or social adjustment. These results also open up relevant prospects for psychological interventions in identity-related issues in patients with TBI.

A Mixed-Method Study on Strategies in Everyday Personal Goals among Community-Dwelling Older Adults.

INTRODUCTION: Although it is well known that preference for selection, optimization, and compensation (SOC) strategies is associated with indicators of successful aging and well-being, very little is known about what predicts the use of SOC as goal management strategies in the daily lives of older adults. The present study investigates predictors of self-reported use of SOC strategies in community-dwelling adults. We expected selection and especially compensation to be higher in individuals with worse subjective health and cognitive performance. On the contrary, given that optimization is an anticipatory strategy to increase goal-relevant means in the absence of resource losses, we did not expect optimization to be related to either health or cognition. METHODS: We performed hierarchical regression to predict use of SOC strategies to achieve everyday personal goals (assessed qualitatively via semi-structured interviews exploring participants' personal goals) from subjective health and objective cognitive performance, controlling for age, apathy, and depression. RESULTS: Poorer self-rated health and worse cognitive performance positively predicted compensation as a goal management strategy (R2 = 20%), whereas self-rated health just failed to significantly predict selection rates. None of the variables of interest predicted optimization. DISCUSSION/CONCLUSION: Whereas previous research suggests associations between reduced resources and decreased absolute frequency of compensation use, the present study found that poorer cognitive status and perceived health are both linked to increased reliance on compensation in order to preserve well-being. In line with their anticipatory nature, the use of optimization strategies was independent from health and cognitive resources in our sample. We discuss the absence of conclusive effects regarding selection in this study in light of the distinction between elective and loss-based selection.

Projecting the self in aging: an exploratory study of self-defining future projections.

The concept of "Self-Defining Future Projections" (SDFPs) has been recently introduced to better explore the link between future thinking and identity. To date, SDFPs have only been examined in young adults and it remains unknown how self-defining future thoughts evolve in aging. In this cross-sectional study, 43 young adults (age range = 19-28; mean age = 23.06) and 43 older adults (age range 60-80; mean age = 69.46) were asked to generate three SDFPs. Our results indicated that SDFPs were less specific in older adults compared to young adults, but there was no difference between the two groups concerning autobiographical reasoning. However, regarding subjective experience, older adults rated imagined future events as containing more sensory details and contextual information and reported a higher feeling of pre-experiencing the personal future. Additionally, older participants described future events that were more positive and less distant in the future, with fewer narratives about future achievements but more narratives describing leisure time, with a similar probability between the two groups that the event will occur in the future. Our study extends previous aging research and adds to the literature by better understanding how future event representations are formed in older adults.

Classification of postoperative behavior disturbances in preschool children: A qualitative study.

BACKGROUND/AIM: Negative postoperative changes in children are frequent and have been described for decades. However, there is currently no theoretical framework, nor any consensual operational criteria for identifying them. This study aims at characterizing the many dimensions involved in postoperative behavioral disturbances in early childhood, using a qualitative analysis applied for the first time to these symptoms. METHOD: Fifty-seven parents of preschool children (1-5 years old; 38 boys), who underwent general anesthesia, were interviewed 10 days after surgery. Semi-structured interviews investigated behavioral disturbances classically described in preschool children. Qualitative analysis of the transcripts allied both deductive and inductive reasoning, and inductive coding was carried out using constant comparison method with dedicated qualitative software. RESULTS: Parents reported both positive and negative postoperative changes. Negative changes were classified in four main categories: (a) Externalizing and (b) Internalizing problems behaviors, (c) Feeding sleeping disruption and (d) Somatic problems, each comprising different sub-categories. Importantly within these categories, the symptoms distribution changed in 5 years old children, compared to younger children. Finally, our method allowed defining whether these (negative or positive) changes were significant or not, that is, the importance of postoperative behavioral changes. CONCLUSION: The results of this study highlight the heterogeneity of postoperative disturbances in preschool children. These results are of primary importance for the definition and measurement of postoperative behavioral disturbances.

Reducing anger outbursts after a severe TBI: a single-case study.

Anger outbursts constitute a frequent behavioural issue after a traumatic brain injury (TBI) and have a strong negative impact on the social outcomes resulting from the TBI. However, few studies have examined the efficacy of specific intervention strategies to reduce the frequency and intensity of anger outbursts. We therefore performed a single-case study on this topic by administering two successive and complementary psychological interventions with an AB design with maintenance (first intervention) and an AC design with maintenance plus a one-month follow-up (second intervention) to a patient with a severe TBI. Whereas the first intervention focused on improving the recognition and expression of basic emotions, the second consisted of a self-regulation programme, including various features such as psychoeducation about self-control strategies, relaxation and assertiveness training that aimed to establish adequate behaviours, which were further promoted by an implementation intentions strategy in the patient's daily life. The results indicated that all interventions resulted in a reduced frequency and intensity of anger outbursts, and the data upheld the specificity of these effects. In addition, a meta-analytic integration of the effects of both interventions on the outcomes indicated a medium effect size. Further research is needed on other patients who experience long-standing anger outbursts to examine whether the observed gains can be replicated, sustained on a longer-term basis and improved.

A direct examination of the cognitive underpinnings of multitasking abilities: A first study examining schizophrenia.

Many real world activities are complex and require multitasking abilities. However, the nature of these abilities remains poorly understood, and in particular in schizophrenia. The aim of the present study was to provide a better understanding of such abilities with the help of a newly developed computerized tool, the Computerized Meeting Preparation Task (CMPT). Fifty-seven individuals with schizophrenia and 39 healthy controls completed the CMPT and an extensive cognitive battery. Patients were also evaluated with a series of clinical measures. During the CMPT, participants are asked to prepare a room for a meeting while, at the same time, dealing with interruptions, solving problems, and remembering prospective memory instructions. The CMPT was found to significantly differentiate patients and healthy controls for several variables. Results also showed that multitasking abilities were related to a large array of cognitive functions and, in particular, to those associated to executive functioning. These relations were not explained by the presence of a general cognitive impairment. Finally, a double dissociation between multitasking abilities and performance on standard cognitive tests was observed. Altogether, these results underline the importance of evaluating multitasking abilities in schizophrenia as it allows detecting cognitive difficulties that cannot be identified by standard cognitive tests.

Self-appraisals and episodic memory: Different psychological factors related to patient versus informant reports of apathy in severe traumatic brain injury.

INTRODUCTION: Apathy is a core feature in patients with traumatic brain injury (TBI). The psychological processes underlying apathy are still unclear, and the few studies conducted on this subject have essentially focused on cognitive processes and informant reports of apathetic manifestations. The aims of the present study were to examine self-reports versus informant reports of diminished initiative/interest, as well as their relationship with different cognitive factors (attention/executive mechanisms, episodic memory, and multitasking) and personal identity factors (self-esteem and self-efficacy beliefs). METHOD: To this end, 74 participants (38 patients with severe TBI matched with 36 control participants) were given three questionnaires to assess self-esteem, general self-efficacy beliefs, and anxio-depressive symptoms and five tasks to assess cognitive processes, including real-life multitasking. In addition, a questionnaire that assessed self-awareness of functional competencies and a questionnaire that assessed lack of initiative/interest were administered to each participant and their relatives. RESULTS: The main results showed that patients demonstrated an awareness of their lack of initiative/interest and that self-reported lack of initiative/interest was best predicted by low general self-efficacy beliefs and self-esteem, whereas informant-reported lack of initiative/interest was predicted by episodic memory difficulties. CONCLUSIONS: These results shed new light on the psychological processes related to apathetic manifestations, as well as the differing perspectives and lived experiences of patients and external observers in the TBI population, which opens interesting prospects for psychological interventions.

Intraindividual Variability in Inhibition and Prospective Memory in Healthy Older Adults: Insights from Response Regularity and Rapidity.

Successful prospective memory (PM) performance relies on executive functions, including inhibition. However, PM and inhibition are usually assessed in separate tasks, and analytically the focus is either on group differences or at most on interindividual differences. Conjoint measures of PM and inhibition performance that take into account intraindividual variability (IIV) are thus missing. In the present study, we assessed healthy older adults' level of performance and IIV in both inhibition and PM using a classical Go/NoGo task. We also created a prospective Go/NoGo version that embeds a PM component into the task. Using dynamic structural equation modeling, we assessed the joint effects of mean level (µ), an indicator of amplitude of fluctuations in IIV (or net IIV; intraindividual standard deviation, iSD), and an indicator of time dependency in IIV (the autoregressive parameter ϕ) in reaction times (RTs) on inhibition and PM performance. Results indicate that higher inhibition failure, but not IIV, predicted PM errors, corroborating the current literature on the involvement of prepotent response inhibition in PM processes. In turn, fastest RT latency (µ) and increased net IIV (iSD) were consistently associated with prepotent response inhibition failure, while coherence in RT pattern (ϕ) was beneficial to inhibition performance when the task was novel. Time-dependent IIV (ϕ) appears to reflect an adaptive exploration of strategies to attain optimal performance, whereas increased net IIV (iSD) may indicate inefficient sustained cognitive processes when performance is high. We discuss trade-off processes between competing tasks.

A life-course and multifactorial approach to Alzheimer's disease: Implications for research, clinical assessment and intervention practices.

According to the dominant biomedical view, Alzheimer's disease (AD) has a precise, necessary and unifying neurobiological cause, which distinguishes it from other neurodegenerative diseases and normal ageing. However, different types of evidence specifically lead to questioning the foundations of this essentialist and category-based approach to AD. It seems more and more evident that AD represents a heterogeneous state, determined by multiple factors and mechanisms that interact and intervene throughout life. This other way of conceiving AD not only requires a change of research objectives, but also a profound modification of clinical assessment and intervention practices. It also appeals to follow the path of prevention.

Can an external device create and trigger intention in a patient with a severe brain injury?

Goal-directed behaviour (GDB), the capacity that allows us to control our environment according to our desires and needs, requires different stages from initial intention to goal achievement. Although GDB is frequently disrupted after acquired brain injury, few studies have addressed the remediation of reduced GDB in patients with severe brain injury. The present study aimed to raise this question in RZ, a patient with severe brain injury who presented a serious reduction in GDB related to difficulties in creating an intention from internal determinants and in selecting an action plan, as well as to memory and attentional impairments. Our objective was to investigate the efficacy of an intervention programme to create and trigger a specific intention in RZ. More specifically, this programme consisted in written prompts, first accompanied by an alarm provided by his mobile phone, but gradually reduced until only the alarm remained, which was implemented in order to improve RZ's attendance at workshop sessions. Results showed that RZ's attendance rate at the workshop sessions increased, indicating that the use of an external device allowed us to create and trigger intention in a patient with severe cognitive impairments.

Procrastination as a Self-Regulation Failure: The Role of Impulsivity and Intrusive Thoughts.

Procrastination has been described as the quintessence of self-regulatory failure. This study examines the relationships between this self-regulatory failure and other manifestations of self-regulation problems, namely impulsivity and intrusive thoughts. One hundred and forty-one participants completed questionnaires assessing procrastination, impulsivity (in particular, the urgency and lack of perseverance dimensions), and intrusive thoughts (i.e., rumination and daydreaming). Main results show that urgency mediated the association between rumination and procrastination, whereas rumination did not mediate the relation between urgency and procrastination. Lack of perseverance mediated the association between daydreaming and procrastination, and daydreaming mediated the relation between lack of perseverance and procrastination. This study highlights the role of impulsivity and intrusive thoughts in procrastination, specifies the links between these self-regulation problems, and provides insights into their (potential) underlying mechanisms. It also opens interesting prospects for management strategies for implementing targeted psychological interventions to reduce impulsive manifestations and/or thought control difficulties accompanying procrastination.

A multifactorial and integrative approach to impulsivity in neuropsychology: insights from the UPPS model of impulsivity.

Risky and excessive behaviors, such as aggressive and compulsive behaviors, are frequently described in patients with brain damage and have dramatic psychosocial consequences. Although there is strong evidence that impulsivity constitutes a key factor at play in these behaviors, the literature about impulsivity in neuropsychology is to date scarce. In addition, examining and understanding these problematic behaviors requires the assumption that impulsivity is a multidimensional construct. Consequently, this article aims at shedding light on frequent risky and excessive behaviors in patients with brain damage by focusing on a unified, comprehensive, and well-validated model, namely, the UPPS model of impulsivity. This model considers impulsivity as a multidimensional construct that includes four facets: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Furthermore, we discuss the psychological mechanisms underlying the dimensions of impulsivity, as well as the laboratory tasks designed to assess each mechanism and their neural bases. We then present a scale specifically designed to assess these four dimensions of impulsivity in patients with brain damage and examine the data regarding this multidimensional approach to impulsivity in neuropsychology. This review supports the need to adopt a multifactorial and integrative approach toward impulsive behaviors, and the model presented provides a valuable rationale to disentangle the nature of brain systems and mechanisms underlying impulsive behaviors in patients with brain damage. It may also foster further relevant research in the field of impulsivity and improve assessment and rehabilitation of impulsive behaviors in clinical settings.

Reduced specificity and enhanced subjective experience of future thinking in ageing: the influence of avoidance and emotion-regulation strategies.

Future thinking in older adults is characterised by a lack of specificity of imagined events and by an equal or even higher subjective experience, compared to younger adults. We considered whether this lack of specificity stemmed partly from the avoidance of a somewhat disturbing future and then examined the extent to which certain types of emotion-regulation strategies, namely positive reappraisal and positive refocusing, contributed to the subjective experience of future thinking. Middle-aged and older adults completed an adapted version of the AMT, in which temporal distance and cue word valence were manipulated, thus resulting in future conditions assumed to represent varying degrees of discomfort. Results indicate that distant future and negative cues restricted both the specificity and the subjective experience of future thinking. In addition, the use of avoidance strategies predicted the nature of future thoughts in the context of a supposed uncomfortable future (i.e., a distant future induced by negative cues), although it followed quite different age-related patterns. Together with the findings that positive reappraisal and positive refocusing (to a lesser extent) contributed to the subjective experience of future thinking, this study indicates that how individuals imagine their personal future also relies on affect- and emotion-regulation strategies.

Patterns of source monitoring bias in incarcerated youths with and without conduct problems.

INTRODUCTION: Antisocial individuals present behaviours that violate the social norms and the rights of others. In the present study, we examine whether biases in monitoring the self-generated cognitive material might be linked to antisocial manifestations during adolescence. We further examine the association with psychopathic traits and conduct problems (CPs). METHODS: Sixty-five incarcerated adolescents (IAs; M age = 15.85, SD = 1.30) and 88 community adolescents (CAs; M age = 15.78, SD = 1.60) participated in our study. In the IA group, 28 adolescents presented CPs (M age = 16.06, SD = 1.41) and 19 did not meet the diagnostic criteria for CPs (M age = 15.97, SD = 1.20). Source monitoring was assessed through a speech-monitoring task, using items requiring different levels of cognitive effort; recognition and source-monitoring bias scores (internalising and externalising biases) were calculated. RESULTS: Between-group comparisons indicate greater overall biases and different patterns of biases in the source monitoring. IA participants manifest a greater externalising bias, whereas CA participants present a greater internalising bias. In addition, IA with CPs present different patterns of item recognition. CONCLUSIONS: These results indicate that the two groups of adolescents present different types of source-monitoring bias for self-generated speech. In addition, the IAs with CPs present impairments in item recognition. Future studies may examine the developmental implications of self-monitoring biases in the perseverance of antisocial behaviours from adolescence to adulthood.

Does multitasking mediate the relationships between episodic memory, attention, executive functions and apathetic manifestations in traumatic brain injury?

Apathy is frequently described in patients with traumatic brain injury (TBI); its negative consequences particularly affect functional independence. Among apathetic manifestations, lack of initiative and lack of interest have mainly been associated with cognitive impairments. However, few studies have been conducted to precisely identify the underlying cognitive processes. Our aims were (1) to determine the best predictor of apathy from among several cognitive processes, including episodic memory and attention/executive mechanisms and multitasking, and (2) to examine to what extent multitasking could mediate the relationships between specific cognitive processes and lack of initiative/interest. Seventy participants (34 patients with TBI matched with 36 control participants) were given a questionnaire to assess anxio-depressive symptoms, four tasks to assess specific cognitive processes, and one task to assess real-life multitasking. Participants' relatives completed an apathy questionnaire. Multitasking, as assessed by the number of goals not achieved, was the only significant predictor of apathetic manifestations. In addition, the mediation analyses revealed that multitasking performance mediated the relationships between verbal episodic memory and lack of initiative/interest, whereas executive and attentional functions were only indirectly related to lack of initiative/interest due to their significant impacts on multitasking. These results shed new light on the aetiology of apathetic manifestations in patients with TBI, indicating how specific cognitive deficits are expressed in real-life multitasking, and consequently, how they may lead to the development and/or maintenance of apathetic manifestations.

Temporal compression in episodic memory for real-life events.

Remembering an event typically takes less time than experiencing it, suggesting that episodic memory represents past experience in a temporally compressed way. Little is known, however, about how the continuous flow of real-life events is summarised in memory. Here we investigated the nature and determinants of temporal compression by directly comparing memory contents with the objective timing of events as measured by a wearable camera. We found that episodic memories consist of a succession of moments of prior experience that represent events with varying compression rates, such that the density of retrieved information is modulated by goal processing and perceptual changes. Furthermore, the results showed that temporal compression rates remain relatively stable over one week and increase after a one-month delay, particularly for goal-related events. These data shed new light on temporal compression in episodic memory and suggest that compression rates are adaptively modulated to maintain current goal-relevant information.

Longitudinal Course and Predictors of Apathetic Symptoms after Severe Traumatic Brain Injury.

OBJECTIVES: Apathy is one of the most common behavioral symptoms encountered after traumatic brain injury (TBI). However, very little is known about the longitudinal course and predictors of apathetic manifestations. The aims of the present study were to examine how apathy changes and the predictive value of cognitive factors (memory, attention/executive mechanisms, and multitasking) and personal identity factors (self-esteem and self-efficacy beliefs) for apathy over a period of 10 months. METHOD: To this end, 68 participants (32 patients with severe TBI matched with 36 control participants) living in the community were enrolled. At Time 1, participants were given three questionnaires to assess self-esteem, self-efficacy beliefs, anxiety and depression symptoms, and five tasks to assess cognitive processes. Simultaneously, a close relative of each participant completed a questionnaire that assessed lack of initiative/initiative. At Time 2, all questionnaires were re-administered to each patient and their relatives. RESULTS: Patients displayed a significant lack of initiative/interest at all post-injury assessments. At the individual level, the results revealed that a majority of patients had no change in their apathetic symptoms over the 10-month follow-up, whereas in the others, apathetic symptoms mostly increased. Furthermore, impaired memory was the only mechanism that significantly predicted later apathetic manifestations. Complementary profile analyses indicated that patients with worsening symptoms over the follow-up period showed higher inaccurate memory at Time 1 than patients with stable symptoms. CONCLUSIONS: These results provide valuable insight into the longitudinal evolution and predictors of apathy after TBI, which opens interesting prospects for psychological interventions.