Individual differences in motivation to change in individuals with eating disorders: A systematic review.

OBJECTIVE: Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD: Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS: This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION: Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE: Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.

OBJETIVO: Se ha sugerido que la motivación al cambio impacta significativamente en los resultados del tratamiento en los trastornos de la conducta alimentaria (TCAs). Esta revisión investigará los factores asociados con la motivación al cambio en los TCAs con el objetivo de apoyar a los clínicos para que estén conscientes y sensibles a los factores que podrían obstaculizar la recuperación e informar las intervenciones basadas en la motivación. MÉTODO: Siguiendo las guías PRISMA, este artículo identificó 24 estudios a través de búsquedas en bases de datos que cumplían con los criterios de elegibilidad. Solo se identificaron correlatos de la motivación, lo que limita la capacidad de esta revisión para identificar relaciones causales. Los factores que cambiaron junto con los cambios en la motivación se identificaron a partir de estudios longitudinales. RESULTADOS: Esta revisión identificó factores como características individuales, psicopatología comórbida, falta de autonomía en el tratamiento y relaciones con otros como asociados con la motivación al cambio en individuos con TCAs. Además, la motivación al cambio aumentó significativamente junto con la autoestima y la renegociación de la identidad cuando se midió longitudinalmente. DISCUSIÓN: La entrevista motivacional típicamente puede centrarse en explorar la ambivalencia hacia el tratamiento, identificando metas y valores, y aumentando la autoeficacia. Sin embargo, esta revisión identifica factores individuales y relacionales como particularmente significativos y que pueden obstaculizar la recuperación de un TCA. Como tal, se han identificado objetivos basados en evidencia para informar a los clínicos y a las intervenciones basadas en la motivación.

Exploring the relationship between clinical and personal models of recovery in anorexia nervosa: A mixed methods study.

OBJECTIVE: There is increasing interest around the relationship between clinically defined recovery from Anorexia nervosa (AN), based on a reduction of symptoms and weight normalisation, and personal models of recovery which emphasise factors such as personal growth. The purpose of this mixed methods study was to evaluate the hypothesis that these two approaches are complimentary, with reduced symptoms associated with higher achievement in personal domains. METHODS: Eighty-one adults who self-defined as fully or partially recovered from AN were recruited into an online study and completed self-report measures of clinical and personal recovery. Participants were also asked questions about their views on the clinical criteria, and this data was analysed using thematic analysis. RESULTS: People who were clinically defined as fully recovered scored significantly higher on measures of personal recovery compared to those defined as not recovered, and there were strong positive associations between lower behavioural and cognitive symptoms, and personal recovery. There was a weaker relationship between personal recovery measures and BMI. Qualitative data indicated that most participants felt that the clinical criteria were not a sufficient definition of recovery. CONCLUSIONS: Implications for the usage of clinical criteria for recovery from AN in research trials and clinical practice are discussed.

Investigating self-blame and trauma symptoms in parents of young people with anorexia nervosa.

BACKGROUND: Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes. OBJECTIVE: This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN. METHODS: A cross-sectional design was used. One hundred and twenty-three parents of young people with AN completed a range of questionnaires assessing self-blame cognitions and PTSD symptoms. RESULTS: Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms. CONCLUSIONS: The findings suggest that negative appraisals regarding self-blame for their child's eating disorder contributed to the potential maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.

Psychometric properties and factor structure of the Revised Beliefs About Emotions Questionnaire.

OBJECTIVE: Given that there is an increasing exploration of the role of beliefs about emotions in emotion regulation and psychotherapy, there is a need for a range of valid and reliable measures of beliefs about emotions. The Beliefs About Emotions Questionnaire (BAEQ) has been shown to be a promising measure of beliefs about emotions. However, to date, no study has attempted to replicate the original factor structure of the BAEQ in an English-speaking country. The present study examined the psychometric properties of the BAEQ in a nonclinical sample. METHOD: Archival data of 1807 adult participants residing in Australia was divided into three equal groups of participants. A confirmatory factor analysis (CFA) was conducted on the first sub-sample, an exploratory factor analysis (EFA) was performed on the second sub-sample, and a second CFA was performed on the third sub-sample. Divergent validity was tested using the heterotrait-monotrait ratio and the concurrent validity was tested through correlations with the subscales of the Three-Factor Eating Questionnaire (TFEQ-R18). RESULTS: The first CFA failed to replicate the original factor structure of the BAEQ. An EFA supported five of the original six factors. A five-factor structure, including 30 out of the original 43 items, was confirmed in a second CFA. The final subscales (Shameful and Irrational, Overwhelming and Uncontrollable, Invalid and Meaningless, Useless and Damaging) demonstrated good construct validity, good internal consistency, and good concurrent and divergent validity. CONCLUSION: The results from this study support a briefer five-factor, 30-item version of the BAEQ (BAEQ-R) as a reliable and valid measure of beliefs about emotions that can be utilised in future research.

Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

AIMS: Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. RESULTS: The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. CLINICAL IMPLICATIONS: The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Systematic review: Exploring the monitoring and reporting of unwanted events in psychotherapy trials for anorexia nervosa.

OBJECTIVE: If a psychotherapeutic intervention has the capacity to produce positive change, the "deterioration effect" theory holds that it must also have the potential for negative effects. However, the definition, measurement, and reporting of unwanted events in psychotherapy is a topic of ongoing discussion. At present this area is under-explored in interventions for anorexia nervosa (AN), a severe mental illness associated with high medical and psychiatric risks. The aim of this article was to undertake a systematic review of published randomized controlled trials (RCTs) evaluating psychotherapeutic interventions for AN, and to assess how unwanted events were defined, monitored, and reported alongside the trial's key findings. METHOD: Using a systematic review methodology, this article identified 23 RCTs through database searches meeting eligibility criteria. Results are presented using a narrative summary approach. RESULTS: Unwanted event reporting varied widely, both regarding definitions of key unwanted events (such as non-compliance or symptom deterioration) and in the amount of detail captured in each paper. DISCUSSION: The review identified two key issues: firstly, a lack of consistent definitions and unclear causality made it difficult to distinguish between unwanted events, and adverse events caused by the interventions. Secondly, it highlighted the difficulty of defining unwanted events where different studies have different populations and goals. Recommendations are made around how the area of defining, monitoring, and reporting unwanted events in RCTs for AN can be taken forward. PUBLIC SIGNIFICANCE: Whilst psychotherapies can be effective in treating mental health conditions, negative or unwanted events can sometimes occur. This review explored how RCTs examining psychotherapy for AN report how they monitor the safety of participants, and how they report unwanted events. We found that the reporting was often inconsistent or hard to interpret, and we have made recommendations for how this can be improved in the future.

OBJETIVO: Si una intervención psicoterapéutica tiene la capacidad de producir un cambio positivo, la teoría del "efecto de deterioro" sostiene que también debe tener el potencial de efectos negativos. Sin embargo, la definición, medición y reporte de eventos no deseados en psicoterapia es un tema de discusión continua. En la actualidad, esta área está poco explorada en las intervenciones para la anorexia nerviosa (AN), una enfermedad mental grave asociada con altos riesgos médicos y psiquiátricos. El objetivo de este trabajo fue realizar una revisión sistemática de los ensayos controlados aleatorios (ECA) publicados que evalúan las intervenciones psicoterapéuticas para la AN, y evaluar cómo se definieron, monitorearon e informaron los eventos no deseados junto con los hallazgos clave del ensayo. MÉTODO: Mediante una metodología de revisión sistemática, este documento identificó 23 ECA mediante búsquedas en bases de datos que cumplían los criterios de elegibilidad. Los resultados se presentan utilizando un enfoque de resumen narrativo. RESULTADOS: El informe de eventos no deseados varió ampliamente, tanto con respecto a las definiciones de eventos no deseados clave (como el incumplimiento o el deterioro de los síntomas) como en la cantidad de detalles capturados en cada artículo. DISCUSIÓN: La revisión identificó dos cuestiones clave: en primer lugar, la falta de definiciones consistentes y la causalidad poco clara dificultaron la distinción entre eventos no deseados y eventos adversos causados por las intervenciones. En segundo lugar, destacó la dificultad de definir eventos no deseados donde diferentes estudios tienen diferentes poblaciones y objetivos. Se hacen recomendaciones sobre cómo se puede llevar adelante el área de definición, monitoreo e informe de eventos no deseados en ECA para anorexia nerviosa.

The lived experience of adolescent depression: A systematic review and meta-aggregation.

BACKGROUND: The under-detection of depression in adolescents suggests that a better understanding of its presentation may be needed. Conceptualizations of adolescent depression are largely the same as adult depression, with minimal consideration of developmental stage. Exploration of first-hand accounts could help to identify any unique features of adolescent depression. Therefore, this systematic review aimed to understand the lived experience of adolescents with depression to inform clinical practice. METHODS: The review was registered with PROSPERO (CRD42020198141). Databases (PsychINFO, CINAL, MEDLINE and EMBASE) were searched in March 2022 to identify peer-reviewed qualitative studies on first-hand experiences of adolescent depression. The Joanna Briggs Institute's qualitative data extraction tool and checklist for qualitative research were used to obtain study data and assess methodological quality of included papers. Meta-aggregation was the method of synthesis, whereby extracted themes from the papers were grouped according to shared meanings. RESULTS: Fifteen papers of mixed methodological quality were identified for inclusion from screening a total of 1,983 references. Studies were published between 2002 and 2021, spanned seven countries and included participants aged 11 to 22 years old. Aggregation of 56 themes resulted in 16 categories and 3 synthesized findings encompassing key aspects of adolescent depression: causes, symptoms and coping. Variability in adolescents' perspectives across these domains was evident. Some symptoms described, such as social disconnection and anger, are not listed in existing diagnostic criteria. CONCLUSIONS: Subjective experiences of depression among adolescents vary and may not entirely match diagnostic criteria. Awareness of this when assessing for depression may improve detection and help to ensure adolescents feel understood.

The experiences of adolescents diagnosed with functional gastrointestinal disorders: An interpretative phenomenological analysis.

The aim of this study was to provide a qualitative perspective of adolescents' experiences of functional gastrointestinal disorders. In-depth semi structured interviews were conducted with eleven adolescents aged 11-16. The transcripts were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: 1) The journey to diagnosis: the good, the bad and the unknown; 2) Making sense of 'functional': the search for meaning; and 3) To share or conceal?: the impact of anticipated stigma on peer disclosure. The themes highlighted a complex process of meaning-making, with limited information about their diagnosis impacting on approaches to self-management and peer disclosure. Findings suggest adolescents would benefit from developmentally appropriate information and resources about the biopsychosocial aetiology of their presentation. It is considered that this may lead to greater self-efficacy in self-management of symptoms and reduce potential for perceived and self-stigma. Further implications for clinical practice and future research are discussed.

Understanding eating and drinking behaviours in Pakistani university students: A conceptual model through qualitative enquiry.

Excess weight in Pakistan's university students is on the rise and is driven by their maladaptive eating behaviours. Practitioners in Pakistan have adopted Western conceptual models to understand obesogenic eating behaviours. However, these models provide incomplete explanations as they miss important culturally specific determinants for such eating behaviours. The goals of this study were two-fold: first, to explore Pakistani university students' perception of their obesity-related eating behaviours and attitudes; second, to develop a culturally sensitive model of obesogenic eating behaviours in university students from Pakistan. Semi-structured interviews were used with twenty-four Pakistani university students who were categorised as obese using the Body Mass Index according to Asia-Specific cut-offs. Interviews were transcribed, translated, and then analysed through a Grounded Theory methodology. Six major categories emerged from interviews: (1) Obesogenic Eating Habits (Social Eating, Emotional Eating, and Eating Whatever and Whenever You Want); (2) Beliefs about Food in the Culture; (3) Neither Too Fat nor Too Thin body belief (4) Student Life Attitudes; (5) Student Stressors; (6) Inconsistent Weight-Control Strategies. A model was developed with cultural beliefs about food, attitudes towards student-life, and stressors as important determinants of students' obesogenic eating habits, while inconsistent weight-control strategies contributed to further weight gain. The findings highlight the importance of identifying culturally specific determinants of eating behaviours among university students in Pakistan. This emerging model can be used to guide the development of future quantitative and also longitudinal studies aimed at identifying targets for therapeutic interventions to manage obesogenic eating behaviours in Pakistani university students.

What is the relationship between dissociation and self-harming behaviour in adolescents?

Deliberate self-harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self-harm to end the aversive experience of dissociation, others propose that self-harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self-harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross-sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self-harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self-harm.

Developing a new measure of dissociation: The Dissociative Experiences Measure, Oxford (DEMO).

The field of dissociation is receiving increasing attention, despite a lack of coherent conceptualisation of the construct. Advances in the field would be aided by a measure that reflects service user experiences of dissociative experiences and can be easily scored. The current study describes the development of a new measure of dissociation (Dissociative Experiences Measure, Oxford; DEMO) that aims to fulfil these criteria. The study follows an exploratory, data-driven, measure development design. Resource searching and feedback from clinicians (n = 3) and service users (n = 6) were used to develop an extensive item pool. An online sample (n = 691) provided data for a factor analysis of the item pool. Factor analysis produced a measure with five subscales: 'unreality', 'numb and disconnected', 'memory blanks', 'zoned out', and 'vivid internal world'. Further analysis indicated that the new measure has high internal consistency, and high convergent, divergent, and discriminant validity. The DEMO shows promise as an up-to-date clinical and research tool for the assessment of dissociative experiences. These results are preliminary, and further validation of the measure with a clinical sample is required.

Investigating the effectiveness of brief cognitive reappraisal training to reduce fear in adolescents.

As adolescent anxiety is common and costly, identifying effective strategies to reduce symptoms is a priority. This study tested whether adolescents could learn to use cognitive reappraisal strategies to attenuate fear during extinction learning. Fifty-seven participants (12-15 years) viewed images of two neutral faces, one which was paired with a fearful expression and shrieking scream (conditioned threat stimulus) and the other that was never paired with the aversive outcome (conditioned safety stimulus) during fear acquisition. Before extinction, participants either received cognitive appraisal training, which explored alternative, benign meanings associated with the scream or a control activity. Self-reported fear ratings in the cognitive reappraisal group were significantly lower to both the conditioned threat and safety stimuli after extinction than the control group. These findings did not characterise fear-potentiated startle data. Potential reasons for the lack of consistency between measures are considered.

Do female dieters have an "eating disorder" self-schema?

BACKGROUND: The processing of schema-related information is important in the maintenance of specific eating disorder (ED)-related belief systems and psychopathology. To date, most research on differences in the processing of ED schematic information has used interview or self-report questionnaire measures. Dieting is a known risk factor for EDs and dieters have been included in some studies. However, they have not been compared with non-dieters on a novel, objective measure of ED related schema processing. METHODS: The current study recruited healthy female volunteers from the community and divided them into dieting (n = 25) and non-dieting (n = 24) groups using rigorous criteria. ED self-schemas with content unrelated to eating, weight and shape were measured using a self-schema processing task. RESULTS: Dieters endorsed significantly more ED relevant words compared to non-dieters, whereas non-dieters rejected significantly more ED relevant words compared to dieters. Reaction times to endorsements and rejections were non-significant when the two groups were compared. In a surprise recall task, dieters recalled significantly more ED relevant words. CONCLUSION: The results of this study support the presence of ED self-schemas with negative content unrelated to eating, weight and shape in otherwise healthy dieters. Implications for future research and the early identification of individuals vulnerable to EDs are discussed.

Parental Bonding and Body Mass Index in a Female Community Sample: The Mediating Role of Eating Disorder Thoughts and Core Beliefs.

BACKGROUND: It is likely that disrupted early parent-child relationships, eating disorder related cognitions and negative self-beliefs are relevant to some women who are overweight/obese. AIMS: This study tested the hypotheses that disrupted parent-child relationships would be linked to higher body mass index (BMI) and that this relationship would then be mediated by cognition. METHOD: A group of women were recruited from the community and completed measures of eating disorder (ED) thoughts, negative self-beliefs, and parental bonding. Individual body mass indices (BMIs) were calculated. RESULTS: One hundred and eighteen women completed the study. There was a relationship between parental bonding and higher BMI. As hypothesized, the relationship between parental bonding (as measured by maternal care, and paternal overprotection) and BMI appeared to be mediated by a range of ED thoughts, and some negative self-beliefs. CONCLUSION: The cognitions measured here, both ED related cognitions and negative self-beliefs, may be a useful target when considering psychological treatment for women who are overweight or obese.

Development and Validation of a Short Version of the Supervisory Relationship Questionnaire.

UNLABELLED: The Supervisory Relationship Questionnaire (SRQ) is one of the few theoretically sound and psychometrically valid questionnaires for measuring the SR within clinical supervision. However, its length can make it difficult to use in clinical practice and research. This study aimed to produce a shorter version of the SRQ (the Short Supervisory Relationship Questionnaire: S-SRQ) that retained its reliability and psychometric validity. The SRQ's 67 items were initially reduced using the criteria of external, internal and face validity. Two hundred and three UK trainee clinical psychologists then completed a series of online questionnaires including the S-SRQ and other clinical supervision measures. A Principal Component Analysis identified three components of the S-SRQ: 'safe base', 'reflective education' and 'structure', and an 18-item version was produced. Analyses revealed that the S-SRQ has high internal reliability, adequate test-retest reliability and good convergent, divergent and predictive validity. Participants also rated the S-SRQ as easy to use and potentially helpful for providing feedback on the SR in supervision. The S-SRQ (three subscales, 18 items) is a valid and reliable measure of the SR from the supervisee perspective. The current findings also support aspects of existing models of the SR. The S-SRQ is a promising measure for use in clinical, training and research settings. Copyright © 2014 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: The Short Supervisory Relationship Questionnaire (S-SRQ) is a psychometrically reliable and valid 18-item measure of the supervisory relationship based on the SRQ. Clinically, the measure represents a quick and accessible means for supervisees to assess the quality of their supervisory relationship and discuss this with their supervisors. It can also be used in conjunction with the supervisor-completed Supervisory Relationship Measure to support a dyadic discussion about clinical supervision and the supervisory relationship.

Medication and psychotherapy in eating disorders: is there a gap between research and practice?

BACKGROUND: Little research has investigated the use of evidence-based guidelines by eating disorder (ED) therapists, or prescribing of psychotropic medication. Moreover, people with EDs have rarely been surveyed on these topics, and their clinical and demographic features have not been presented. This study investigated perception of psychotherapy, psychotropic medication and the clinical characteristics of a community sample of people with EDs. METHOD: An online survey methodology was used to recruit 253 people with eating disorders in the community. Where feasible, comparisons were made between four types of eating disorder, anorexia nervosa, bulimia nervosa, and two types of atypical or 'sub-threshold' eating disorder. RESULTS: Unlike medication, reported psychotherapy showed some congruence with evidence based and other guidance. Most participants were currently receiving either psychotherapy, medication or both, and most had a severe and chronic ED. CONCLUSIONS: Findings are considered in light of use of evidence-based treatment for EDs, calls for greater dissemination of cognitive behaviour therapy (CBT); indications that much may be poor quality; and the importance of what treatments to offer those who are chronically and severely ill. Development of theory and novel treatments is considered a priority.

Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review.

Comorbid anxiety is common in bipolar spectrum disorders [BPSD], and is associated with poor outcomes. Its clinical relevance is highlighted by the "anxious distress specifier" in the revised criteria for Bipolar Disorders in the Diagnostic and Statistical Manual 5th Edition [DSM-5]. This article reviews evidence for the effectiveness of psychological therapy for anxiety in adults with BPSD (bipolar I, II, not otherwise specified, cyclothymia, and rapid cycling disorders). A systematic search yielded 22 treatment studies that included an anxiety-related outcome measure. Cognitive behavioural therapy [CBT] for BPSD incorporating an anxiety component reduces anxiety symptoms in cyclothymia, "refractory" and rapid cycling BPSD, whereas standard bipolar treatments have only a modest effect on anxiety. Preliminary evidence is promising for CBT for post-traumatic stress disorder and generalised anxiety disorder in BPSD. Psychoeducation alone does not appear to reduce anxiety, and data for mindfulness-based cognitive therapy [MBCT] appear equivocal. CBT during euthymic phases has the greatest weight of evidence. Where reported, psychological therapy appears acceptable and safe, but more systematic collection and reporting of safety and acceptability information is needed. Development of psychological models and treatment protocols for anxiety in BPSD may help improve outcomes.

Cognitive reappraisal of peer rejection in depressed versus non-depressed adolescents: functional connectivity differences.

BACKGROUND: Depression is the most common psychiatric disorder in adolescence, and is characterised by an inability to down-regulate negative emotional responses to stress. Adult studies suggest this may be associated with reduced functional connectivity between prefrontal and subcortical regions, yet the neurological mechanisms in adolescence remain unclear. METHODS: We developed a novel, age-appropriate, reappraisal paradigm to investigate functional connectivity during reappraisal of a real-life source of stress in 15 depressed and 15 non-depressed adolescents. During fMRI, participants i) attended to, and ii) implemented reappraisal techniques (learnt prior to fMRI) in response to, rejection. RESULTS: Reappraisal reduced negative mood and belief in negative thoughts in both groups alike, however during reappraisal (versus attend) trials, depressed adolescents showed greater connectivity between the right frontal pole and numerous subcortical and cortical regions than non-depressed adolescents. CONCLUSIONS: These findings tentatively suggest that, when instructed, depressed adolescents do have the ability to engage neural networks involved in emotion regulation, possibly because adolescence reflects a period of heightened plasticity. These data support the value of cognitive reappraisal as a treatment tool, identify neural markers that could be used to optimise current therapies, and lay the foundations for developing novel neuroscientific techniques for the treatment of adolescent depression.

Developing a measure of appraisal: a psychometric analysis of the parental appraisal of cleft questionnaire.

OBJECTIVE: To develop a questionnaire measure of appraisals for parents of children with a cleft (the Parental Appraisal of Cleft Questionnaire) and to investigate the ability of the Parental Appraisal of Cleft Questionnaire to predict variance in parental well-being. Design, Participants, Setting: The study used a cross-sectional postal and online questionnaire design with a retest component involving parents of children with a cleft lip and/or palate. Data are presented for 179 parents, predominantly women (74.9%), aged 22 to 58 years. MAIN OUTCOME MEASURES: Participants completed the appraisal measure under development; other measures of psychological well-being, social support, and socially desirable responding; and demographic information. RESULTS: Overall, the Parental Appraisal of Cleft Questionnaire was found to have a coherent factor structure, good internal reliability, and good test-retest reliability. The Parental Appraisal of Cleft Questionnaire was also found to predict a significant amount of unique variance in well-being over and above the variance predicted by demographic, social support, and social desirability variables. CONCLUSIONS: Parental appraisals, measured by the Parental Appraisal of Cleft Questionnaire, were found to predict unique variance in well-being. These findings are discussed in relation to adjustment to cleft lip and/or palate for parents. Directions for future research are outlined and the implications for clinical practice and services are discussed.

Applying a cognitive model to binge eating in a female community sample.

OBJECTIVE: Little is known about a potential cognitive model for binge eating, although cognitive behavioural techniques have been proposed as appropriate models of intervention. This study initiated the development of a cognitive model by applying an established cognitive model for bulimia nervosa. METHOD: A community sample of women was recruited via the internet and participants completed measures of eating disorder thoughts, negative self-beliefs, attachment, mood and binge eating severity. RESULTS: Eating disorder thoughts and negative self-beliefs were applicable to women in the community who binge eat. Attachment relationships characterised by decreased emotional warmth and increased overprotection, were correlated with binge eating in women and this relationship was mediated by eating disorder thoughts and negative self-beliefs. DISCUSSION: The cognitive model of bulimia was applicable to some extent to women in the community who binge eat. Attachment may also be related to binge eating and this relationship may be mediated by cognition.