Becoming Aware Through Internal Exploration: Understanding Psychotherapy on Conceptual and Neurobiological Levels

A cognitive map is a suitably structured representation that enables novel computations using previous experience; for example, planning a new route in a familiar space1. Work in mammals has found direct evidence for such representations in the presence of exogenous sensory inputs in both spatial2,3 and non-spatial domains4–10. Here we tested a foundational postulate of the original cognitive map theory1,11: that cognitive maps support endogenous computations without external input. We recorded from the entorhinal cortex of monkeys in a mental navigation task that required the monkeys to use a joystick to produce one-dimensional vectors between pairs of visual landmarks without seeing the intermediate landmarks. The ability of the monkeys to perform the task and generalize to new pairs indicated that they relied on a structured representation of the landmarks. Task-modulated neurons exhibited periodicity and ramping that matched the temporal structure of the landmarks and showed signatures of continuous attractor networks12,13. A continuous attractor network model of path integration14 augmented with a Hebbian-like learning mechanism provided an explanation of how the system could endogenously recall landmarks. The model also made an unexpected prediction that endogenous landmarks transiently slow path integration, reset the dynamics and thereby reduce variability. This prediction was borne out in a reanalysis of firing rate variability and behaviour. Our findings link the structured patterns of activity in the entorhinal cortex to the endogenous recruitment of a cognitive map during mental navigation.

BackgroundWhile the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co‐occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas.AimsTo explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co‐occurring SLCN and mental health difficulties.Methods & ProceduresSemi‐structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data.Outcomes & ResultsParticipants felt that SLCN and mental health difficulties frequently co‐occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial.Conclusions & ImplicationsFuture research should explore and evaluate current services and service set‐up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population.WHAT THIS PAPER ADDSWhat is already known on the subjectResearch suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well‐being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under‐researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties.What this paper adds to existing knowledgeSLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co‐occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined.What are the potential or actual clinical implications of this work?This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention‐based studies.

BackgroundDespite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., “unexplored territory” or “going in circles”) serves as a robust marker of mental navigation.MethodsUsing large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation.ResultsWe found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play.ConclusionMental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.

BackgroundChildren with mental health difficulties are at increased risk of many adverse psychological, academic, and social outcomes. Emotion regulation is a key transdiagnostic factor in the development and maintenance of mental health challenges. Parents and the family system (e.g., parental functioning, parenting, parent-child relationship) play a central role in children’s development of emotion regulation and, in turn, their mental health. Therefore, continued efforts are needed to understand the effectiveness of emotion-focused treatments for child mental health difficulties, particularly those that include a family-based approach. Emotion Focused Family Therapy (EFFT) is an intervention for parents of children with mental health difficulties that teaches parents advanced skills to support their child’s emotional development, potentially leading to improvements in the psychological functioning of the affected child as well as the family. Despite this, EFFT’s efficacy has yet to be tested empirically via a randomized controlled trial.MethodsA six-week group modality of EFFT was developed based on the standard manualized version of a two-day group modality of EFFT. Efficacy of the six-week group modality of EFFT will be tested in a randomized controlled trial among parents of children aged 7 to 15 with anxiety, depression, or behavioral challenges. Parents will be randomized to the intervention condition or waitlist control condition. Online questionnaires and in-lab assessments will be conducted at pre-treatment, post-treatment, 4-month follow-up and 1-year follow-up. Intervention effects on primary (parent psychological symptoms, child psychological symptoms, parent emotion regulation, child emotion regulation, parent-child co-regulation) and secondary (parental emotion socialization, parent emotion blocks, parental self-efficacy, perceived parental stress, treatment satisfaction, treatment fidelity) outcomes will be analyzed by linear mixed models.DiscussionThe study protocol describes the randomized controlled trial of EFFT, a parent group intervention for parents of children with anxiety, depression, and behavioral challenges. Findings contribute to the understanding of the efficacy of EFFT as a time-limited, transdiagnostic intervention for the treatment of child mental health challenges with potential positive impacts on parent and family functioning.Trial registration [2a]ClinicalTrials.gov: NCT05603000. Prospectively registered October 13, 2022.Protocol version [3]Version 1.1 November 2023.

Spatial information is typically represented in memory in a form that facilitates operations like spatial reasoning, mental navigation, search, and perspective shifts. This apparently happens whether learning is through primary experience or description, and it appears to happen whether the learned configuration is large- or small-scale. Typical methods used in the cognitive map and mental models literatures diverge, however, in several ways that might affect representation (e.g., medium of input at learning, size of the referent situation, and delay from learning to test). The cognitive map literature shows that spatial representation of large-scale environments persists, though often biased toward spatial simplification over time. This represents one optimal solution to the problem of retaining information in a form that facilitates likely cognitive operations while minimizing resources devoted to storing the information. The current studies investigate whether mental models learned from description are subject to the same tendencies or whether they revert with time to a less spatial format that better optimizes cognitive economy. Secondly, these studies investigate the extent to which visual input at learning affects how the information is represented.KeywordsMental ModelSpatial ModelSpatial RepresentationProbe TypeInference ProbeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Generative Predictive Codes by Multiplexed Hippocampal Neuronal Tuplets

Accessible Summary Some people with a learning disability need to go to hospital to get help with their mental health or if they have challenging behaviour. We wanted to see if we could help people get the right support at home so they did not have to go to hospital We had a special meeting to help this happen called a ‘Planning Live’ meeting These meetings helped some people stay at home and get support without having to go to hospital. For the people who had to come into hospital, they had a shorter stay and could go home more quickly. AbstractBackground: Recent government policy has focused on reducing the number of people with a learning disability receiving treatment for challenging behaviour or mental health difficulties in hospitals (including in assessment and treatment units; ATU). People with a learning disability should be supported to remain in their community when receiving support for challenging behaviour or mental health difficulties whenever possible.Methods: This study considered a novel intervention based on person‐centred planning practice, which aimed to coordinate a person's support, identify outstanding needs and increase communication. This intervention intended to reduce rates of inpatient admission, and support the person to remain in their community, whilst ensuring their needs are met. This intervention was assessed by considering the number of people admitted to the inpatient services before and after the intervention, the length of inpatient admissions before and after the intervention, and by analysing qualitative feedback from participants in the intervention.Results: ‘Planning Live’ meetings were held for 102 people. Forty‐five meetings were held retrospectively following an emergency admission. Following the ‘Planning Live’ meeting, five people had a planned admission and 52 people did not have an inpatient admission. The median length of inpatient stay fell from 143.5 days before the introduction of ‘Planning Live’ to 66 days (a statistically significant reduction). Qualitative feedback shows that the process was largely seen as helpful by professionals, families and individuals taking part in the meetings.Conclusions: The results suggest this person‐centred intervention contributed towards a reduction in the amount of time individuals stayed in hospital. However, the total number of hospital admissions rose following the intervention.

BackgroundSelf-injurious behavior (SIB) in adolescents is a pressing public health issue, compounded by emotional dysregulation, behavioral challenges, and increased suicide risk. While much research has focused on interpersonal trauma, the impact of non-interpersonal traumatic events—such as those stemming from the COVID-19 pandemic—remains less clear.MethodsWe investigated the associations between SIB, mental health difficulties, and COVID-19–related traumatic stress in a non-clinical sample of 5,612 Greek adolescents (55.4% female; mean age = 13.42 ± 0.96 years) from the Global Child and Adolescent Mental Health Study. Participants completed the Strengths and Difficulties Questionnaire (SDQ) to assess emotional symptoms, conduct problems, hyperactivity, and peer difficulties, and the Children’s Revised Impact of Event Scale-8 (CRIES-8) to evaluate post-traumatic stress symptoms. SIB was assessed via self-report, and specific COVID-19–related experiences (e.g., quarantine, hospitalization) were recorded alongside measures of suicidal ideation and suicide attempts.ResultsOverall, 25.5% (n = 1,424) of adolescents reported engaging in SIB, 28.1% (n = 1,566) endorsed suicidal ideation, and 8.4% (n = 471) had attempted suicide. Adolescents reporting SIB had significantly higher total SDQ scores (M = 17.47 [SD = 5.82]) than those without (M = 11.22 [SD = 5.40]; p < 0.001). In logistic regression analyses, each one-point increase in emotional symptoms (OR = 1.17, 95% CI [1.12, 1.21]), conduct problems (OR = 1.17, 95% CI [1.12, 1.23]), and peer problems (OR = 1.08, 95% CI [1.03, 1.15]), as well as each one-point decrease in prosocial behavior (OR = 0.92, 95% CI [0.88, 0.96]), significantly elevated the odds of SIB. Moreover, higher intrusive symptoms on the CRIES-8 were modestly associated with increased odds of SIB (OR = 1.03, 95% CI [1.01, 1.05]). Among COVID-19–related experiences, personal hospitalization due to COVID-19 predicted SIB (OR = 1.26, 95% CI [1.04, 1.53]). Additionally, female gender (OR = 2.33, 95% CI [2.04, 2.63]), suicidal ideation (OR = 4.82, 95% CI [4.09, 5.69]), and a history of suicide attempts (OR = 5.08, 95% CI [3.77, 6.83]) further compounded the risk.ConclusionsOur findings demonstrate a multifaceted interplay between mental health difficulties and trauma-related stress in the emergence of SIB among adolescents. These data highlight the importance of early detection and targeted interventions addressing both emotional dysregulation and trauma-specific symptoms, particularly for youth with direct, severe COVID-19 experiences, to mitigate SIB and its associated risks.

When humans mentally “navigate” bidimensional uniform conceptual spaces, they recruit the same grid-like and distance codes typically evoked when exploring the physical environment. Here, using fMRI, we show evidence that conceptual navigation also elicits another kind of spatial code: that of absolute direction. This code is mostly localized in the medial parietal cortex, where its strength predicts participants’ comparative semantic judgments. It may provide a complementary mechanism for conceptual navigation outside the hippocampal formation.

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings. Key learning aims (1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions. (2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties. (3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care.

The study of navigation is informed by ethological data from many species, laboratory investigation at behavioural and neurobiological levels, and computational modelling. However, the data are often species-specific, making it challenging to develop general models of how biology supports behaviour. Wiener et al. outlined a framework for organizing the results across taxa, called the ‘navigation toolbox’ (Wiener et al. In Animal thinking: contemporary issues in comparative cognition (eds R Menzel, J Fischer), pp. 51–76). This framework proposes that spatial cognition is a hierarchical process in which sensory inputs at the lowest level are successively combined into ever-more complex representations, culminating in a metric or quasi-metric internal model of the world (cognitive map). Some animals, notably humans, also use symbolic representations to produce an external representation, such as a verbal description, signpost or map that allows communication of spatial information or instructions between individuals. Recently, new discoveries have extended our understanding of how spatial representations are constructed, highlighting that the hierarchical relationships are bidirectional, with higher levels feeding back to influence lower levels. In the light of these new developments, we revisit the navigation toolbox, elaborate it and incorporate new findings. The toolbox provides a common framework within which the results from different taxa can be described and compared, yielding a more detailed, mechanistic and generalized understanding of navigation.

ABSTRACTAIM: This exploratory mixed methods study aimed to inform future research by investigating if teachers and children from one primary school perceived any changes in children’s social, emotional and mental health difficulties following art therapy and if so, what the children perceived as helpful about the sessions. METHODS: The study included 45 children and 10 class teachers within one UK primary school. The researchers analysed routine questionnaires from teachers and a children's evaluation interviews, triangulating these with data from a teacher focus group. RESULTS: The findings show significant and medium effect sizes for positive teacher-rated changes in children’s overall stress, conduct, hyperactivity, and procsocial behaviour and a large effect on perceived impact of children’s difficulties on their lives. Teacher-rated emotional distress and peer problems showed small changes that did not reach statistical significance. The positive changes were corroborated by the teachers' and children's qualitative reports. Aspects of art therapy which children found particularly helpful were; making and thinking about art; expressing, thinking and learning about thoughts and feelings; and sessions being fun. CONCLUSION: The study highlighted perceived positive changes and no negative changes in children’s SEMH difficulties. However, future research is necessary to examine clinical effectiveness.Plain-language summaryIn this article we describe a research study which aimed to explore if teachers and children perceived any changes to children’s social, emotional or mental health difficulties after the children attended art therapy within their primary school. We were also interested in learning from the children if they thought anything in particular had been helpful about their art therapy sessions in order to inform future research and the development of this particular approach to art therapy.The art therapists asked the class teachers to fill out a Strengths and Difficulties Questionnaires at the beginning and end of art therapy. The class teachers also attended a focus group so we could learn more about their general observations of the children before and after attending art therapy. The art therapists also interviewed the children to learn if they perceived any changes since coming to art therapy and if so, what in particular they thought had helped bring about these changes.We found that statistical analysis of the questionnaire scores mostly agreed with what the teachers and children said and that there was generally some positive change to the social, emotional and mental health difficulties the children had been experiencing. The teachers also let us know that some of the children still had residual problems. The children emphasised that making and thinking about art along with expressing, thinking and learning about thoughts and feelings had been particularly helpful. It was also important to the children that the sessions were fun.In conclusion, the teachers and children in this primary school perceived art therapy as helpful to the children and that it merits further research in order to develop the approach used by the art therapists and to see if it is effective in larger research studies including more children, schools and art therapists.

WHAT IS KNOWN ON THE SUBJECT?: The COVID-19 pandemic has induced a considerable amount of mental health difficulties, ranging from anxiety and depression to psychosis. As services struggle to cope with the demand for support, the effect of such psychological challenges on quality of life remains a major concern. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Since the beginning of the COVID-19 pandemic, a vast amount of research has focused on the physical consequences of the virus. Gradually, studies on the mental health effects related to the pandemic started to emerge, as it became clear that mental health difficulties were as present and as concerning as the physical ones. Whilst such studies commonly explore the prevalence and nature of the presenting mental health challenges, the publication of personal mental health experiences linked to the ongoing situation is lacking. Introducing the human element in literature is an important means of raising awareness on the mental health difficulties that can be triggered by the pandemic. Using public figures such as the individual in this paper is additionally powerful due to the role model effect. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The paper highlights the need for enhanced awareness and monitoring of mental health especially by health professionals who therefore need to receive adequate mental health training. Furthermore, mental health awareness efforts need to be considered as being a part of the role of the psychiatric and mental health nurse who is at a prime position to educate, monitor and support those receiving care.

The role of schemas in the experience of distress, burden, and wellbeing in parents and siblings of people with serious mental health difficulties.

Accessible summary Network Training is a way that helps people to understand behaviour like hurting people or breaking things, called ‘challenging behaviour’. Network Training is where lots of people meet up to think about the person showing challenging behaviour. We did Network Training to help understand the behaviours of a boy who has a learning disability. His support workers, teachers and doctors came to think about what was making him show challenging behaviours. The people who came to the training thought that it was useful. Abstract Background: Network Training is an intervention that draws upon systemic ideas and behavioural principles to promote positive change in networks of support for people defined as having a learning disability. To date, there are no published case studies looking at the outcomes of Network Training. Materials and Methods: This study aimed to investigate the impact of Network Training on a network of support for a boy labelled as having learning disabilities and challenging behaviour, including sexually harmful behaviour. Participants in the Network training completed two questionnaires; one designed for this study and The Challenging Behaviours Attributions Scale at two baseline points and following the intervention. Results: Network Training led to positive changes in the confidence, understanding, strengths focus and joint working of the individual's network. There was no significant change in participants' CHABA scores. Conclusion: This case study provides preliminary evidence that Network Training may be of benefit to children labelled as having learning disabilities, and merits further investigation.