Negative Cues Research Articles

The effects of valid and invalid expectations about stimulus valence on behavioural and electrophysiological responses to emotional pictures

Previous studies have shown that uncertainty about the expected valence of an upcoming stimulus modulates behavioural and neural responses to the stimulus. However, relatively little is known about how invalid emotion expectations (i.e. expecting a positive picture but seeing a negative picture) affect neural and behavioural responses. To investigate this, two experiments were conducted where participants viewed and rated the pleasantness of emotional pictures that were preceded by a cue. In Experiment 1, there were three cue conditions: uncertain, valid and invalid. The uncertain cue did not indicate the valence of the upcoming picture, whereas cues in the valid condition (70% of positive and negative cues) correctly indicated the valence of the upcoming picture. The remaining trials were invalid, where the valence of the picture differed from the expected valence. Behavioural results showed that invalidly cued negative pictures elicited more neutral valence ratings compared to validly cued pictures. In Experiment 2 we replicated the findings of Experiment 1, and in addition found an increased amplitude for the early (400–600 ms) portion of the late positive potential (LPP) for invalidly compared to validly cued pictures. Together, these results show that invalid expectations influence the neural and behavioural processing of subsequently presented emotional pictures, where invalidly cued pictures led to attenuated (i.e., more neutral) emotional responses, and enhanced early LPP amplitude, compared to validly cued pictures.

Ambiguous Bodies: The Role of Displayed Arousal in Emotion [Mis]Perception

Emotions of other people cannot be experienced directly but are often inferred from a variety of verbal and nonverbal information, including expressive body movement (EBM). Inferring emotional states is critical in social interaction, and questions remain about the factors contributing to ambiguity of EBM. In addressing this issue, researchers have looked to the link between displayed arousal, or the intensity of the emotional expression, and the potency of a nonverbal signal to convey emotional content such as valence or category. This study reports experimental results that address limitations of prior research regarding the ambiguity of EBM. Using motion-capture technology that permits isolation of expressive cues, the results suggest that for displays of anger and happiness (a) the ambiguity of the emotional valence and category increases as a linear function of the displayed arousal, and (b) observers show a negative response bias and greater sensitivity to negative cues. Implications of these findings for research on emotion perception are discussed.

Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking?

ObjectivesTo counter the attractiveness of cigarettes, Article 11 of the Framework Convention on Tobacco Control provides for the possibility of including warnings on cigarettes. The objective of our research was to explore perceptions of cigarettes designed to be dissuasive (displaying the warning ‘Smoking kills’ in uppercase or lowercase, a ‘skull and crossbones’ pictogram, unattractive shades of brown or dark green or a combination of all these negative cues). Study designIn-depth interviews were conducted with 31 people in France aged 15–25 years (10 daily smokers, 10 occasional smokers and 11 non-smokers; 15 females and 16 males). MethodsParticipants were shown different dissuasive cigarettes (displaying the warning ‘Smoking kills’, a ‘skull and crossbones’ pictogram, unattractive shades of brown or dark green or a combination of all three) and current branded ones. Open-ended questions were asked about the attractiveness of the cigarettes, perception of risk, the image of the smoker and influence on the desire to quit or not to start. Discussions were audio-recorded and transcribed. ResultsThe different dissuasive cues were found to increase negative health perceptions (e.g., increase risk), reduce positive smoker image and the perceived pleasure of smoking (e.g., embarrassment of smoking in front of friends), decrease the desire to start smoking and increase the desire to quit. The most dissuasive cigarette was an unattractively dark-coloured cigarette which displayed both the warning ‘Smoking kills’ and a ‘skull and crossbones’ pictogram. ConclusionThis study highlights the importance of the appearance of cigarettes and suggests that dissuasive cigarettes may be an innovative tobacco control measure for governments.

Understanding associations between negatively biased attention and depression and social anxiety: positively biased attention is key

ABSTRACTBackground and objectives: Although research supports the premise that depressed and socially anxious individuals direct attention preferentially toward negative emotional cues, little is known about how attention to positive emotional cues might modulate this negative attention bias risk process. The purpose of this study was to determine if associations between attention biases to sad and angry faces and depression and social anxiety symptoms, respectively, would be strongest in individuals who also show biased attention away from happy faces.Methods: Young adults (N = 151; 79% female; M = 19.63 years) completed self-report measures of depression and social anxiety symptoms and a dot probe task to assess attention biases to happy, sad, and angry facial expressions.Results: Attention bias to happy faces moderated associations between attention to negatively valenced faces and psychopathology symptoms. However, attention bias toward sad faces was positively and significantly related to depression symptoms only for individuals who also selectively attended toward happy faces. Similarly, attention bias toward angry faces was positively and significantly associated with social anxiety symptoms only for individuals who also selectively attended toward happy faces.Conclusions: These findings suggest that individuals with high levels of depression or social anxiety symptoms attend preferentially to emotional stimuli across valences.

Individual differences in resting-state connectivity and giving social support: implications for health.

There is a growing appreciation for the health benefits of giving support, though variability in such behavior exists. Based on the possibility that the dorsomedial (DMPFC) default network subsystem is associated with social thinking and behavior, integrity of this subsystem may facilitate giving support to others. The current study tested associations between DMPFC subsystem connectivity at rest and tendencies related to giving support. During a functional magnetic resonance imaging session, 45 participants completed an emotional social cues task, a resting-state scan and self-report measures of social support. Supportive behavior during the month following the scan was also assessed. Greater DMPFC subsystem connectivity at rest was associated with greater support giving (though not receiving or perceiving support) at the time of the scan and one month later. Results held after adjusting for extraversion. In addition, greater resting-state DMPFC subsystem connectivity was associated with attenuated dorsal anterior cingulate cortex, anterior insula and amygdala activity to others’ negative emotional social cues, suggesting that DMPFC subsystem integrity at rest is also associated with the dampened withdrawal response proposed to facilitate care for others in need. Together, results begin to hint at an additional role for the ‘default’ social brain: giving support to others.

TTYL :-) … Nonverbal cues and perceptions of personality and homophily in synchronous mediated communication

ABSTRACT Person perception is an integral aspect of human communication and is increasingly relevant in computer-mediated communication (CMC) because of the mobile and ubiquitous nature of mediated communication. Based on the hypothesis that nonverbal cues in CMC such as emoticons, acronyms, exaggerated spellings, acronyms, and altered sentence structure are similar to face-to-face nonverbal cues and have similar communicative outcomes, this study examines the effect of nonverbal cues in online synchronous interactions on perceptions of personality and homophily. Employing a between-subjects post-test experimental design, participants (N = 505) were randomized to view one of three transcripts of an instant messaging conversation in which nonverbal cues along with the valence were manipulated. Results showed that subjects in the positive nonverbal cues condition were perceived to be extraverted and agreeable; those in the negative nonverbal cues condition were perceived to be neurotic, and those in the control condition were perceived to be conscientiousness and homophilous. The findings suggest that nonverbal cues in synchronous mediated communication allow individuals to engage in impression formation.

P146 Fine Motor Development Through Mealtime Lessons in Head Start Classroom

Background Early childhood nutrition and kindergarten readiness are pillars of child development. Factors such as food insecurity, socioeconomic status and the built environment effect childhood nutrition and academic success. This project aims to improve fine motor development through concentrated mealtime activities. Objective Assess the feasibility of a mealtime curricula to promote fine motor skill development in Head Start classrooms. Study Design, Settings, and Participants First teacher surveys and in-depth interviews, were administered, collecting demographic information, teacher responsibilities, and the classroom environment. Mealtime observational assessments were collected at baseline, mid-point, and end of study period. Eight week-long mealtime fine motor skill lessons were implemented. Post implementation evaluation surveys were conducted. Measurable Outcome/Analysis Descriptive analysis was conducted of survey data, including correlation analysis of teacher knowledge/ experience/ values and classroom facilitators and barriers. Interviews collected facilitators and barriers of mealtime feasibility, constraints, and perceptions of familial mealtime practices. Qualitative data were coded for themes using a three-coder model. Classroom observation data was categorized by feeding style, pedagogical approach, barriers, positive/ negative feeding cues, and other factors of mealtime facilitation. Lesson plan evaluations provided teacher perspectives of project feasibility. Results Key interview and survey findings included a teacher focus of role-modeling during meal-time, behavior reinforcement, and attempts of parent communication. Furthermore, teachers desire tools to help with mealtime feeding behaviors and skill building. Overall, teachers were successful in implementing fine motor lessons. Lessons which practice fine motor skills in multiple settings were rated most positively. Barriers of implementation included breaks in the school schedule, lack of parent reinforcement, and unpredictable menu cycles. Conclusion Teachers were overall positive and willing to implement mealtime lessons, and reported positive feedback regarding increased structure around mealtime. Mealtime lessons present an opportunity to merge concepts of fine motor development and positive feeding practices. Funding Texas State University, Caminitos Research Collaborative.

Stress as Offense to Self: a Promising Approach Comes of Age

Stress is related to goals being thwarted. Arguably, protecting one’s self, both in terms of personal self-esteem and in terms of social self-esteem, is among the most prominent goals people pursue. Although this line of thought is hardly disputed, it does not play the prominent role in occupational health psychology that we think it deserves. Stress-as-Offense-to-Self theory focuses on threats and boosts to the self as important aspects of stressful, and resourceful, experiences at work. Within this framework we have developed the new concepts of illegitimate tasks and illegitimate stressors; we have investigated appreciation as a construct in its own right, rather than as part of larger constructs such as social support; and we propose that the threshold for noticing implications for the self in one’s surroundings typically is low, implying that even subtle negative cues are likely to be appraised as offending, as exemplified by the concept of subtly offending feedback. Updating the first publication of the SOS concept, the current paper presents its theoretical rationale as well as research conducted so far. Research has covered a variety of phenomena, but the emphasis has been (a) on illegitimate tasks, which now can be considered as an established stressor, and (b) on appreciation, showing its importance in general and as a core element of social support. Furthermore, we discuss implications for further research as well as practical implications of an approach that is organized around threats and boosts to the self, thus complementing approaches that are organized around specific conditions or behaviors.

Associations of depression severity with heart rate and heart rate variability in young adults across normative and clinical populations

Limitations of current depression treatments may arise from a lack of knowledge about unique psychophysiological processes that contribute to depression across the full range of presentations. This study examined how individual variations in heart rate (HR) and heart rate variability (HRV) are related to depressive symptoms across normative and clinical populations in 152 young adults (aged 18–35 years). Moderating effects of sex and antidepressant medication status were considered. Electrocardiogram data were collected during “vanilla” baseline and in response to positive and negative emotional cues. Linear regressions and repeated-measures mixed models were used to assess the relationships between Beck Depression Inventory-II (BDI-II) scores, sex, antidepressant use, and cardiovascular outcomes. Baseline models yielded significant main effects of BDI-II and sex on HR and significant interactions between antidepressant medication status and BDI-II on HRV outcomes. The main effects of BDI-II and sex on HR were no longer significant after controlling for cardiorespiratory fitness. Participants who denied current antidepressant use (n = 137) exhibited a negative association and participants who endorsed current antidepressant (n = 15) use exhibited a positive association between BDI-II scores and HRV. Emotional reactivity models were largely non-significant with the exception of a significant main effect of antidepressant medication status on high-frequency HRV reactivity. Results indicated antidepressant medication use may moderate the relationship between depression severity and cardiovascular functioning, but this requires replication given the modest proportion of medicated individuals in this study. Overall, findings suggest cardiovascular processes and cardiorespiratory fitness are linked to depression symptomatology and may be important to consider in depression treatment.

Association between cue lead time and template-for-rejection effect.

The human visual system can actively prioritize task-relevant features to search for a target. Recent studies have reported cases in which the system may suppress irrelevant features by using a template for rejection. However, in those studies, the templates used for rejection were limited to the color domain, and they have yielded mixed results. Our literature review identified three differences among studies that may be responsible for such mixed results: differences in the spatial segmentation of items (i.e., segregated or intermixed across the display), differences in how features are defined and reported (i.e., combined or separate), and differences in cue lead times (short or long). Participants searched for a target-line segment in a shape and identified its orientation from among non-target line-shaped compound shapes that were preceded by one of three cue displays. Positive cues indicated that the target segment would appear in a shape, and negative cues that it would not appear in a shape. Neutral cues indicated that a particular shape would not appear in the current search display. The results demonstrated that reaction times were faster under the negative-cue condition than the neutral-cue condition, reflecting the effect of a shape-based template for rejection (Experiment 1). Experiment 2 replicated the absence of the effect in the shape domain. Experiment 3 indicated that the template-for-rejection effect occurred only when the cue lead time was relatively long, suggesting that time is required (approximately 2,400 ms or longer) for the visual system to form rejection templates. Experiment 4 excluded the possibility that a confound in the target-defining/reporting feature was involved. These results indicated that apparent inconsistencies in research on the template-for-rejection effect can be explained in terms of the time required for templates to be configured.

Reduced autobiographical memory specificity affects general distress through poor social support

ABSTRACTSharing specific autobiographical events is likely to influence the support people give us; a person who shares little detail of their lives may be unlikely to attract social support and this may in turn contribute towards anxious and depressive symptoms. Participants (N = 142) reported memories evoked by negative and positive cue words and these memories were coded for whether or not they referred to a specific event lasting less than 24 h. At this time (T1) and one year later (T2), participants also completed the UCLA Life Stress Interview (LSI), which includes a measure of social support, and measures of depression and anxiety comprising a general distress latent construct. The tendency to recall fewer specific memories was associated with lower social support given by friends and romantic partners and this was in turn associated with elevated general distress at T2, even when accounting for T1 social support and general distress. Our findings contribute to the literature regarding the social function of memory and suggest another route via which reduced specificity contributes to emotional disorders.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BackgroundChildhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child’s ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues—such as during cognitive reappraisal—buffers risk for internalizing symptoms following exposure to adversity. MethodsWe provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging. ResultsAmong maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment. ConclusionsThese preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

Styrene, (+)-trans-(1R,4S,5S)-4-Thujanol and Oxygenated Monoterpenes Related to Host Stress Elicit Strong Electrophysiological Responses in the Bark Beetle Ips typographus

Bark beetles kill apparently vigorous conifers during epidemics by means of pheromone-mediated aggregation. During non-endemic conditions the beetles are limited to use trees with poor defense, like wind-thrown. To find olfactory cues that help beetles to distinguish between trees with strong or weak defense, we collected volatiles from the bark surface of healthy felled or standing Picea abies trees. Furthermore, living trees were treated with methyl jasmonate in order to induce defense responses. Volatiles were analyzed by combined gas chromatography and electroantennographic detection (GC-EAD) on Ips typographus antennae. Compounds eliciting antennal responses were characterized by single sensillum recording for identification of specific olfactory sensory neurons (OSN). Release of monoterpene hydrocarbons decreased, while oxygenated compounds increased, from spring to early summer in felled trees. In both beetle sexes particular strong EAD activity was elicited by trace amounts of terpene alcohols and ketones. 4-Thujanol gave a very strong response and the absolute configuration of the tested natural product was assigned to be (+)-trans-(1R,4S,5S)-thujanol by stereoselective synthesis and enantioselective gas chromatography. One type of OSN responded to all ketones and five other OSN were characterized by the type of compounds that elicited responses. Three new OSN classes were found. Of the eight EAD-active compounds found in methyl jasmonate-treated bark, the known anti-attractant 1,8-cineole was the one most strongly induced. Our data support the hypothesis that highly active oxygenated host volatiles could serve as positive or negative cues for host selection in I. typographus and in other bark beetles.

Factor and reliability analysis of a brief scale to measure motivation to change lifestyle for dementia risk reduction in the UK: the MOCHAD-10

BackgroundModifying lifestyle risk factors for dementia is a public health priority. Motivation for change is integral to the modification of health-related risk behaviours. This study investigates the psychometric properties of the previously validated tool entitled ‘Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction Scale’ (MCLHB-DRR) for use in the UK.MethodsA sample of 3,948 individuals aged 50 and over completed the 27-item MCLHB-DRR online. The psychometric properties of the scale were explored via Exploratory Principal Axis Factoring (PAF) with Oblimin rotation. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure using chi-square (χ2), the goodness-of-fit index (GFI), the comparative fit index (CFI), the root mean square error of approximation (RMSEA) and Root Mean Square Residual (RMR) as fit indices to evaluate the model fit. Internal consistency (Cronbach α) was measured for the final scale version.ResultsExploratory Factor Analysis (EFA) resulted in a parsimonious 10-item, two-factor structure (5 items each, factor loadings > 0.3) that explained 52.83% of total variance. Based on the Pattern Matrix, Factor 1 was labelled “Positive Cues to Action” and Factor 2 was labelled “Negative Cues to Action”. After addressing some errors in covariances, CFA showed a good fit where all fit indices were larger than 0.90 (GFI = 0.968, CFI = 0.938) and smaller than 0.08 (RMSEA = 0.072, RMR = 0.041). The standardized coefficients of Factor 1 and Factor 2 ranged from 0.30 to 0.73 and were all statistically significant (p < 0.001). The final scale showed moderate to high reliability scores (Factor 1 α = 0.809; Factor 2 α = 0.701; Overall α = 0.785).ConclusionsThe new MOCHAD-10 (Motivation to Change Behaviour for Dementia Risk Reduction Scale) is a short, reliable and robust two-factor, 10-item clinical tool for use in preventative health care and research to evaluate motivation to change lifestyle for dementia risk reduction.

Shifts in momentary motivation to quit smoking based on experimental context and perceptions of motivational instability

BackgroundSmoking quit intentions (i.e., plans or commitments to reduce smoking) are distinct from quit motivation (i.e., desire to quit). Motivation to quit is a dynamic avoidance motivational state, likely subject to frequent fluctuations and shifts based on environmental context, similar to craving (an approach motivational state). Moreover, people's perceptions of motivational instability may influence their momentary quit motivation and beliefs surrounding their abilities to manage the quit process successfully. MethodsIn the current study, smokers were recruited online. Baseline motivation to quit was examined along with perceptions of motivational instability. Participants who reported some interest in eventually quitting (n = 174; Mage = 45.29, SD = 14.81, 74.1% women) were randomly assigned to negative affect, cigarette or neutral cue conditions and then momentary motivation to quit was assessed, followed by a validated index of quit intentions. ResultsParticipants in the negative affect and cigarette cue conditions reported greater momentary motivation to quit than participants in the neutral condition (F = 3.73, p = .03), particularly for people who reported upfront that their motivation did not change from day-to-day (F = 3.97, p = .02). In addition, greater momentary quit motivation predicted stronger quit intentions (B = 0.66, p < .001). ConclusionFindings from this study suggest that motivation to quit is likely dynamic and influenced by context as well as by self-perceptions. Implications suggest that further efforts to separate motivation from intention may be useful in understanding smokers' desires and plans to quit smoking.

Evidence of reward system dysfunction in youth at clinical high-risk for psychosis from two event-related fMRI paradigms

Abnormal reward processing is thought to play an important role in the development of psychosis, but relatively few studies have examined reward prediction errors, reinforcement learning (RL), and the reward circuitry that subserves these interconnected processes among individuals at clinical high-risk (CHR) for the disorder. Here, we present behavioral and functional neuroimaging results of two experimental tasks designed to measure overlapping aspects of reward processing among individuals at CHR (n = 22) and healthy controls (n = 19). We found no group differences in response times to positive, negative, or neutral outcome-signaling cues, and no significant differences in brain activation during reward anticipation or receipt. Youth at CHR, however, displayed clear RL impairments, as well as attenuated responses to rewards and blunted prediction error signals in the ventral striatum, dorsal anterior cingulate cortex (dACC), and ventromedial prefrontal cortex (vmPFC). Greater contrasts for cue valence (gain-loss) and outcome magnitude (large-small) in the vmPFC were associated with more severe negative symptoms, and deficits in dACC signaling during RL were associated with more depressive symptoms. Our results provide evidence for RL deficits and abnormal prediction error signaling in the brain's reward circuitry among individuals at CHR, while also suggesting that reward motivation may be relatively preserved at this stage in development. Longitudinal studies, medication-free participants, and comparison of neurobehavioral measures against both healthy and clinical controls are needed to better understand the role of reward system abnormalities in the development of psychosis.

Behavioral Adaptation to Negative Social Cues in Depressed Patients According to Personal History of Suicide Attempt- COMPASS

Behavioral Adaptation to Negative Social Cues in Depressed Patients According to Personal History of Suicide Attempt- COMPASS

Collective Cell Migration: Wisdom of the Crowds Transforms a Negative Cue into a Positive One

The Semaphorin ligands and their Plexin receptors are known to induce cell-cell repulsion. A new study now finds that protrusion collapse, induced by Semaphorin-5C-Plexin-A interactions at the cell-cell contact, promotes planar polarization and collective migration of follicular cells in Drosophila.

Out of Context, Beyond the Face: Neuroanatomical Pathways of Emotional Face-Body Language Integration in Adolescent Offenders.

Background: Adolescent offenders (AOs) are characterized by social-norm transgression and aggressive behaviors. Those traits have been associated with alterations in socio-cognitive processes, including facial emotion recognition. While this would suggest that AOs tend to interpret negative emotional cues as threatening information, most research has relied on context-free stimuli, thus failing to directly track integrative processes typical of everyday cognition.Methods: In this study, we assessed the impact of body language and surrounding context on facial emotion recognition in AOs and non-offenders (NOs). We recruited 35 AOs from a reform school for young male offenders and 30 NOs matched for age and sex with the former group. All participants completed a well-validated task aimed to determine how contextual cues (i.e., emotional body language and surrounding context) influence facial emotion recognition through the use of congruent and incongruent combinations of facial and bodily emotional information.Results: This study showed that AOs tend to overvalue bodily and contextual signals in emotion recognition, with poorer facial-emotion categorization and increased sensitivity to context information in incongruent face-body scenarios. This pattern was associated with executive dysfunctions and disruptive behaviors, as well as with gray matter (GM) of brain regions supporting body-face recognition [fusiform gyrus (FG)], emotion processing [cingulate cortex (CC), superior temporal gyrus (STG)], contextual integration (precuneus, STG), and motor resonance [cerebellum, supplementary motor area (SMA)].Discussion: Together, our results pave the way for a better understanding of the neurocognitive association between contextual emotion recognition, behavioral regulation, cognitive control, and externalized behaviors in AOs.

Gaze-contingent Attention Bias Modification Training and its Effect on Attention, Interpretations, Mood, and Aggressive Behavior

Cognitive theories propose that aggression is associated with specific patterns of attention to social cues, and suggest that cognitive biases in attention and interpretation are interrelated, The current study tested whether these attention patterns can be altered using a single session of a novel gaze-contingent cognitive bias modification paradigm (CBM-A) and assessed the impact of this on interpretation bias, aggressive behavior and mood. University students (18–31 years) were randomly assigned to either a single session of positive training (n = 40) aimed at increasing attention to pro-social cues, or negative training (n = 40) aimed at increasing attention to negative cues. Results showed that the positive training indeed resulted in an increase in pro-social attention bias, while the negative training seemed not to have an effect on attention to negative cues. Both groups did not differ on their interpretations, mood levels, self-reported aggression and behavioral aggression. Findings suggest that this novel gaze-contingent CBM-A paradigm can indeed alter biased gaze processes, but may not impact interpretations, aggression and mood. The current study was conducted in a non-clinical sample, further research with a clinical aggressive sample, such as forensic patients is necessary to further explore these issues.