Targets For Psychological Interventions Research Articles

P060 Pilot study showing the efficacy and acceptability of an acceptance and commitment therapy based brief psychological intervention on mood and disability in patients with early inflammatory arthritis

Abstract Background/Aims Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence base for psychological intervention is scarce and of poor quality. One trial has found CBT intervention early post-diagnosis of rheumatoid arthritis has small to medium effect sizes for depression and anxiety and no effect on disability. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a good evidence base for a number of long term health conditions. The target process in ACT is psychological flexibility, which relates closely to a number of positive life outcomes including adaptive response to illness and trauma. Psychological inflexibility has been shown to be associated with poorer function and psychological wellbeing in chronic pain populations and more recently juvenile idiopathic arthritis specifically. We aimed to evaluate outcomes for a sample (n = 12) of newly diagnosed (within 3 years of diagnosis) patients with inflammatory arthritis who underwent an individualised ACT intervention using patient satisfaction data, qualitative feedback and measures of mood, quality of life and psychological flexibility. Methods Patients received up to 7 sessions of one to one therapy. Outcome measures included PHQ-9, GAD-7, compACT, and Brief Pain Inventory (BPI) and a satisfaction questionnaire with open questions inviting qualitative responses. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. Correlation analysis was conducted using Pearsons correlation coefficients. Results Patients who took part in the brief intervention showed significant improvement in depression, anxiety, quality of life and psychological flexibility. Effect sizes were large. Correlation analysis showed strong correlations between PF and both depression and quality of life. Changes in PF from baseline to end of therapy strongly correlated with changes in depression and disability, and moderately correlated with anxiety. Subanalyses will be presented to understand which particular components of PF most closely relate to improvements in outcomes on disability and mood. Conclusion A brief one to one ACT-based psychological intervention conferred good benefit for a rheumatology population. Results suggest PF is a key therapeutic target in psychological interventions for people with arthritis and that ACT is a viable, highly acceptable and promising alternative to CBT in this population. More studies are needed to understand whether this effect is generalisable and longer-term outcomes. Disclosure L. Maher-Edwards: None. N. Ng: None. D. Gillanders: None.

Cognitive and behavioral factors of quality of life in patients with somatoform disorders

IntroductionStudies of the cognitive and behavioral factors of perpetuation and quality of life in patients with somatoform disorders are important for identifying targets for psychological interventions and risk groups (Piontek et al., 2018, Dehoust et al., 2017, Schaefer et al., 2012, Flasinski et al., 2020).ObjectivesTo reveal beliefs and behavior in patients with somatoform disorders associated severity of somatic complaints and poorer subjective well-being.Methods125 patients with somatoform disorders 17-68 years old filled Screening for Somatoform Symptoms (Rief, Hiller, 2003), Cognitions About Body And Health Questionnaire (Rief et al., 1998), Scale for the Assessment of Illness Behaviour (Rief, Ihle, Pigler, 2003), and Quality of Life Enjoyment and Satisfaction Questionnairie-18 (Ritsner et al., 2005).ResultsSeverity of somatoform symptoms is higher in patients with catastrophization of bodily sensations, autonomic sensations, belief in their bodily weakness, somatosensory amplification, scanning for bodily symptoms, and disturbances in daily activities due to illness (r=.18-.38, p<.05). Adjusting for the severity of somatoform symptoms, subjective well-being was lower in patients with higher belief in their bodily weakness and somatosensory amplification, autonomic sensations, expression of symptoms, and changes in daily activities due to illness (r=.21-.40, p<.05).ConclusionsThe results suggests that regardless of symptoms severity poorer quality of life in patients with somatoform disorders is associated with beliefs about body and body perception that could be addressed in psychotherapy.

Parental Anxiety and Posttraumatic Stress Symptoms in Pediatric Food Allergy

The purpose of this study was to explore anxiety, worry, and posttraumatic stress symptoms (PTSS) in parents of children with food allergies, and to evaluate whether these three psychological outcomes could be predicted by allergy severity, intolerance of uncertainty, and food allergy self-efficacy. Participants were 105 parents who reported their children to have medically diagnosed food allergies. Participants were recruited to a study on parent wellbeing through an allergy clinic and social media advertisements. Participants completed online questionnaires assessing anxiety, worry, PTSS, intolerance of uncertainty, food allergy self-efficacy, and demographic and allergy information. In this sample, 81.0% of parents reported clinically significant worry, 42.3% met the clinical cut-off for PTSS, and 39.1% reported moderate-extremely severe anxiety. Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes, with mixed results for allergy severity. However, intolerance of uncertainty was the only variable to consistently account for unique variance within regression models. This study highlights the need for greater awareness of mental health in parents of children with food allergy. The study also indicates that factors impacting on parents' perception of threat may be most strongly predictive of psychological outcomes, warranting further research. Finally, the study indicates that intolerance of uncertainty may be a promising target for psychological interventions within this population.

Blended cognitive behaviour therapy for children and adolescents with mitochondrial disease targeting fatigue (PowerMe): study protocol for a multiple baseline single case experiment

BackgroundMitochondrial disease is a rare, hereditary disease with a heterogeneous clinical presentation. However, fatigue is a common and burdensome complaint in children and adolescents with mitochondrial disease. No psychological intervention targeting fatigue exists for paediatric patients with a mitochondrial disease. We designed the PowerMe intervention, a blended cognitive behaviour therapy targeting fatigue in children and adolescents with mitochondrial disease. The aim of the intervention is to reduce perceived fatigue by targeting fatigue-related cognitions and behaviours.MethodsA multiple baseline single case experiment will be conducted in five children (8–12 years old) and 5 adolescents (12–18 years old) with mitochondrial disease and severe fatigue. Patients will be included in the study for 33 weeks, answering weekly questions about the fatigue. Patients will be randomly assigned a baseline period of 5 to 9 weeks before starting the PowerMe intervention. The intervention consists of face-to-face and online sessions with a therapist and a website with information and assignments. The treatment will be tailored to the individual. Each patient will work on their personalized treatment plan focusing on personally relevant goals. The primary outcome is perceived fatigue. Secondary outcomes are quality of life, school presence and physical functioning.DiscussionThe results of the PowerMe study will provide information on the efficacy of a blended cognitive behaviour therapy on reducing perceived fatigue and its impact on daily life in children and adolescents with mitochondrial disease. Strengths and limitations of the study design are discussed.Trial registrationDutch Trial Register NTR 7675. Registered on 17 December 2018. Identifier https://www.trialregister.nl/trial/7433

Psychiatric symptoms during the COVID-19 outbreak in older adults with bipolar disorder.

Older adults with bipolar disorder (OABD) are vulnerable for a COVID-19 infection via multiple pathways. It is essential for OABD to adhere to the COVID-19 measures, with potential consequences for the psychiatric symptoms. This situation offers the unique opportunity to investigate factors of vulnerability and resilience that are associated with psychiatric symptoms in OABD. This study included 81 OABD patients aged over 50 years. Factors measured at baseline in patients that participated in 2017/2018 were compared with factors measured during the COVID-19 outbreak. Participants experienced less psychiatric symptoms during COVID-19 than (67.9% euthymic) than at baseline (40.7% euthymic). There was no difference in loneliness between COVID-19 and baseline. Not having children, more feelings of loneliness, lower mastery, passive coping style and neuroticism were associated with more psychiatric symptoms during COVID-19 measures. Participants experienced less psychiatric symptoms during COVID-19 measures when compared to baseline. Our results indicate promising targets for psychological interventions aimed at curing and preventing recurrence in OABD and improving quality of life in this growing vulnerable group.

Psychological processes in the experience of hereditary angioedema in adult patients: an observational study

BackgroundHereditary angioedema associated to C1 inhibitor deficiency (C1-INH-HAE) is a pathological condition characterized by episodes of subcutaneous swelling and it is frequently associated with discomfort and social impairment of the patients, due to the anxiety experienced for an unpreventable manifestation of an attack during daily life. In children increased level of stress and alexithymia have been associated to C1-INH-HAE, and the latter correlated also with the severity of the disease. We hypothesized that the involvement of psychological issues may impact on the severity of C1-INH-HAE in adult patients as well, interfering with their ability to engage with the management of the disease.Methods28 adult patients with C1-INH-HAE were evaluated for clinical (C1-INH-HAE Severity Score) and psychological factors (alexithymia, emotion regulation, stress, patient health engagement, general severity index) by means of validated questionnaires.ResultsMean age (standard deviation [SD]) was 45 (11) years and time from diagnosis was 20 (12) years. The mean C1-INH-HAE severity score was 6.4. Alexithymia was absent in 22 (78%) patients. Moderate and high stress levels were present in 17 (61%) and 4 (14%) patients, respectively. Moderate-high discomfort was experienced by 9 (36%) patients and a discomfort beyond the clinical attention threshold was shown by 3 (12%) patients. Stress correlated with patient health engagement and with psychological discomfort.ConclusionsIn C1-INH-HAE, patients health engagement and moderate-high psychological discomfort are linked with stress but not with the severity of the disease or alexithymia. A better patient health engagement may be a target for psychological intervention in clinics to ameliorate the stress perceived by C1-INH-HAE patients.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic.

BackgroundThis study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic.MethodsA total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields.ResultsMarried, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic.ConclusionIt is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

Feeding the addiction: Narrowing of goals to habits

Whilst the initiation of cocaine use is typically goal-directed and motivated by the rewarding effects of the drug, drug-taking can become habitual over time, rendering the user less sensitive to cocaine's hedonic value. Experimental studies suggest that patients with cocaine use disorder (CUD) are particularly prone to develop habits, even in non-drug related contexts. CUD patients have previously been shown to consume higher levels of high-calorie foods and report more uncontrolled eating, suggesting a tendency towards habitual or dysregulated food-related behaviours. We investigated this in CUD patients compared with healthy controls. Participants were presented with a series of food images and asked to rate their willingness to pay for, and their motivation to consume the foods. Self-reported motivations for food choices were collected using a validated questionnaire. Our data suggests CUD patients display goal-narrowing towards cocaine, as well as habitual tendencies towards both cocaine and food. These findings stress the importance of addressing non-drug related behaviours when treating CUD patients. Further, they suggest that habits may provide a novel and additional target for psychological interventions, for example, through the retraining of maladaptive habits. Whilst research into the feasibility and efficacy of habit retraining is certainly required, the potential for a new avenue of treatment should not be ignored.

Fostering the Reconstruction of Meaning Among the General Population During the COVID-19 Pandemic.

The COVID-19 outbreak has seen people in many countries asked to radically modify their way of life in compliance with sweeping safety measures. During the current crisis, technology is turning out to be key, in that it allows practitioners to deliver psychological services to people who would otherwise be unreachable. However, professionals cannot solely rely on their traditional modes of practice, in that different methods are required to bring to light the needs of those affected by the emergency. People are being overwhelmed by a cascade of unusual and unexpected events that are putting a strain on their everyday routines and usual meaning-making systems; ongoing challenges to their employment and financial status will likely divert personal resources away from psychological well-being. We therefore argue that psychologists should also consider the needs of the general population. Among those who may require help–aside from the main targets of psychological intervention, such as healthcare personnel and COVID-19 patients and their relatives–specific attention should be paid to those who are not at the center of the crisis. We suggest that this large segment of potential users may benefit from a non-medical approach focused on the promotion of meaning-making processes. Indeed, the disruptive nature of the current situation hinders sense-making and threatens to undermine psychological balance and well-being, at an individual as well as at a societal level. The present article proposes a methodological perspective based on the reconstruction of meaning-making processes (sense of coherence, predictability, metaphors, narratives). Specifically, psychological interventions should promote personal and collective resources with a view to: “normalizing” current distressful experiences (i.e., acknowledging that such reactions are normal in light of the present situation); widening the observational field, taking relational contexts into account, and promoting an understanding of distressful experiences as coping strategies; fostering meaning-making/reconstruction processes through the use of appropriate metaphors and narratives; promoting a sense of coherence. We present two clinical vignettes to illustrate how these principles might be applied in practice. In conclusion, the exceptional psychological challenges posed by the COVID-19 pandemic require practitioners to adopt a broad and flexible perspective on clinical intervention.

Catastrophising and repetitive negative thinking tendencies in patients with psychogenic non-epileptic seizures or epilepsy

PurposePrevious research suggests that catastrophisation and perseverative, or repetitive negative thinking (RNT) could play an important role in the aetiology of Psychogenic Nonepileptic Seizures (PNES). This study was designed to explore whether these cognitive tendencies are more prevalent in patients with PNES than those with epilepsy and to examine the relationship between these cognitions, depression, anxiety, seizure frequency and diagnosis. Methods26 patients with PNES (PWPNES) and 29 with epilepsy (PWE) self-reported RNT (Perseverative Thinking Questionnaire), catastrophisation tendencies (modified Safety Behaviors and Catastrophizing Scale), symptoms of anxiety (Generalised Anxiety Disorder Assessment 7) and depression (Primary Health Questionnaire 9) as well as seizure frequency. ResultsRNT and catastrophic thinking were highly correlated with each other and more prevalent in PWPNES than PWE. Positive correlations were also found between all other self-report measures and seizure frequency. The PNES diagnosis predicted RNT (perseverative thinking) independently of catastrophic thinking, anxiety, depression and seizure frequency. ConclusionPWPNES exhibit greater negative perseverative and catastrophising cognitive tendencies than PWE. PNES as a diagnosis independently predicted RNT. Hence, RNT and catastrophisation should be considered as possible specific targets for psychological interventions in patients with PNES.

Chronic postoperative pain and psychological factors

Chronic postoperative pain and psychological factors Abstract. Chronic postsurgical pain is highly prevalent, also or particularly in hand surgical patients. Considerable progress has been made in identifying risk and protective factors for chronic postsurgical pain. Psychological - that is cognitive, affective and behavioral - aspects including depression, anxiety, pain catastrophizing and patient trust in physician also play a key role in determining the probability of developing chronic pain after surgery. These factors are measurable and serve as important targets for specific psychological interventions by the surgeon or an interdisciplinary team. Empirical evaluation of these treatments demonstrates that psychological as well as interdisciplinary multimodal interventions are accepted by surgical patients and able to reduce postsurgical pain and disability.

Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic.

RationalePsychological resilience is characterized as the ability to respond to extreme stress or trauma or adverse experience successfully. While the relation between public emergencies and psychological distress is well known, research on therelationship between psychological resilience and mental health is very limited during the outbreak of public health emergencies.ObjectiveThis research investigated the relationship between psychological resilience and mental health (depression, anxiety, somatization symptoms) among the general population in China.MethodPsychological resilience, depression, anxiety, and somatization symptoms of 1770 Chinese citizens were investigated during the epidemic peak of coronavirus disease 2019 (COVID-19) (23rd February 2020 to 2nd March 2020). The analyses were done through the Connor-Davidson Resilience Scale (CD-RISC), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Patient Health Questionnaire-15 (PHQ-15) scale.ResultsThe prevalence of depression, anxiety, somatization symptoms was found to be 47.1%, 31.9%, 45.9%, respectively, among all participants. From them, 18.2% showed moderate to severe symptoms of depression, 8.8% showed moderate to severe symptoms of anxiety, and 16.6% showed moderate to severe symptoms of somatization. Psychological resilience was negatively correlated with depression (standardized β = −0.490, P < 0.001), anxiety (standardized β = −0.443, P < 0.001), and somatization symptom scores (standardized β = −0.358, P < 0.001), while controlling for confounding factors. Analysis of the three-factor resilience structure showed that strength and tenacity were correlated with depression (standardized β = −0.256, P < 0.001; standardized β = −0.217, P < 0.001), anxiety (standardized β = −0.268, P < 0.001; standardized β = −0.147, P < 0.001), and somatization symptoms (standardized β = −0.236, P < 0.001; standardized β = −0.126, P < 0.01).ConclusionsOur results suggest that there is a high prevalence of psychological distresses among the general population at the peak of the COVID-19 epidemic in China, which is negatively correlated with resilience. Psychological resilience represents an essential target for psychological intervention in a public health emergency.

Modulation of startle and heart rate responses by fear of physical activity in patients with heart failure and in healthy adults

Fear of physical activity (FoPA) has been suggested as a barrier to physical activity in patients with heart failure and might be associated with low adherence to exercise regimen despite medical guideline recommendations. The present study examined physiological indicators of FoPA by assessing startle modulation (via EMG at the orbicularis oculi muscle) and heart rate responses (derived from ECG) after affective priming with lexical stimuli of positive, neutral, and negative valence, as well as words related to physical activity as potentially phobic cues. After screening for FoPA in patients with heart failure and healthy adults, twenty participants each were assigned to one of three subsamples: a healthy control group and two cardiac patient groups scoring either low or high on FoPA. The high-FoPA group showed startle potentiation and more pronounced heart rate acceleration (than did controls) in the phobic prime condition, indicating defensive response mobilization. Among the patients, higher FoPA accounted for 30% of the startle potentiation by phobic priming, whereas general anxiety, depression, and disease severity were no significant predictors of startle modulation. These findings suggest that FoPA in patients with heart failure is associated with defensive responses on a physiological level that might be indicative of avoidance behavior, thereby contributing to low adherence to exercise regimen. Thus, FoPA presents a significant target for psychological interventions to foster physical activity in cardiac patients.

ROLE OF EMOTIONAL FACTORS IN FORMATION OF CARDIOVASCULAR PATHOLOGY (ON THE EXAMPLE OF THE MYOCARDIAL INFARCTION AND DIABETES OF THE 2ND TYPE)

Aim. To investigate a role of emotional factors in formation of cardiovascular pathology (on the example of a myocardial infarction and diabetes of the 2nd type).&#x0D; Methods. The symptomatic questionnaire of SCL-90-R (from English Symptom Check List-90-Revised), a scale of alarm of Beck, the test questionnaire of a depression, a scale of hopelessness of Beck, a test technique of type of the relation to a disease and treatment TOBOL. The obtained data are processed by means of the statistical SPPS 20 program.&#x0D; Results. The research showed that emotional factors influencing development of cardiovascular pathology, advancing a demonstration of the disease. Women at a stage of formation of cardiovascular pathology have more expressiveness of symptoms of a distress with tendency to its strengthening, fixing on the somatic feelings, existence of easy and moderate disturbing and depressive symptomatology with reactions of irritability leading to the avoiding behavior and also fear of loss of independence with feeling of own inferiority in comparison with other people, escape in the disease. The professional demand is more important for men, unlike women, leading to concealment of relevant symptomatology, perhaps, unconscious. They are not inclined to fix the attention on painful feelings, cannot attach significance on them, explaining their disease with fatigue at work. All this leads to later request for medical care and serious consequences. In men with cardiovascular pathology in the moderated and expressed degree the disturbing and depressive symptomatology is expressed with a dysphoria, violations of night sleep, ergopathic or anozognostic type of the relation to a disease is shown. The disturbing depression of patients with cardiovascular pathology is supported by observance of the high therapeutic security, risk of development of the complications causing a feeling of loss of control over own life and future that promotes formation of living position for disabled. Knowledge of features of the emotional sphere of the patients with for the first time revealed SD of the 2nd type who had a myocardial infarction expands possibilities of correction of negative impact of emotional factors on formation and progressing of cardiovascular pathology.&#x0D; Conclusions. Emotional factors such as alarm and depression influence formation of cardiovascular pathology and advance a demonstration of the disease. More often women are fixed on somatic complaints, and men with cardiovascular pathology cannot attach significance to somatic symptoms that leads to later request for medical care. Emotional factors should be considered as main targets of psychological intervention when developing programs of prevention along with the known somatic indicators that assumes need of interaction of experts of different clinical disciplines.

Exposure to Potentially Traumatic Events, Posttraumatic Stress Symptoms, Pain Catastrophizing, and Functional Somatic Symptoms Among Individuals With Varied Somatic Symptoms: A Moderated Mediation Model

The relationships between exposure to potentially traumatic events (PTEs), as well as posttraumatic stress symptoms (PTSS) and somatic syndromes, have recently been exemplified. Exposure to PTEs can also set in motion complex psychological processes such as pain catastrophizing that is associated with PTSS and somatic syndromes. However, the specific moderating role of pain catastrophizing in these links remains relatively unexamined. The present study aims to assess a moderated mediation model in which catastrophizing will moderate the indirect effect of exposure to PTEs on the number of somatic symptoms and chronic pain severity via PTSS, among individuals with somatic syndromes. A volunteers' sample of 175 Israeli adults with varied somatic symptoms responded to online validated self-report questionnaires in a cross-sectional designed study. Participants' self-reported PTSS rates (57.1%) were high. PTSS and pain catastrophizing, but not exposure to PTEs, were related to chronic pain severity. Interestingly, a moderated mediation analysis indicated that the indirect effect of catastrophizing in the relation between exposure to PTEs and the number of somatic symptoms via PTSS existed only among those with high levels of catastrophizing. The present study highlights the assumption that functional somatic syndromes (FSS) have much in common. Our findings support a moderated mediation model that begins with exposure to PTEs that leads to PTSS, which in turn increase the number of somatic symptoms. Higher levels of pain catastrophizing might attenuate this indirect link by affecting the interpretation of PTSS and create a vulnerability to more somatic symptoms. Thus, changes in cognitive-sensory processing in the form of catastrophic thinking can affect psychobiological processes and heighten sensitivity to stimuli arising in the body and should be considered as possible target for future research and psychological interventions.

Accepting the unacceptable? Exploring how acceptance relates to quality of life and death anxiety in a cancer population

Background: Quality of life is a core concern for cancer patients, which can be negatively affected by illness-related death anxiety; yet understanding of how to appropriately target psycho-oncological interventions remains lacking. We aimed to explore experiential acceptance in cancer patients, and whether acceptance – as an alternative to avoidant coping – was related to and predictive of better quality of life and death anxiety outcomes. Methods: We used a longitudinal, quantitative design with a follow-up after three months. Seventy-two participants completed a questionnaire-battery measuring illness appraisals, acceptance and non-acceptance coping-styles, quality of life, and death anxiety; 31 participants repeated the battery after three months. Results: Acceptance was an independent explanatory and predictive variable for quality of life and death anxiety, in the direction of psychological health. Acceptance had greater explanatory power for outcomes than either cancer appraisals or avoidant response styles. Avoidant response styles were associated with greater death anxiety and poorer quality of life. Conclusions: The findings support the role of an accepting response-style in favourable psychological outcomes, identifying a possible target for future psychological intervention. Response styles that might be encouraged in other therapies, such as active coping, planning, and positive reframing, were not associated with beneficial outcomes.

Accepting the unacceptable? Exploring how acceptance relates to quality of life and death anxiety in a cancer population

Background: Quality of life is a core concern for cancer patients, which can be negatively affected by illness-related death anxiety; yet understanding of how to appropriately target psycho-oncological interventions remains lacking. We aimed to explore experiential acceptance in cancer patients, and whether acceptance – as an alternative to avoidant coping – was related to and predictive of better quality of life and death anxiety outcomes. Methods: We used a longitudinal, quantitative design with a follow-up after three months. Seventy-two participants completed a questionnaire-battery measuring illness appraisals, acceptance and non-acceptance coping-styles, quality of life, and death anxiety; 31 participants repeated the battery after three months. Results: Acceptance was an independent explanatory and predictive variable for quality of life and death anxiety, in the direction of psychological health. Acceptance had greater explanatory power for outcomes than either cancer appraisals or avoidant response styles. Avoidant response styles were associated with greater death anxiety and poorer quality of life. Conclusions: The findings support the role of an accepting response-style in favourable psychological outcomes, identifying a possible target for future psychological intervention. Response styles that might be encouraged in other therapies, such as active coping, planning, and positive reframing, were not associated with beneficial outcomes.

Role of self-focussed reappraisal of negative emotion in emergence of emotional symptoms in adolescent girls.

Adolescent subthreshold emotional symptoms arise from impaired self-referential information-processing and approach-avoidance behaviour network integration, which compromises goal evaluation and pursuit strategies. We investigated whether impairment of negative emotion (goal) reappraisal strategies (self-focussing and self-distancing) generates emotional symptoms (emotional disorders precursors). Using functional magnetic resonance imaging and a triple-network model (default mode, executive control and salience), functional connectivity differences within and between networks, and their modulation by task and relationships with emotional symptoms were determined in healthy adolescent girls (N = 202) grouped by presence or absence of emotional symptoms. The groups differed in spectral power distribution and in dorsal default mode network and right executive control network modulation when self-focussing and self-distancing, respectively. Girls without emotional symptoms had greater spectral power and less network modulation. Greater spectral power was associated with reduced emotional symptoms and less dorsal default mode network modulation when self-focussing. The early phases of anxiety and depressive disorders in adolescence are marked by emotional symptoms that usually emerge in the context of negative life events. To contend with the negative effect of such events, a typical reappraisal strategy is to distance oneself and switch the focus of one's thinking. This brain-imaging study in adolescent girls prone to the development of emotional disorders has found functional changes in key neural networks that are involved in reappraisal and shown that this process is impaired. This is important because it provides an early indication of these common disorders and a potential target for psychological interventions.

Imaginator: A Proof-of-Concept Feasibility Trial of a Brief Imagery-Based Psychological Intervention for Young People Who Self-Harm.

The Imaginator study tested the feasibility of a short mental imagery-based psychological intervention for young people who self-harm and used a stepped-wedge design to investigate effects on self-harm frequency reduction at 3 and 6months. A total of 38 participants aged 16-25 were recruited via community self-referral and mental health services. Participants were randomized to immediate delivery of Functional Imagery Training (FIT) or usual care followed by delayed delivery after 3months. FIT comprised two face-to-face sessions, five phone sessions, and use of a smartphone app. Outcomes' assessment was blind to allocation. Three quarters of those who began treatment completed face-to-face sessions, and 57% completed five or more sessions in total. Self-harm frequency data were obtained on 76% of the sample at 3months (primary outcome) and 63% at 6months. FIT produced moderate reductions in self-harm frequency at 3months after immediate (d=0.65) and delayed delivery (d=0.75). The Immediate FIT group maintained improvements from 3 to 6months (d=0.05). Participants receiving usual care also reduced self-harm (d=0.47). A brief mental imagery-based psychological intervention targeting self-harm in young people is feasible and may comprise a novel transdiagnostic treatment for self-harm.

Similarities and Differences of Strategies between Bipolar and Depressive Disorders on Stress Coping.

ObjectiveAs coping strategies can influence the illness course of mood disorder, they could be potential targets for psychological intervention. The current study investigated the similarities and differences in stress coping styles between bipolar disorder (BD) and depressive disorder (DD). MethodsSubjects with BD (n=135) and DD (n=100) who met the DSM-IV diagnostic criteria were included in this analysis. Coping strategies were assessed using the coping inventory for stressful situations and depressive symptoms were assessed by Beck depression inventory. ResultsThe BD group showed significantly more avoidant and task-oriented coping than the DD group (t=2.714, p=0.007; t=2.193, p=0.039). After excluding the effect of the depressive symptoms themselves (by comparing two groups in non-depressive state), the BD group still showed significantly more avoidant and task-oriented coping than the DD group (t=2.040, p=0.045; t=2.556, p=0.013), but when the symptoms of depression get greater, the difference between BD and DD coping strategies were reduced. ConclusionSubjects with BD tend to use more task and avoidant coping than DD subjects. But when the symptoms of depression get greater, the difference in coping strategies between BD and DD were reduced.