Extending previous research, we applied latent profile analysis in a sample of adults with a history of recurrent depression to identify subgroups with distinct response profiles on the Five Facet Mindfulness Questionnaire and understand how these relate to psychological functioning. The sample was randomly divided into two subsamples to first examine the optimal number of latent profiles (test sample; n = 343) and then validate the identified solution (validation sample; n = 340). In both test and validation samples, a four-profile solution was revealed where two profiles mapped broadly onto those previously identified in nonclinical samples: "high mindfulness" and "nonjudgmentally aware." Two additional subgroups, "moderate mindfulness" and "very low mindfulness," were observed. "High mindfulness" was associated with the most adaptive psychological functioning and "very low mindfulness" with the least adaptive. In most people with recurrent depression, mindfulness skills are expressed evenly across different domains. However, in a small minority a meaningful and replicable uneven profile indicating nonjudgmental awareness is observable. Current findings require replication and future research should examine the extent to which profiles change from periods of wellness to illness in people with recurrent depression and how profiles are influenced by exposure to mindfulness-based intervention.

Self-compassion and its cultivation in psychological interventions are associated with improved mental health and well-being. However, the underlying processes for this are not well understood. We randomly assigned 135 participants to study the effect of two short-term self-compassion exercises on self-reported-state mood and psychophysiological responses compared to three control conditions of negative (rumination), neutral, and positive (excitement) valence. Increased self-reported-state self-compassion, affiliative affect, and decreased self-criticism were found after both self-compassion exercises and the positive-excitement condition. However, a psychophysiological response pattern of reduced arousal (reduced heart rate and skin conductance) and increased parasympathetic activation (increased heart rate variability) were unique to the self-compassion conditions. This pattern is associated with effective emotion regulation in times of adversity. As predicted, rumination triggered the opposite pattern across self-report and physiological responses. Furthermore, we found partial evidence that physiological arousal reduction and parasympathetic activation precede the experience of feeling safe and connected.

This paper explores the relationship between dispositional self-compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self-compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self-compassion, use of cognitive emotion regulation strategies, and changes in mood and self-devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self-compassion showed greater mood recovery after mood induction, and less self-devaluation across the experimental procedure, independent of their mood-repair condition or habitual forms of cognitive emotion regulation. These results suggest that self-compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.

This study examined the factor structure of the Self-Compassion Scale (SCS) using a bifactor model, a higher order model, a 6-factor correlated model, a 2-factor correlated model, and a 1-factor model in 4 distinct populations: college undergraduates (N = 222), community adults (N = 1,394), individuals practicing Buddhist meditation (N = 215), and a clinical sample of individuals with a history of recurrent depression (N = 390). The 6-factor correlated model demonstrated the best fit across samples, whereas the 1- and 2-factor models had poor fit. The higher order model also showed relatively poor fit across samples, suggesting it is not representative of the relationship between subscale factors and a general self-compassion factor. The bifactor model, however, had acceptable fit in the student, community, and meditator samples. Although fit was suboptimal in the clinical sample, results suggested an overall self-compassion factor could still be interpreted with some confidence. Moreover, estimates suggested a general self-compassion factor accounted for at least 90% of the reliable variance in SCS scores across samples, and item factor loadings and intercepts were equivalent across samples. Results suggest that a total SCS score can be used as an overall mesure of self-compassion.

Research into the effectiveness and mechanisms of mindfulness-based interventions (MBIs) requires reliable and valid measures of mindfulness. The 39-item Five Facet Mindfulness Questionnaire (FFMQ-39) is a measure of mindfulness commonly used to assess change before and after MBIs. However, the stability and invariance of the FFMQ factor structure have not yet been tested before and after an MBI; pre to post comparisons may not be valid if the structure changes over this period. Our primary aim was to examine the factor structure of the FFMQ-39 before and after mindfulness-based cognitive therapy (MBCT) in adults with recurrent depression in remission using confirmatory factor analysis (CFA). Additionally, we examined whether the factor structure of the 15-item version (FFMQ-15) was consistent with that of the FFMQ-39, and whether it was stable over MBCT. Our secondary aim was to assess the general psychometric properties of both versions. CFAs showed that pre-MBCT, a 4-factor hierarchical model (excluding the "observing" facet) best fit the FFMQ-39 and FFMQ-15 data, whereas post-MBCT, a 5-factor hierarchical model best fit the data for both versions. Configural invariance across the time points was not supported for both versions. Internal consistency and sensitivity to change were adequate for both versions. Both FFMQ versions did not differ significantly from each other in terms of convergent validity. Researchers should consider excluding the Observing subscale from comparisons of total scale/subscale scores before and after mindfulness interventions. Current findings support the use of the FFMQ-15 as an alternative measure in research where briefer forms are needed. (PsycINFO Database Record

AbstractTimely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests.To discriminate between the STEPs users (SU; n=32) and controls (n=32, age and sex matched), we employed k-nearest neighbours (kNN) classifier, and applied it to objective, quantitative and interpretable features derived from the ‘mirror game’ (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. We show that the proposed classifier achieves an excellent performance, AUC = 0.89 (95%CI 0.73-1), Sensitivity = 0.75 (95%CI 0.5-1), Specificity = 1 (95%CI 0.62-1), evaluated on 25% hold-out and 1000 folds. We demonstrate that this performance is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification. We also find that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance.Our findings show that introduction of standardised battery of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.Author summaryNeuropsychiatric assessment and accurate diagnosis are notoriously challenging. Psychosis represents a classical example of this challenge where many at-risk of psychotic illness individuals (often very young) are misdiagnosed and/or inappropriately treated clinically. Our study demonstrates that combining digital tests with data analytics has potential for simplifying neuropsychiatric assessment. It shows that using measurements from TMT and MG allows to differentiate between people accepted for assessment in specialist team for early psychosis (STEP) and controls with excellent performance (AUROC > 0.9), while achieving 100% specificity (no false positive detections). The study shows feasibility of using cheap, portable equipment, assembled from off-the-shelf components, for collection of clinically relevant data that could be used to inform clinical decision making. Moreover, our study, with its state-of-the-art performance and interpretable results, demonstrate high clinical potential of implementing digital batteries of behavioural tests in clinical practice. Such developments would not only help to stratify STEPs users but would facilitate rapid assessment for all people seeking care in early intervention services. This in turn would contribute to improving the quality of life and wellbeing of individuals at risk of developing psychosis.FundingEPSRC Impact Acceleration Account, Impact & Knowledge Exchange Award, Jean Golding Institute seed corn, Avon & Wiltshire Mental Health Partnership NHS Trust Research Capability Funding.PS was generously supported by the Wellcome Trust Institutional Strategic Support Award 204909/Z/16/Z. KTA gratefully acknowledges the financial support of the EPSRC via grant EP/T017856/1.For the purpose of open access, the authors have applied a ‘Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising.

Abstract
. Purpose
. Self-evaluation and interpersonal factors are theoretically and empirically linked to depression in young people. An improved understanding of the multifactorial developmental pathways that explain how these factors predict depression could inform intervention strategies.
.
. Methods
. Using structural equation modeling, this study explored whether self-evaluation and interpersonal factors were associated with adolescent depressive symptoms in a population-based sample (n = 11,921; Avon Longitudinal Study of Parents and Children, ALSPAC), across four development stages: early and late childhood plus early and middle adolescence from 3 to 17 years old.
.
. Results
. Early good parenting practices predicted self-esteem, fewer peer difficulties, good friendships and fewer depressive symptoms in late childhood development outcomes. Higher self-esteem and less negative self-concept mediated the effect of early good parenting practice on reduced depressive symptoms in middle adolescence. The hypothesized erosion pathway from depressive symptoms in late childhood via higher levels of negative self-concept in early adolescence to depressive symptoms in middle adolescence was also confirmed. Additionally, peer difficulties played a mediation role in developing depressive symptoms. Contrary to the hypothesis, poor friendships predicted fewer depressive symptoms. The analysis supported a developmental pathway in which good parenting practices in early childhood led to fewer peer difficulties in late childhood and to less negative self-concept in early adolescence, which in turn predicted fewer depressive symptoms in middle adolescence.
.
. Conclusion
. The social-developmental origin of youth depressive symptoms was supported via the effect of peer relationships in late childhood on self-evaluation in early adolescence.
.

Research has shown that high trait anxiety can alter multisensory processing of threat cues (by amplifying integration of angry faces and voices); however, it remains unknown whether differences in multisensory processing play a role in the psychological response to trauma. This study examined the relationship between multisensory emotion processing and intrusive memories over seven days following exposure to an analogue trauma in a sample of 55 healthy young adults. We used an adapted version of the trauma film paradigm, where scenes showing a car accident trauma were presented using virtual reality, rather than a conventional 2D film. Multisensory processing was assessed prior to the trauma simulation using a forced choice emotion recognition paradigm with happy, sad and angry voice-only, face-only, audiovisual congruent (face and voice expressed matching emotions) and audiovisual incongruent expressions (face and voice expressed different emotions). We found that increased accuracy in recognising anger (but not happiness and sadness) in the audiovisual condition relative to the voice- and face-only conditions was associated with more intrusions following VR trauma. Despite previous results linking trait anxiety and intrusion development, no significant influence of trait anxiety on intrusion frequency was observed. Enhanced integration of threat-related information (i.e. angry faces and voices) could lead to overly threatening appraisals of stressful life events and result in greater intrusion development after trauma.

Meat is consistently the most highly valued food across most cultures, and is overconsumed in high income countries, driving declines in planetary and human health. Simultaneously, meat is also frequently an object of food taboos and feelings of disgust. Meat disgust has been studied in vegetarians in the past but may not be limited to meat avoiders and could potentially be used as a basis for interventions to reduce meat consumption. However, meat disgust and the mechanisms that may link it to meat avoidance are not well understood. This thesis aims to further our understanding of meat disgust by offering contributions to theory, evidence, and methodology. The current state of meat disgust research is reviewed in Chapter One, followed by four studies that investigate the concept of meat disgust in meat-eating and meat-avoiding populations. Chapter Two presents findings from a cross-sectional and longitudinal study in a sample of vegetarians, flexitarians, and omnivores that assessed meat disgust and meat intake over time and found that many vegetarians, as well as some flexitarians and omnivores, experience meat disgust, and that this affects levels of meat intake in meat-eating groups. Chapter Three compares meat disgust to similar food rejection responses towards plant-based foods and finds that meat, as opposed to disliked plant foods is a potent elicitor of core disgust. In Chapter Four, a quasi-experimental longitudinal study is presented that observed increases in meat disgust in a small sample of meat eaters following their attempts to avoid meat for one month during ‘Veganuary’. Here, a new theory of the causal relationship between meat disgust and meat avoidance is presented, that proposes disgust as the default response to meat which can be suppressed to allow the consumption of some meat. This theory is further tested in Chapter Five which presents a mega analysis of data on general disgust sensitivity and meat consumption collected in the three previous chapters, showing that any differences in disgust sensitivity across diet groups or effects on meat intake can be explained by demographic covariates and thereby supporting the theory that meat intake and may be de-coupled from disgust sensitivity via a suppression mechanism. Chapter Six embeds the findings on meat disgust from within this thesis with others’ findings and tests the newly proposed ‘suppression theory’ against two other, existing theories with regards to how well all of the findings can
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be explained. Additionally, the four different methodologies that were used in this thesis to study meat disgust are reviewed in Chapter Six, and recommendations for future studies in this field are made.

Rejection sensitivity, a propensity to perceive and act strongly to potential rejection, can impact many aspects of one’s life, including having a negative effect on mental health. With a possible detrimental effect of rejection sensitivity on stress-related disorders, it is important to gain more understanding of the subject in order to prevent and treats the negative effect of rejection sensitivity. Chapter 1, presents a literature review on the impacts of rejection sensitivity, including impacts on behaviour, cognition, physiology, and emotion. From this, a model is proposed that incorporates rejection sensitivity into Ehlers and Clark’s cognitive model of posttraumatic stress disorder (PTSD). The empirical studies of the PhD investigate different aspects of this extended theoretical framework. Chapter 2 presents findings of a cross-sectional survey in trauma survivors showing that rejection sensitivity is associated with vulnerable attachment, social support, and posttraumatic-stress disorder. The results of this study supported important aspects of the proposed theoretical model of the thesis. Chapter 3 focused on possible mechanisms how social rejection can impact the level of stress and physiological stress responses, and how individual differences in rejection sensitivity moderates these effects. The finding indicated that whilst being rejected or accepted through an experimental vignette task did not influence subjective stress level, high levels of rejection sensitivity made a significant contribution to increases in stress level following social evaluation and thus partially supported the extended theoretical model. Building on Chapter 3, Chapter 4 investigated the contribution of rejection sensitivity to the psychophysiological responses during a virtual reality lab trauma, as well as the role of subsequent rejecting or accepting social interaction on trauma recovery. No associations between rejection sensitivity and variations in physiological responses were found. Social rejection following traumatic experience also did neither contribute to increase in stress reactivity nor subsequent intrusions. This finding suggested that recovery from trauma may not be influenced by immediate social interaction following the traumatic experience and hence did not support the theoretical model. In Chapter 5, a secondary data analysis revealed that rejection sensitivity was associated with childhood trauma, substance use experiences, perceived social support, stress and depression. These findings provide support for parts of the theoretical model and highlight the importance of rejection sensitivity for trauma recovery and stress-related disorder. Chapter 6 presents an overall discussion of the findings of the thesis, including the discussion related to literature reviews; specifically, the impacts of rejection sensitivity on physiology and stress-related mental health. The chapter also provides limitations and strengths of the studies with the main focused on the methodology used for the rejection tasks. Finally, how the findings can be used as a guide for future directions, and clinical implications, were presented.

Study Aims: the aim was to use theoretical understandings of behavioural change, from the COM-B model, to explore the experiences of experts from different contexts working with survivors who may have BI and to make recommendations for training in UK third sector DV organisations.
Participants: Eleven experts by profession and experience in the field of brain injury and/ or domestic violence from the United Kingdom and United States of America.
Methods: Qualitative methodology was employed. Data were collected using semi-structed individual interviews. Data were analysed using reflexive thematic analysis and adopted a critical realist philosophical approach.
Analysis: Analysis constructed three themes with nine subthemes which are explored in detail, these are: 1) Lack of understanding of traumatic brain injury and domestic violence, 2) Specified educational needs of practitioners and 3) Changing practitioners’ behaviour.
Major implications: the participants identified factors which influenced practitioners working in UK domestic violence third sector organisations understanding of brain injury in domestic violence survivors, including a gender and racial biases. Participants felt that how change is implemented and maintained in the long term needs to be considered thoughtfully. The behaviour change wheel (Michie et al. 2014) is one way which organisations could identify what they need to do to support organisational and individual level change in practice.
Keywords: Brain Injury, Domestic Violence, Third Sector, Training, Behaviour Change

Objective. Military spouses face unique challenges which can result in psychological distress
and breakdowns in relationship satisfaction. Previous reviews have considered systemic
interventions and support for partners of veterans. Limited information is known about
interventions used to support the wellbeing, resilience or couple functioning of active-duty
military spouses. This review aimed to explore the quality, outcomes and effectiveness of
interventions which currently exist. Method. A systematic review of 541 studies from the
databases Ovid PsycInfo, Ovid Medline, PubMed, and Web of Science was conducted.
Interventions focused on supporting mental health disorders were excluded. A total of 537
studies were screened, providing 16 studies for review and appraisal via the Effective Public
Health Practice Project tool. Results. 16 studies, rated as weak or medium quality, evaluated
13 interventions with outcomes for non-serving spouses, mostly located in the United States
(US). Interventions were either deployment specific or supported military life in general
using diverse formats. Most studies reported outcomes for couple functioning, with six aimed
at wellbeing and/or resilience. Two interventions were designed specifically for use by non serving spouses, with the remainder couple- or family-focused. Conclusion. Findings suggest
various interventions for the military spouse exist. However, these mostly require additional
family members to be present. Only two interventions were primarily aimed at the non serving spouse alone. Overall findings suggest positive outcomes for non-serving spouses in
the short-term, with limited evidence of long-term effectiveness. Suggestions are provided for
further research, alongside development of interventions for non-serving spouses located
within the United Kingdom (UK).

The purpose of this study was to explore Chinese-speaking international students’ (CIS) mental health and help-seeking during the COVID-19 pandemic in the United Kingdom (UK). Using a qualitative method, data was gathered from 13 CISs using individual semi-structured interviews. Participants were given a choice to have the interview conducted in English or Mandarin with the majority of the participants (n=10) choosing Mandarin. Two topics were focused on: challenges faced during the pandemic while studying overseas and help seeking; and within these topics four main themes were developed: feeling unsafe, feeling isolated, seeking help from friends and family, and seeking professional help. Not all the challenges shared by participants are related to the COVID-19 situation, however it is undeniable that COVID-19 has added to the challenges already being faced by CIS. Participants reported that they prefer to seek help from peers or family during times of distress rather than professional help due to various reasons, such as language barriers, limited understanding of mental health and mental health system in the UK. Further research is required to understand the challenges that participants faced while navigating two sets of health beliefs during the COVID-19 pandemic, their experience with microaggression/racism and its impact on overall mental wellbeing.

Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA +  major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.

Therapists delivering trauma-focused interventions are at risk of developing conditions such as secondary traumatic stress or post-traumatic stress disorder. SCTherapist, an online guided self-help intervention designed to reduce symptoms of PTSD and improve self-compassion, was developed to address a current intervention gap for trauma therapists. The present study employed a single case experimental design to assess the effectiveness of the SCTherapist intervention using a sample of six trauma therapists. Symptoms of post-traumatic stress disorder and self-compassion were both assessed at baseline, post-intervention and three-month follow-up. Daily questionnaire data assessing distress, emotional distance and self-compassion were collected. One participant’s self-compassion scores improved significantly in daily self-report data. All other daily data did not show significant changes. Five participants improved in overall post-traumatic stress disorder scores between baseline and post-intervention, and three maintained improvements at follow-up. Self-compassion scores improved for five participants post-intervention and four participants reported improvements at follow-up. The intervention was found to be acceptable to participants. Implications and areas for future research are discussed.

LITERATURE REVIEW: the Role of Inter-goal Conflict in Depressive Symptomatology: a Systematic Review

Objective: Intra-psychic conflict underpins theories of motivation; however, its mechanisms and correlates remain poorly understood. Goals represent a broad category of motivational constructs which are conceptualised hierarchically, according to their specificity (level of abstraction), from low-level, action-oriented, goal-tasks to high-level, organising values. The goals literature has investigated the links between inter-goal conflict and a broad range of outcomes, including depression, well-being and psychopathology. This review set out to synthesise existing evidence for a relationships between inter-goal conflict and depressive symptoms.
Method: Studies exploring the relationship between inter-goal conflict and depression in adults were selected from multi-disciplinary and subject-specific databases, published prior to the 20th of March 2021. A systematic search yielded 122 records with 79 non-duplicated results. Screening of 28 full-text publications led to 10 eligible studies, from which data were synthesised in narrative form.
Results: the evidence reviewed indicates that inter-goal conflict is positively correlated with depressive symptoms in adults, although findings were mixed and longitudinal studies did not support a causal association. Effect sizes of eligible studies ranged from small to medium, with some controlling for covariates. Studies were predominantly cross-sectional; therefore, scope for casual inference was limited.
Conclusions: at present, evidence supporting the hypothesis that inter-goal conflict is associated with depressive symptoms in adults is modest. More longitudinal investigations are needed to determine the presence and direction of causality. Construct specificity, implicit motivation and rumination also require further investigation to understand their relationship to inter-goal conflict and depression.

EMPIRICAL PAPER: the Relationship Between Intrapersonal Goal-Value Conflict and Depressive Symptomatology

Background: Intrapsychic goal-conflict underpins classical and contemporary theories of motivation; however, its mechanisms and correlates remain poorly understood. Motivational conflict is associated with a broad range of outcomes, including depression, well-being and psychopathology. It is hypothesised that rumination mediates the link between cognitive-motivational conflict and depression. To date, research has focused on horizontal conflict between motivational constructs with similar specificity. Little is known about vertical relationships between motivational constructs with divergent specificity. Values are thought to be central to conceptions of personal identity because they serve as high-level, organising reference points for low-level action-oriented goal constructs; thus, clarifying vertical relationships may shed light on the mechanisms of depression, well-being and psychopathology. The present study investigated the relationship between goal-value conflict and depressive symptoms with rumination hypothesised as a partial mediator of the relationship.
Method: This cross-sectional, correlational study recruited a non-clinical, unselected sample of 218 adult participants from the student population of Exeter University. Participants were assessed on measures of depressive symptomatology, rumination, personal strivings, values and goal-value conflict using matrix methods. Trait rumination and striving importance were entered as covariates in the mediation analysis.
Results: a significant association was not found between striving-value conflict and depressive symptomatology. Depressive symptoms were positively associated with trait and striving rumination; however, striving rumination was not found to mediate a relationship between goal-value conflict and depression. On average, participants reported harmony between strivings and values.
Conclusions: Striving-value conflict was not found to be a significant factor in depression or goal rumination. This could be due to values being abstract and, therefore, not action-oriented, or because unmeasured implicit motivational factors were at play. Future research should explore the role of both construct specificity and implicit cognition in goal-value relationships, rumination and depression.

Suicidality is a common public health concern in young people. Previous research has highlighted pain as a key correlate of suicidality in young people. However, the long-term experience of pain may vary between individuals, and the relationship between distinct pain trajectories and suicidality is poorly understood. This study aims to describe the number and nature of distinct pain trajectories, their demographic and clinical correlates, including baseline suicidality, and whether identified pain trajectories may predict future suicidality. Secondary data analyses were performed, using longitudinal data from the British Child and Adolescent Mental Health Survey (N = 7977), collected at five timepoints between 2004 and 2007 on a population-based sample of UK youth (5-16 years). Data were collected from up to three respondents (parents, teachers, and 11 + year-olds). Latent Class Growth Analysis was used to identify distinct pain trajectories, explore predictors of these trajectories, and establish whether trajectories predicted future suicidality. We identified the following four pain trajectories: increasing (33.6%), decreasing (4.5%), persistent/recurrent probability of pain (15.7%), and no pain (46.2%). Pain trajectories were associated with unique demographic and clinical correlates. Only the persistent/recurrent (vs. no-pain) trajectory was predicted by baseline suicidality (aOR = 2.24; 95% bootstrap-CI = 1.59-3.26). Furthermore, the persistent/recurrent trajectory predicted future suicidality (aOR = 1.03, 95% bootstrap-CI = 1.01-1.06), after controlling for baseline suicidality, psychiatric disorder, age, and gender. Findings provide a better understanding of correlates associated with distinct pain trajectories and long-term risk of suicidality in young people, suggesting a bidirectional pain-suicidality association and emphasising the need of targeted support for young people with persistent/recurrent pain.

Armed Forces personnel are exposed to traumatic experiences during their work; therefore, they are at risk of developing emotional difficulties such as post-traumatic stress disorder (PTSD), following traumatic experiences. Despite evidence to suggest that self-compassion is effective in reducing the symptoms of PTSD, and greater levels of self-compassion are associated with enhanced resilience, self-compassion in armed forces personnel and armed forces veterans remains under-researched. As a result, it is not known if therapeutic approaches that use self-compassion interventions are an acceptable and effective treatment for this population. Having previously shown that a one-off self-compassion exercise has temporary beneficial psychophysiological effects in non-clinical participants, we conducted this proof-of concept study to investigate whether this exercise is equally beneficial in veterans who had experienced deployment to a combat zone. Additionally, we examined if brief a self-compassion exercise can temporarily reduce hyperarousal symptoms and increase feelings of social connectedness. The current study also investigated the association between PTSD symptom severity, emotion regulation, and self-compassion in 56 veterans. All participants listened to a loving-kindness meditation for self-compassion (LKM-S) and psychophysiological recordings were taken throughout. Psychophysiological effects were observed including heart-rate (HR), skin conductance (SCL), and heart-rate variability (HRV) to determine associations with PTSD and changes in response associated with the self-compassion induction. PTSD symptom severity, dispositional emotion regulation, and self-compassion were measured, and participants also completed state measures of hyperarousal and social connectedness before and after the LKM-S. The findings partially demonstrated that self-compassion can be elicited in a veteran population but there were considerable individual differences in psychophysiological responses. The findings are discussed in light of existing theories of PTSD and self-compassion and the implications of using self-compassion based psychological approaches with veterans.

BACKGROUND: Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD. METHODS: We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV. RESULTS: As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses. CONCLUSION: the results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.

OBJECTIVES: Self-compassion is the ability to be kind to oneself in adversity. This multidimensional construct is typically assessed by the Self-Compassion Scale (SCS). In Chinese samples, there have been inconsistent psychometric findings that impede cross-cultural research. This study aimed to explore the factor structure of the Chinese version (SCS-C). METHODS: Two samples of young Chinese adults were recruited (Sample 1, N = 465, 141 men, Mean age [Mage] = 20.26; Sample 2, N = 392, 71 men; Mage = 18.97). Confirmatory factor analyses and exploratory structural equation modeling (ESEM) were used to examine previously reported four- and six-factor structures of SCS-C. RESULTS: Although ESEM supported the six-factor structure when a problematic item was omitted, we found stronger evidence for a novel four-factor structure of the SCS-C revealed with self-kindness, common humanity, mindfulness, and uncompassionate self-responding. This suggests that Chinese individuals have a different understanding of the negative components of the original self-compassion definition, which was based on the United States and other mostly Western samples. Omega coefficients of the bifactor models suggested that using the SCS total score in Chinese samples is inappropriate. However, high factor determinacy and construct replicability indicated that the general factor of SCS-C could be used in a structural equation modeling context for both four-factor and six-factor structures. CONCLUSIONS: When using the existing SCS-C in path models, researchers should use a latent variable approach and establish the measurement construct rather than sum scores of the scale or subscales without checking the factor structure in future empirical studies. Also, the SCS-C needs to be revised, and we proposed directions forward for future research.

Background Although childhood abuse has been consistently associated with cardiovascular disease in later adulthood, its associations with cardiometabolic health in younger adults are poorly understood. We assessed associations between childhood physical, sexual, and psychological abuse and cardiometabolic outcomes at 18 and 25 years. Methods and Results We used data on 3223 participants of the ALSPAC (Avon Longitudinal Study of Parents and Children). Exposure to childhood abuse was self-reported retrospectively at 22 years. We used linear regression to assess the associations between childhood abuse and cardiometabolic outcomes at 18 and 25 years. At 18 years, physical (β 1.35 kg/m2; 95% CI, 0.66-2.05), sexual (β 0.57 kg/m2; 95% CI 0.04-1.11), and psychological (β 0.47 kg/m2; 95% CI 0.01-0.92) abuse were associated with higher body mass index. Physical abuse was also associated with lower high-density lipoprotein cholesterol (β -0.07 mmol/L; 95% CI, -0.13 to -0.01) and higher C-reactive protein (31%; 95% CI, 1%-69%), and sexual abuse was associated with higher heart rate (β 1.92 bpm; 95% CI 0.26-3.58). At age 25, all 3 types of abuse were additionally associated with higher insulin, and sexual abuse was associated with lower cholesterol (-0.14 mmol/L; 95% CI, -0.26 to -0.01). The age at which abuse occurred (

In everyday life, information from multiple senses is integrated for a holistic understanding of emotion. Despite evidence of atypical multisensory perception in populations with socio-emotional difficulties (e.g. autistic individuals), little research to date has examined how anxiety impacts on multisensory emotion perception. Here we examined whether the level of trait anxiety in a sample of 56 healthy adults affected audiovisual processing of emotion for three types of stimuli: dynamic faces and voices, body motion and dialogues of two interacting agents, and circles and tones. Participants judged emotion from four types of displays - audio-only, visual-only, audiovisual congruent (e.g. angry face and angry voice) and audiovisual incongruent (e.g. angry face and happy voice) - as happy or angry, as quickly as possible. In one task, participants based their emotional judgements on information in one modality while ignoring information in the other, and in a second task they based their judgements on their overall impressions of the stimuli. The results showed that the higher trait anxiety group prioritized the processing of angry cues when combining faces and voices that portrayed conflicting emotions. Individuals in this group were also more likely to benefit from combining congruent face and voice cues when recognizing anger. The multisensory effects of anxiety were found to be independent of the effects of autistic traits. The observed effects of trait anxiety on multisensory processing of emotion may serve to maintain anxiety by increasing sensitivity to social-threat and thus contributing to interpersonal difficulties.

Humans generally fear those different to them (i.e. an out-group) in the same way they fear natural predators. But fear pushes us to derogate others, whether they constitute a threat or not. Research has examined how fear associated with specific intergroup relations interferes with how individuals relate to in-group and out-group members. However, we know relatively little about how intergroup relations might be affected by incidental emotions. We tested how incidental fear affects empathy toward in-group and out-group members. We found that exposing participants to fearful imagery was sufficient to reduce empathy, but only in response to out-group suffering. We discuss how these findings provide insight into how fear is often leveraged to encourage social tribalism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Literature Review:
Background
Rejection sensitivity has been proposed as a mediator between experiences of childhood trauma and the development of attachment style, with individuals with high rejection sensitivity being more likely to develop an insecure attachment style (Feldman & Downey, 1994). However, it has not been investigated whether rejection sensitivity is differentially associated with different types of insecure and with secure attachment style.
Objectives
To establish the relationship between a popular measure of rejection sensitivity, the rejection sensitivity questionnaire (RSQ), and measures of adult attachment that assess secure, anxious and avoidant attachment.
Method
Systematic review of all literature to date using PsychInfo, Medline, Web of Science, ScienceDirect, SCOPUS and Proquest databases with a narrative discussion. Papers were assessed for quality using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (NIH, 2014).
Results
Twenty-seven relevant papers were included, consisting exclusively of cross-sectional studies. 24 out of 27 studies reported a significant correlational relationship between measures of attachment and rejection sensitivity as measured by the RSQ, with greater effect sizes for anxious styles of attachment Higher ratings of insecure attachment were related to higher ratings of rejection sensitivity, whereas secure attachment was negatively associated with rejection sensitivity. 6 studies additionally examined mediation and moderation influences of attachment on rejection sensitivity on various outcomes including symptoms of eating disorders and friendship satisfaction.
Conclusions
Overall, there is strong evidence to suggest that rejection sensitivity is positively correlated with all insecure styles of attachment. There is also emerging evidence that it is negatively correlated with secure attachment. However, the existing research uses cross-sectional design and self-report measures of adult attachment, and no studies examined causal links between rejection sensitivity and attachment. It is therefore important for clinicians to assess and formulate the impact of rejecting parenting on psychopathology. Future reviews looking into child and adolescent populations are suggested to establish directional relationships between attachment and rejection sensitivity.

Empirical Paper:
Objective
This researchields aimed to test the hypothesis that rejection sensitivity would moderate attachment priming following a recall of a rejection, specifically that those high on rejection sensitivity would benefit more from secure priming.
Methods
In an online experimental study, 167 young adults were asked to complete measures of trait rejection sensitivity and attachment, before completing a rejection task. After this, participants were randomly divided into neutral and secure attachment priming tasks. Repeated outcome measures were the state adult attachment measure (SAAM), which participants filled out before and after priming.
Results
Feelings of state attachment anxiety and avoidance were significantly greater following recall of a rejection than after priming. Feelings of state attachment security were significantly lower following recall of a rejection than after priming. Priming-related changes were associated with priming condition only for state attachment security and not anxiety or avoidance. Although trait variables of attachment anxiety and avoidance and rejection sensitivity were all significantly associated with medium to large effect sizes, rejection sensitivity was not associated with changes in state attachment before and after secure priming.
Conclusion
Despite being related to trait attachment, rejection sensitivity does not have a relationship to changes in state attachment due to secure priming following a rejection. Experiences of interpersonal rejection appears to trigger defensive strategies of attachment avoidance and anxiety. This indicates that rejection-salient cues can elicit insecure attachment strategies.

Abstract
. Objectives
. Recent
research has suggested that Chinese individuals from a collectivist culture may have a different understanding of self-compassion, which could differentially contribute to mental health. This study aimed to obtain an in-depth insight into Chinese adults’ understanding of self-compassion.
.
. Methods
. Four online focus groups in Chinese undergraduates discussed the construct of self-compassion based on self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. Thematic analysis was used to analyse the data.
.
. Results
. Chinese participants valued benign self-criticism and self-reflection when contemplating their understanding of self-compassion. Similarly, participants’ view of self-compassion dimensions can be described as dialectical in that they reflected both negative and positive perceptions in each factor rather than suggesting separate and purely negative or purely positive dimensions. There was also an overlap in the interpretation of the negative dimensions (self-judgment, isolation, and over-identification).
.
. Conclusions
. The findings highlight particularities in the understanding of self-compassion in these Chinese students, which may be influenced by philosophical traditions promoting dialecticism and the dual focus on the transformation of the self and social participation. This suggests the importance of a cultural perspective when studying self-compassion and interpreting relevant research findings.
.

Objective: the current study investigated the effects of both single and repeated security attachment primes, compared to neutral attachment primes, on increasing state perceptions of social support, positive affect and decreasing perceived stress in a healthy student sample.
Methods: the study employed a mixed between- and within-subjects design, with participants (N = 118) remotely receiving either a security attachment prime or a neutral attachment prime followed by daily repeated security attachment primes or neutral attachment primes, over a five day period. Baseline self-report measures included dispositional attachment style, perceived social support, stress and the impact of COVID-19. Self-report state measures of felt security (manipulation check), perceived social support, positive affect and stress were measured pre prime, post prime and on four subsequent days.
Results: Findings suggest that, during a global pandemic, participants receiving a remote (one-off) security attachment prime reported significantly higher levels of state felt security post prime when compared to participants receiving a (one-off) neutral attachment prime. However, no significant differences were found with regard to the other assessed variables - state perceived social support, positive affect or perceived stress. During the repeated aspect of the study, no significant differences were found, between conditions, for state perceived social support, positive affect or felt security, though some evidence was found to suggest that with repeated security attachment primes, participants report less perceived state stress than those receiving repeated neutral attachment primes.
Conclusions: Though findings are mixed, the research does highlight the possible utility of remote security attachment primes in experimentally manipulating state felt security and, in addition, the potential use of repeated security attachment primes in reducing state perceived stress. Though further research is required, and recommendations for this are provided, the findings are relevant to models of attachment theory and the future delivery of remote clinical interventions.

Keywords: Attachment, security priming, repeated priming, perceived social support, stress, positive affect.

Psychosocial factors play a critical role in young people mental health and influence various developmental outcomes. This thesis aimed to examine a theory-informed multifactorial model of adolescent depressive symptoms that included self-perception and interpersonal factors. Briefly, this model posits that early parenting practices exert influence via self-perception and peer relationships (e.g. peer difficulties and friendships) and directly play a role in depressive symptoms. Depressive symptoms, on the other hand, could also negatively influence self-perception, such as low self-esteem and self-compassion, and one’s social relationships, such as more peer difficulties and poor friendships. Furthermore, the model accounts for early parenting behaviour and peer relations playing an important role in developing self-esteem and self-compassion, but also for the opposite effect, one’s self-perception can also impact peer relationships. The current thesis examined the model through a cross-sectional study recruiting adolescents in the UK and China (Study 3) and a secondary data analysis study using data from Avon Longitudinal Study of Parents and Children (Study 4). Before examining the hypothesised developmental pathways, Study 1 and Study 2 were conducted to explore the construct of self-compassion in Chinese samples due to the definition and assessment debate in the current literature. The current thesis found that positive parenting, self-esteem, self-compassion and fewer peer difficulties play a protective role in adolescent depression, but the role of friendships in depression remains unclear. Also, the notion that positive parenting and peer relationships shape how children think about themselves, known as social-origin development of self-perception, was supported. Conversely, during adolescence, self-perception and peer relationships were associated with each other. Finally, the thesis identified cultural differences in the development of young people’s depressive symptoms with social relationships being more important in a collectivist culture and self-compassion being more eminent an individualist culture. The current thesis discussed theoretical and clinical implication of the findings and provided several assessment considerations of psychosocial factors in empirical studies in adolescents. Future studies should further explore the hypothesised pathway model. Keywords: depressive symptoms, self-perception, peer relationships, positive parenting, culture difference

Abstract
Self-compassion, being kind to oneself in difficult times, is a way of relating to oneself that promotes better mental health, but little is known about how self-compassion affects interpersonal relationships. The current study examined the association between self-compassion and adolescent depressive symptoms from an interpersonal perspective in different cultural contexts. Adolescents (N = 422/570, Mean age = 14.44/13.41, UK/China) completed questionnaires about their perceptions of their parents' behaviour towards them, self-compassion, friendships and depressive symptoms. Structural equation modelling revealed that positive parenting was positively associated with higher self-compassion, positive friendship quality, and with fewer depressive symptoms in both samples. Additionally, we confirmed a negative association between self-compassion and depressive symptoms. The pathway from positive parenting to lower depressive symptoms via higher self-compassion was also corroborated in both cultures. Contrary to our hypothesis, positive quality of friendship was associated with higher depressive symptoms in both countries. Conflicts were associated with more depressive symptoms in the Chinese sample only. There was evidence of a negative association between self-compassion and conflicts in the Chinese sample only. Finally, the direct association between self-compassion and depressive symptoms was greater in the UK sample, whereas in the Chinese sample, interpersonal factors were more strongly associated with self-compassion and depressive symptoms. Our findings suggest that self-compassion may be a useful therapeutic target to improve social functioning and mental health among adolescents and that it may be necessary to account for cross-cultural differences in interpersonal factors when designing psychological interventions.

RATIONALE: Social functioning is modulated by the endogenous opioid system. In opioid use disorder, social functioning appears disrupted, but little research has delineated the nature of these deficits and their relationship to acute opioid use. OBJECTIVES: the current study aimed to assess both emotional and cognitive empathy, along with subjective and physiological responses to social exclusion in opioid users who were either acutely intoxicated or non-intoxicated from using opioids. METHODS: Individuals on an opioid substitution medication (OSM) were divided into 'intoxicated users' (had taken their OSM the same day as testing, n = 20) and 'non-intoxicated users' (had taken their OSM > 12 h ago, n = 20) and compared with opioid-naïve controls (n = 24). Empathy was assessed using the multifaceted empathy test and self-report questionnaire. Participants also underwent a period of social exclusion (Cyberball Game) and completed measures of mood and physiological responses (salivary cortisol and heart rate). RESULTS: Non-intoxicated users had significantly lower emotional empathy (the ability to experience others' emotions), as well as greater anger after social exclusion when compared with the intoxicated users and controls. Anger did not change with social exclusion in the intoxicated user group and cortisol levels were lower overall. CONCLUSIONS: Reduced ability to spontaneously share the emotions of others was reported in non-intoxicated users, particularly regarding positive emotions. There was some support for the idea of hyperalgesia to social pain, but this was restricted to an enhanced anger response in non-intoxicated users. Equivalent rates of empathy between the intoxicated users and controls could indicate some remediating effects of acute opioids.

Systematic Literature Review Abstract

Objective: Self-compassion is associated with greater well-being and happiness and reduced symptoms of psychological distress. Negative self-compassion such as self-criticism, has the opposite effect. Having higher self-compassion involves the use of a range of emotion regulation strategies, including aspects of cognitive and attentional control. Executive function (EF) describe skills involved in these ‘higher order’ or supervisory cognitive processes such as the ability to shift attention, inhibit automatic responses and use working memory (WM). Research to date has shown that interventions either self-compassion or EF skills can result in improvements to the other. To explore the association between these two variables, this systematic review collated studies that measured the relationship between EF and self-compassion, self-criticism and self-blame.
Method: Studies that measured self-compassion, self-criticism or self-blame, and assessed EF skills in adults, were selected from a number of databases, both multidisciplinary and subject-specific, prior to 1st April 2020. The search strategy provided 183 results,128 after duplicates were removed. Full text screening of 39 studies led to the inclusion of seven papers for this review.
Results: Results provided partial support for the association of WM with self-criticism, but no confirmed support for the association of self-compassion, self-criticism or self-blame with other aspects of EF. Results were not conclusive due to the lack of quality research.
Conclusions: There is scant support at present for the association of levels of self-compassion, self-criticism or self-blame, with EF skills, however there is also little quality support for the lack of a relationship between them. Further research would be needed to address what appears to be a gap in the evidence base.

Keywords: self-compassion, self-criticism, self-blame, executive function, systematic review
Empirical Paper
Abstract


Objective: PTSD is known to cause significant impairments to social interactions and general functioning. It is associated with poor self-image and low levels of self-compassion. Cognitive difficulties associated with the disorder include deficiencies in levels of executive function (EF). Low self-compassion and poor EF skills are suggested to be involved in the maintenance of PTSD. Despite this, little is known about the association between self-compassion and EF, and still less of their combined role in PTSD. To address this gap, the association of trait and state levels of self-compassion, with EF skills was investigated in a population who had experienced traumatic events.
Methods: Fifty-two adults (M=33.71 years; SD = 17.01) participated in the study. of this, 33 met a current diagnosis of PTSD (26 women, 7 men) and 19 had symptoms below the diagnostic threshold (13 women, 6 men). The participants completed measures of trait self-compassion, PTSD symptoms and a self-report EF measure before completing Trails and Stroop tests to assess specific attention switching and inhibition skills. State levels of self-compassion were measured before and after listening to a recording of a self-compassion induction.
Results: Findings showed that (1) state levels of self-compassion increased significantly following the induction, but the degree of change was not predictable from the other factors, (2) PTSD symptom severity was predicted independently and significantly by both the trait measure of self-compassion and the self-report measure of EF, furthermore (3) levels of trait self-compassion were associated to, and predicted by, self-report measures of EF.
Conclusion: the study did not confirm any factors that could predict change in levels of state self-compassion; however, it demonstrated that PTSD symptoms were associated with both EF and self-compassion, increasing support for interventions to target these areas. In addition, the association of EF skills to levels of self-compassion increases our understanding of the role of cognitive functions in supporting well-being.
Keywords: PTSD, self-compassion, executive function

Extending previous research, we applied latent profile analysis in a sample of adults with a history of recurrent depression to identify subgroups with distinct response profiles on the Five Facet Mindfulness Questionnaire and understand how these relate to psychological functioning. The sample was randomly divided into two subsamples to first examine the optimal number of latent profiles (test sample; n = 343) and then validate the identified solution (validation sample; n = 340). In both test and validation samples, a four-profile solution was revealed where two profiles mapped broadly onto those previously identified in nonclinical samples: "high mindfulness" and "nonjudgmentally aware." Two additional subgroups, "moderate mindfulness" and "very low mindfulness," were observed. "High mindfulness" was associated with the most adaptive psychological functioning and "very low mindfulness" with the least adaptive. In most people with recurrent depression, mindfulness skills are expressed evenly across different domains. However, in a small minority a meaningful and replicable uneven profile indicating nonjudgmental awareness is observable. Current findings require replication and future research should examine the extent to which profiles change from periods of wellness to illness in people with recurrent depression and how profiles are influenced by exposure to mindfulness-based intervention.

Systematic review:
Abstract
Background: Adherence to treatment plans for children with chronic
disorders is around 50%. Barriers to good adherence include parental factors such as parental stress, with parents of children with a chronic condition found to have higher levels of parental stress than parents of children without such a condition. However, no review has assessed the relationship between parental stress and adherence irrespective of child diagnosis.
Method: PRISMA-P guidelines were followed to ensure transparency. CINAHL, Medline, EMBASE and PsycINFO databases were searched using relevant terms from creation to July 2019. 1067 articles were identified and screened for eligibility, resulting in 14 studies being included.
Results: Overall a negative relationship between parental stress and adherence was found, such that increased parental stress related to poorer adherence. Exceptions to this are discussed. Papers utilised varied measures for parental stress and adherence and assessed a number of different childhood disorders. Parental stress was found to be a multifaceted concept including aspects such as time pressures, emotional strain and financial difficulties.
Conclusion: Parental stress is a possible target for interventions aiming to improve paediatric adherence. However, given the multifaceted nature of parental stress interventions may benefit from targeting particular aspects (e.g. alleviating financial pressures). Further, clinics could work towards routinely screening for parental stress and developing a clinical cut-off indicating high stress among parents whose child has a chronic illness. Future research directions include further consideration of additional factors identified within this review as also related to adherence (e.g. health beliefs, family conflict).
Keywords: parental stress, paediatric chronic health disorder, adherence

Distance-based research intervention
Background: Only 50% of paediatric neuropsychological recommendations are adhered to because parents struggle to understand them and can feel too overwhelmed to implement them. The Information-Motivation-Behaviour skills (IMB) model offers a novel way to design neuropsychological interventions that specifically address parental barriers and thus improve adherence.
Method: Four families, recruited through a national clinic, completed a single-case experimental multiple baseline design study. An IMB-informed intervention comprising a baseline and intervention phase was designed to improve adherence to neuropsychological recommendations for children with rare neurological conditions. A pre-baseline measure of recommendation implementation informed by conversations with families was completed retrospectively. An online daily outcome measure regarding the implementation of eight recommendations was completed over thirty-one days. Three (of the eight) recommendations, ‘targeted recommendations,’ were chosen by families in collaboration with the researcher as the focus for the intervention. The remaining five were ‘non-targeted recommendations.’ Visual analysis, randomisation tests and effect size tests of adherence were completed. Pre and post intervention measures of parental stress and child’s everyday functioning were completed and analysed using the Reliable Change Index (RCI). Parents provided feedback regarding the acceptability of the intervention.
Results: Two children in the study had diagnoses of Sturge-Weber Syndrome (SWS), one with Congenital Melanocytic Nevus (CMN) and one had a chromosomal disorder. Implementation of targeted recommendations significantly increased following the intervention when data was analysed as a group. No significant increases were found for non-targeted recommendations. Visual analysis did show implementation increases from pre-baseline to baseline and for non-targeted recommendations, suggesting the simple information and focusing of recommendations provided at study commencement enabled some improved adherence. However, these increases were typically not sustained and were not as large as increases following the intervention for targeted recommendations. RCI analyses typically did not demonstrate improved levels of parental stress or the child’s everyday functioning. Parental feedback regarding the study indicated the intervention design was manageable and accessible.
Conclusion: This is the first study to design an IMB informed intervention to improve adherence for paediatric neurological conditions, suggesting future research could continue to apply the model. Targeted recommendation increases indicate that information, motivation, and behaviour skills are all required for sustained and significant increases in adherence. The IMB model components could be incorporated into clinical neuropsychological assessments and used to inform and tailor reports and recommendations. Future studies could consider how the IMB model can be adapted to develop interventions to support improved adherence for different difficulties.
Key words: Paediatric neurological conditions, parents, recommendations, adherence, IMB model, intervention, single-case experimental design, online survey

Systematic review:
Background: Despite growing evidence showing links between Post Traumatic Stress Disorder (PTSD) and shame, and the protective role of self-compassion in relation to shame and self-criticism, there is no systematic review of the existing literature investigating whether Compassion Focused Interventions (CFI) reduce shame in people with PTSD.
Objectives: This review addresses this gap and evaluates the research investigating the impact of CFIs on shame and negative cognitions of the self in adults with PTSD.
Method: a systematic review, with no time restrictions, was completed using PsycINFO, Medline, Embase, Web of Science, Psychology & Behavioral Sciences Collection, PILOTS and PubMed. Additionally, relevant websites with articles by key authors in the field of interest were checked. References of included articles were screened to identify other relevant research studies.
Results: in identifying only four articles, the review revealed research in this area is scarce. There is evidence that CFIs can lead to reductions in PTSD symptoms, shame and negative cognitions of the self (e.g. self-blame, guilt) in people with PTSD. However, due to a small number of studies included in this review, with mainly weak methodologies, it is impossible to reliably establish the effect of CFIs on people with PTSD.
Conclusions: CFIs have a potential to reduce shame and negative cognitions of the self in adults with PTSD. However, due to limited research in this area and existing studies having weak methodologies, further research is needed with more studies incorporating stronger methodologies (e.g. Randomised Controlled Trials comparing CFIs with an active control group).
Keywords: self-compassion, post-traumatic stress disorder, shame, negative cognitions, self-criticism
Empirical paper:.
Despite emerging evidence indicating that self-compassion can have protective effects against shame and self-criticism, there is a lack of studies investigating direct effects of self-compassion on state shame and self-criticism when exposed to social stress. This study addressed this gap and investigated, in 62 healthy individuals, whether a brief Loving Kindness Meditation to self (LKM-S, n = 32), known to temporarily increase state self-compassion, can attenuate psychophysiological responses to a psychosocial stress test (Montreal Imaging Stress Task [MIST]) as compared to a neutral emotion induction (NEU, n = 30). An experimental design was used with self-report measures of shame, self-criticism and self-compassion as well as physiological measures of heart rate (HR), skin conductance level (SCL) and heart rate variability (HRV). It was investigated whether LKM-S has a protective effect in terms of reducing state shame and self-criticism when participants were exposed to MIST as compared to NEU. It was hypothesized that participants from LKM-S will have lower scores on state shame and self-criticism post MIST and higher self-compassion levels post MIST in LKM-S as compared to NEU. Additionally, the research used markers of sympathetic and parasympathetic variables to investigate whether LKM-S attenuated physiological responses to MIST. None of the described hypothesis were confirmed. The findings suggest that a brief one-off self-compassion intervention, although it temporarily increased self-reported self-compassion, is not sufficient to protect against shame and self-criticism in the context of a psychosocial stressor.
Keywords: Self-compassion, shame, self-criticism, physiology, Heart Rate Variability, the Montreal Imaging Stress Task

Objective: Treatment outcomes for anorexia nervosa (AN) remain unsatisfactory. Substantial research has investigated the neuropsychological effects of AN, often with mixed results. One explanation for the inconsistencies is that there exist several distinct neuropsychological profiles within AN. Profiles have been reported, though not associated with clinical or demographic variables, limiting their utility. Suboptimal statistical techniques may undermine these findings. Method: an existing dataset of healthy controls (HCs) and AN patients (n = 423) was subjected to secondary analysis using latent profile analysis and a neural network to investigate latent profiles and the existence of non-linear neuropsychological structure. Profiles were compared with respect to demographic and clinical variables. Results: the latent profile analysis revealed five AN neuropsychological profiles. Patients in a globally neuropsychologically impaired profile were older than those in a high-average with high verbal profile and weighed less than those in an average performance profile. A non-linear neural network failed to outperform a linear neural network on a diagnosis classification task. Discussion: the five-profile solution extended the neuropsychological groups previously found in the literature. This study is the first to successfully associate latent neuropsychological profile to clinically meaningful variables, though the profile in which differences were observed was tiny (7% of patients). None of the discovered profiles differed in terms of anxiety, undermining support for the noradrenergic hypothesis of AN. The failure of the non-linear neural network to outperform the linear network indicates that AN neuropsychological ability does not contain significant non-linearity, indicating that conventional statistical techniques can model them.

Opioid use disorder (OUD) is reaching epidemic proportions worldwide, and is notoriously difficult to treat. Compassion focused therapy (CFT) has emerged as therapeutic tool for treating individuals exhibiting high levels of self-criticism and low self-esteem, both of which are common in OUD. Until now, however, there had been no research investigating this therapy in patients with OUD. Before running a premature clinical trial, it is important to fully assess the feasibility and acceptability of this treatment in this group of individuals. We aimed to assess the feasibility of CFT treatment in individuals with OUD in a short group intervention, which was co-created by the research team, service users and a local drugs service. The intervention involved three 2-hour sessions held over 3 weeks, where participants engaged in compassion-orientated psychoeducation and self-compassionate exercises. Individuals were randomly assigned to either the CFT group (n = 15), the active control (relaxation) group (n = 12) or the waitlist control group (n = 11). of 103 individuals approached, 45% attended a baseline visit suggesting the treatment was acceptable to this group. A relatively low attrition rate across the 3 groups was found for CFT (21.1%), with no difference in drop-out between the groups. Qualitative analysis of interviews with participants identified a desire for more sessions. Compassion focused therapy was thus feasible and well-tolerated in those with OUD, and a further trial to evaluate any clinical differences may be warranted.

Opioid use disorder (OUD) is a growing global concern as overdoses have drastically increased over recent years. There is an urgent requirement for novel and more effective treatments. Investigating the role of social factors in the onset and maintenance of OUD may be a promising approach. In Chapter 1, I review the role of social vulnerability factors in OUD, and how social functioning may be altered in opioid drug users via changes to the endogenous opioid system. In Chapter 2, I report greater pleasurable effects and reduced aversive effects of an acute dose of morphine in individuals with histories of childhood trauma (without histories of OUD). This suggested history of childhood trauma may increase the rewarding value of opioids, and therefore be a major vulnerability factor preceding OUD. Impairments to social functioning in those with OUD is then investigated in Chapter 3, where I report reduced empathy for others’ emotions alongside greater anger following social exclusion. These findings indicate social risk factors and impaired social functioning as an important area that should be considered in the search for novel treatments for OUD. In Chapter 4 I report on a brief intervention of compassion-focused therapy (CFT) for OUD, showing that this novel treatment is feasible and tolerable in this population. Another potential therapeutic avenue to improve social functioning is by using MDMA adjunct to psychotherapy, therefore in Chapter 5 I examined whether social functioning is negatively affected by MDMA use. Low level, repeated MDMA use was associated with improved empathy and did not affect social distress, highlighting it as potentially suitable for treating social impairments in OUD. In Chapter 6, I discuss the wider theoretical implications and propose a social risk factor model for OUD. I also discuss the clinical implications of the findings, potential limitations to the work, and suggestions for future directions for improving social functioning in OUD. In conclusion, social functioning is disrupted in OUD, and experiences of childhood trauma and social stressors may prime people to the addictive effects of these drugs; however, CFT or MDMA-assisted psychotherapy may be beneficial for treating OUD.

Self-compassion and its cultivation in psychological interventions are associated with improved mental health and well-being. However, the underlying processes for this are not well understood. We randomly assigned 135 participants to study the effect of two short-term self-compassion exercises on self-reported-state mood and psychophysiological responses compared to three control conditions of negative (rumination), neutral, and positive (excitement) valence. Increased self-reported-state self-compassion, affiliative affect, and decreased self-criticism were found after both self-compassion exercises and the positive-excitement condition. However, a psychophysiological response pattern of reduced arousal (reduced heart rate and skin conductance) and increased parasympathetic activation (increased heart rate variability) were unique to the self-compassion conditions. This pattern is associated with effective emotion regulation in times of adversity. As predicted, rumination triggered the opposite pattern across self-report and physiological responses. Furthermore, we found partial evidence that physiological arousal reduction and parasympathetic activation precede the experience of feeling safe and connected.

Purpose of Article. ABI results in a range of psychological difficulties such as identity changes and low acceptance of the limitations following injury. These factors are not well addressed by existing treatment approaches. Compassion Focused Therapy (CFT) has been promising for the ABI population in case and naturalistic studies, but its efficacy has not been studied experimentally.
Materials and Methods. The present study used a single case experimental design (SCED) to investigate if a digitally adapted guided self-help CFT protocol increases self-compassion and decreases self-criticism. In addition to being acceptable to participants and facilitating successful achievement of personal goals. Five Participants completed a five week-digitally distributed CFT course which used a mixture of psychoeducation and compassionate imagery exercises.
Results and conclusion. The study found no significant change from the baseline to intervention phase on scores of self-compassion and self-criticism. Visual analysis indicated variability in scores during the intervention as compared to the baseline for the majority of participants. Pre and post scores of self-compassion and self-criticism reliably changed in line with predictions. All participants completed the study and feedback suggested the intervention was acceptable and supportive to their recovery from the ABI. Goal-directed behaviour showed a small increase during the study. Issues around the length of the intervention and measure of self-compassion and self-criticism are discussed, as well as implications for future research and clinical practice.

Objective. Research demonstrates that self-compassion is linked to burnout and other psychological wellbeing outcome measures such as quality of life, stress, depression, and wellbeing. It is known that care occupations, and specifically those who work with individuals with learning disabilities, suffer with burnout and other psychological symptoms such as anxiety and depression. Several studies have examined these relationships in care staff. However, they have not been examined in a UK healthcare context, nor in a sample of learning disabilities staff for whom burnout is prevalent and relevant. With self-compassion as a moderator, this study
investigated burnout’s relationship to depression and psychological wellbeing respectively, in a UK learning disabilities staff sample.
Methods. 120 adult staff members (97 females and 23 males) aged between 18 and 64 years who work with adults with learning disabilities participated in the study. Participants completed an anonymised online questionnaire comprising the Self-Compassion Scale; the Maslow Burnout Inventory; the Beck Depression Inventory; and the Ryff Scale of Psychological Wellbeing.
Results. Self-compassion was at an average level for this sample and
depression scores were low. Moderation analyses illustrated that self-compassion significantly moderated the relationship between burnout (personal accomplishment) and psychological wellbeing (positive relationships with others); and burnout (both emotional exhaustion and personal accomplishment) and depression.

Introduction: Subjective memory impairment (SMI) refers to the perception of memory difficulties in the absence of objective memory impairment. SMI is a relatively common phenomenon in later life, affecting 43-77% of people over the age 65 years (Larrabee & Crook, 1994). Experience of SMI is associated with psychological distress, e.g. SMI is predictive of symptoms of depression and anxiety (Hurt, Burns, & Barrowclaugh, 2011). Previous research has suggested that self-compassion is positively associated with aspects of well-being in older adults (Phillips & Ferguson, 2012) and has been found to moderate the relationship between subjective physical health and subjective well-being (Allen, Goldwasser & Leary, 2012).
Objective: the aim of the study was to extend the research of Allen, Goldwasser and Leary (2012) and investigate whether self-compassion moderates the relationship between subjective memory impairment and memory-related psychological distress in older adults.
Methods: a cross-sectional correlational design was used to examine relationships between SMI, psychological distress and trait self-compassion, while controlling for depression and anxiety. A sample of 71 adults over the age of 60 years completed a series of questionnaires to measure the constructs of interest. The Addenbrooke’s Cognitive Examination – 3 (Hsieh, Shubert, Hoon, Mioshi, & Hodges, 2013) was used to verify that cognitive functioning was in a normal range for the participant’s age.
Results: Self-reported psychological distress was significantly positively associated with SMI (r =. 51, n = 69, p

This paper explores the relationship between dispositional self-compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self-compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self-compassion, use of cognitive emotion regulation strategies, and changes in mood and self-devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self-compassion showed greater mood recovery after mood induction, and less self-devaluation across the experimental procedure, independent of their mood-repair condition or habitual forms of cognitive emotion regulation. These results suggest that self-compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.

Literature Review:
The current review presents a recent review of the effectiveness of psychological therapies to treat sleep difficulties (such as insomnia and nightmares) in sufferers of posttraumatic stress disorder (PTSD). The review also aimed to investigate whether there are differences in the effectiveness of specific psychological therapies to treat sleep disturbances in PTSD, such as between the different types of psychological therapies such as cognitive behavioural therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT). Eleven studies were included in the review that met the inclusion and exclusion criteria. Results are presented in tables and a descriptive account is included. The review demonstrates that psychological therapies are effective for the treatment of insomnia and other sleep difficulties such as nightmares. However, firm conclusions cannot be drawn about the effectiveness of different types of psychological therapies as studies predominantly used CBT and only one non-CBT study was included in the review. Comparisons between the effectiveness of different CBT approaches is also not possible as there was a large range of diversity in the study characteristics and also there were only a small number of studies for each intervention, which therefore limits the generalisability of results in the current review. It may be that different CBT interventions such as CBT-I or EERT and IRT may be better suited to treat insomnia and nightmares respectively, but further research needs to be conducted into which of these approaches are beneficial for different PTSD specific sleep difficulties.

Empirical Paper:
Initial studies demonstrate that self-compassion reduces symptoms of PTSD in Armed Forces Veterans (AFV), however the use of self-compassion approaches in AFV is under-researched. The current study utilised self-report and psychophysiological measures to investigate whether a single self-compassion experimental induction reduced hyperarousal symptoms (PTSD Cluster E symptoms) and increased feelings of social connectedness in AFV. The study hypothesised that there would be a decrease in hyperarousal symptoms and an increase in social connectedness, which would be associated with PTSD severity. Fifty-three AFV who had been deployed to a combat zone took part in the study, of which n = 15 (28.3%) currently met criteria for PTSD and n = 4 (7.5%) met criteria for Subsyndromal PTSD. on the PCL-5. Participants listened to a recording of a Loving Kindness Meditation for self-compassion (LKM-S) and psychophysiological recordings were taken throughout. Participants completed state measures of hyperarousal and social connectedness before and after the LKM-S. Findings partially demonstrated that self-compassion can be elicited in an AFV population. However, changes on the self-report measures were largely not supported by psychophysiological measures, apart from skin conductance levels (SCL). The longevity of the effects observed in the study were not measured and should be investigated in future studies. Although this study has demonstrated that self-compassion can be elicited within the AFV population, further research is needed including to test a longer self-compassion intervention.

This study examined the factor structure of the Self-Compassion Scale (SCS) using a bifactor model, a higher order model, a 6-factor correlated model, a 2-factor correlated model, and a 1-factor model in 4 distinct populations: college undergraduates (N = 222), community adults (N = 1,394), individuals practicing Buddhist meditation (N = 215), and a clinical sample of individuals with a history of recurrent depression (N = 390). The 6-factor correlated model demonstrated the best fit across samples, whereas the 1- and 2-factor models had poor fit. The higher order model also showed relatively poor fit across samples, suggesting it is not representative of the relationship between subscale factors and a general self-compassion factor. The bifactor model, however, had acceptable fit in the student, community, and meditator samples. Although fit was suboptimal in the clinical sample, results suggested an overall self-compassion factor could still be interpreted with some confidence. Moreover, estimates suggested a general self-compassion factor accounted for at least 90% of the reliable variance in SCS scores across samples, and item factor loadings and intercepts were equivalent across samples. Results suggest that a total SCS score can be used as an overall mesure of self-compassion.

Research into the effectiveness and mechanisms of mindfulness-based interventions (MBIs) requires reliable and valid measures of mindfulness. The 39-item Five Facet Mindfulness Questionnaire (FFMQ-39) is a measure of mindfulness commonly used to assess change before and after MBIs. However, the stability and invariance of the FFMQ factor structure have not yet been tested before and after an MBI; pre to post comparisons may not be valid if the structure changes over this period. Our primary aim was to examine the factor structure of the FFMQ-39 before and after mindfulness-based cognitive therapy (MBCT) in adults with recurrent depression in remission using confirmatory factor analysis (CFA). Additionally, we examined whether the factor structure of the 15-item version (FFMQ-15) was consistent with that of the FFMQ-39, and whether it was stable over MBCT. Our secondary aim was to assess the general psychometric properties of both versions. CFAs showed that pre-MBCT, a 4-factor hierarchical model (excluding the "observing" facet) best fit the FFMQ-39 and FFMQ-15 data, whereas post-MBCT, a 5-factor hierarchical model best fit the data for both versions. Configural invariance across the time points was not supported for both versions. Internal consistency and sensitivity to change were adequate for both versions. Both FFMQ versions did not differ significantly from each other in terms of convergent validity. Researchers should consider excluding the Observing subscale from comparisons of total scale/subscale scores before and after mindfulness interventions. Current findings support the use of the FFMQ-15 as an alternative measure in research where briefer forms are needed. (PsycINFO Database Record

BACKGROUND AND OBJECTIVES: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. DESIGN: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. METHODS: the sample comprised 393 university staff and students (RangeAge= 18-49, 85% females) who completed online measures. RESULTS: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. CONCLUSIONS: the study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.

Previous studies have found that communicating acceptance and understanding (validation) enhances the recipient's psychological and physiological wellbeing compared with receiving nonunderstanding feedback (invalidation). Yet, such studies have not established whether it is validation or absence of invalidation that is beneficial. This study examined the social, physiological, and emotional effects of validating and invalidating feedback in more detail, by employing a control group. Ninety healthy volunteers were randomly allocated to receive validating, invalidating, or no feedback during a series of stressor tasks. Self-report ratings, psychophysiological measurements and social engagement behaviors were recorded. While there were no significant differences between validated and control participants, invalidated participants showed increased physiological and psychological arousal on several measures and reduced social engagement behaviors compared with the other two groups. the relevance of these findings for understanding adverse effects of invalidation during clinical interactions is discussed.

Objectives: Cognitive-behavioral models highlight the role of learning and memory biases in the development and maintenance of chronic pain. However, the extent to which a memory bias is a consequence of the clinical state of being a chronic pain subject is unknown. This article presents a study which delineates the influence of chronic and acute pain on autobiographical memory retrieval. Methods: 16 healthy controls and 16 individuals with chronic pain participated in an autobiographical memory task during two sessions (a current pain and a pain-free session for the chronic pain subjects) and received neutral words that served as a cue for the retrieval of past life events. Results: the valence of remembered life events in individuals with chronic pain was more negative when they were in pain compared to pain-free states. Conversely, both groups did not differ in their ratings of the reported memories during the pain-free condition. In addition, no significant relationship between mood and the valence of retrieved memories was found. Conclusions: the present data demonstrate that current pain but not chronic pain per se can exert specific influences on remembering in participants with chronic pain. This memory bias could be a predisposition for the development of chronic pain but could also be a pain-maintaining consequence of painful experiences. This should be addressed in longitudinal studies.

OBJECTIVES: Cognitive-behavioral models highlight the role of learning and memory biases in the development and maintenance of chronic pain. However, the extent to which a memory bias is a consequence of the clinical state of being a chronic pain subject is unknown. This article presents a study which delineates the influence of chronic and acute pain on autobiographical memory retrieval. METHODS: 16 healthy controls and 16 individuals with chronic pain participated in an autobiographical memory task during two sessions (a current pain and a pain-free session for the chronic pain subjects) and received neutral words that served as a cue for the retrieval of past life events. RESULTS: the valence of remembered life events in individuals with chronic pain was more negative when they were in pain compared to pain-free states. Conversely, both groups did not differ in their ratings of the reported memories during the pain-free condition. In addition, no significant relationship between mood and the valence of retrieved memories was found. CONCLUSIONS: the present data demonstrate that current pain but not chronic pain per se can exert specific influences on remembering in participants with chronic pain. This memory bias could be a predisposition for the development of chronic pain but could also be a pain-maintaining consequence of painful experiences. This should be addressed in longitudinal studies.

Emotional facial expressions provide important non-verbal cues as to the imminent behavioural intentions of a second party. Hence, within emotion science the processing of faces (emotional or otherwise) has been at the forefront of research. Notably, however, such research has led to a number of debates including the ecological validity of utilising schematic faces in emotion research, and the face-selectively of N170. In order to investigate these issues, we explored the extent to which N170 is modulated by schematic faces, emotional expression and/or selective attention. Eighteen participants completed a three-stimulus oddball paradigm with two scrambled faces as the target and standard stimuli (counter-balanced across participants), and schematic angry, happy and neutral faces as the oddball stimuli. Results revealed that the magnitude of the N170 associated with the target stimulus was: (i) significantly greater than that elicited by the standard stimulus, (ii) comparable with the N170 elicited by the neutral and happy schematic face stimuli, and (iii) significantly reduced compared to the N170 elicited by the angry schematic face stimulus. These findings extend current literature by demonstrating N170 can be modulated by events other than those associated with structural face encoding; i.e. here, the act of labelling a stimulus a 'target' to attend to modulated the N170 response. Additionally, the observation that schematic faces demonstrate similar N170 responses to those recorded for real faces and, akin to real faces, angry schematic faces demonstrated heightened N170 responses, suggests caution should be taken before disregarding schematic facial stimuli in emotion processing research per se.

A predominant expectation that social relationships with others are safe (a secure attachment style), has been linked with reduced threat-related amygdala activation. Experimental priming of mental representations of attachment security can modulate neural responding, but the effects of attachment-security priming on threat-related amygdala activation remains untested. Using functional magnetic resonance imaging, the present study examined the effects of trait and primed attachment security on amygdala reactivity to threatening stimuli in an emotional faces and a linguistic dot-probe task in 42 healthy participants. Trait attachment anxiety and attachment avoidance were positively correlated with amygdala activation to threatening faces in the control group, but not in the attachment primed group. Furthermore, participants who received attachment-security priming showed attenuated amygdala activation in both the emotional faces and dot-probe tasks. The current findings demonstrate that variation in state and trait attachment security modulates amygdala reactivity to threat. These findings support the potential use of attachment security-boosting methods as interventions and suggest a neural mechanism for the protective effect of social bonds in anxiety disorders.

The Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) and the Self-Compassion Scale (SCS; Neff, 2003) are widely used measures of mindfulness and self-compassion in mindfulness-based intervention research. The psychometric properties of the FFMQ and the SCS need to be independently replicated in community samples and relevant clinical samples to support their use. Our primary aim was to establish the factor structures of the FFMQ and SCS in individuals with recurrent depression in remission, since Mindfulness-Based Cognitive Therapy (MBCT) was developed as a treatment for preventing depressive relapse. In order to determine the consistency across populations, we examined the factor structures of the FFMQ and SCS in 3 samples: (1) a convenience sample of adults, (2) a sample of adults who practice meditation, and (3) a sample of adults who suffer from recurrent depression and were recruited to take part in a trial of MBCT. Confirmatory factor analyses (CFAs) showed that a 4-factor hierarchical model of the FFMQ best fits the community sample and the clinical sample but that a 5-factor hierarchical model of the FFMQ best fits the meditator sample. CFA did not endorse the SCS 6-factor hierarchical structure in any of the 3 samples. Clinicians and researchers should be aware of the psychometric properties of the FFMQ to measure mindfulness when comparing meditators and nonmeditators. Further research is needed to develop a more psychometrically robust measure of self-compassion. © 2014 American Psychological Association.

The five facet mindfulness questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) and the self-compassion scale (SCS; Neff, 2003) are widely used measures of mindfulness and self-compassion in mindfulness-based intervention research. The psychometric properties of the FFMQ and the SCS need to be independently replicated in community samples and relevant clinical samples to support their use. Our primary aim was to establish the factor structures of the FFMQ and SCS in individuals with recurrent depression in remission, since mindfulness-based cognitive therapy (MBCT) was developed as a treatment for preventing depressive relapse. In order to determine the consistency across populations, we examined the factor structures of the FFMQ and SCS in 3 samples: (1) a convenience sample of adults, (2) a sample of adults who practice meditation, and (3) a sample of adults who suffer from recurrent depression and were recruited to take part in a trial of MBCT. Confirmatory factor analyses (CFAs) showed that a 4-factor hierarchical model of the FFMQ best fits the community sample and the clinical sample but that a 5-factor hierarchical model of the FFMQ best fits the meditator sample. CFA did not endorse the SCS 6-factor hierarchical structure in any of the 3 samples. Clinicians and researchers should be aware of the psychometric properties of the FFMQ to measure mindfulness when comparing meditators and nonmeditators. Further research is needed to develop a more psychometrically robust measure of self-compassion.

Patients with posttraumatic stress disorder (PTSD) exhibiting disturbances in information processing, including trouble with attention, were studied. Event-related potentials (ERPs)-specifically, the P3 components (P3a, P3b, and P3 working memory {P3wm})-provide an objective, non-invasive, and cost-effective method for evaluating such disturbances. We evaluated the potential clinical utility of P3 components by examining the differences between PTSD and several control groups: normal participants, non-PTSD patients with trauma, and medicated patients with PTSD. We performed a meta-analysis of the ERP literature between 1990 and 2010 using a random effects model. P3a amplitude was larger in patients with PTSD compared to non-PTSD patients having trauma in the context of trauma-related distracters. P3b amplitude was also larger in patients with PTSD than in patients having trauma without PTSD, but in the context of trauma-related stimuli. P3b amplitude was smaller in patients with PTSD compared to normal controls in the context of neutral stimuli. P3wm signals were smaller with shorter latencies in patients with PTSD compared to normal controls or medicated patients with PTSD. The receiver-operator characteristic (ROC) analysis revealed that each P3 component had some potential to accurately classify patients, typically using amplitude for at least one lead. In conclusion, differences in P3 amplitude and latency between patients with PTSD and control patients confirm the results of Karl et al and extend our understanding of P3 as a neural correlate of working memory. These results further provide guidance on the potential design of future clinical trials supporting the development of P3 components as a PTSD diagnostic aid.

Posttraumatic stress disorder (PTSD) has been related to a number of functional and structural brain alterations. This chapter aims to review the current understanding of the role of functional brain asymmetries for negative (PTSD) and positive posttraumatic outcomes (posttraumatic growth) and for the successful treatment of PTSD. Theoretically, this chapter is based on theories of brain asymmetry and emotion which propose that asymmetries of brain activation are related to certain features of human emotion (e.g. valence, approach or withdrawal tendencies, arousal). These theories are supported by asymmetries found in the alpha frequency of the electroencephalogram (EEG). Recent findings of EEG alpha asymmetry in patients with PTSD are reviewed and implications for its theoretical understanding, treatment and further research are discussed. © 2011 Nova Science Publishers, Inc. All rights reserved.

This study explored the effects of oxytocin on Compassion Focused Imagery (CFI), that is, imagining another "mind" being deeply compassionate to oneself, and the interaction of these effects with self-criticism and feeling socially safe with others. Forty-four healthy participants (29 men and 15 women) completed self-report measures of self-criticism, attachment style, and social safeness before taking part in a double-blind randomized placebo controlled study. They attended two imagery sessions, receiving oxytocin in one and a placebo in the other. Positive affect was measured before and after each imagery session, and "imagery experience" was assessed after each session. Overall, oxytocin increased the ease of imagining compassionate qualities but there were important individual differences in how CFI was experienced. Participants higher in self-criticism, lower in self-reassurance, social safeness, and attachment security had less positive experiences of CFI under oxytocin than placebo, indicating that the effects of oxytocin on affiliation may depend on attachment and self-evaluative styles.

OBJECTIVE: Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees. DESIGN: in a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index. RESULTS: the CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group. CONCLUSION: Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need replication in a larger trial.

OBJECTIVES: Treatment effects on post-traumatic growth (PTG) and its subdomains were investigated together with predictors of the Janus-face model of PTG. DESIGN: Effects were investigated within a randomized controlled trial of cognitive-behavioural therapy (CBT) for post-traumatic stress disorder (PTSD). METHOD: Forty motor vehicle accident survivors were randomly assigned to a treatment or waiting condition. PTG was measured by the Post-traumatic Growth Inventory and complemented by its possible predictors (optimism, openness). RESULTS: the CBT treatment proved to be highly effective in terms of PTSD symptom reduction. In contrast to previous findings, however, there was no treatment effect on PTG in general. The CBT group showed, however, increases in PTG subdomains 'new possibilities' and 'personal strength'. CONCLUSIONS: the results of this study caution researchers to naively expect PTG as a uniformly positive outcome to evaluate treatment effectiveness.

BACKGROUND: Resting brain activity appears altered in Attention Deficit/Hyperactivity Disorder (ADHD). The default mode interference hypothesis (Sonuga-Barke and Castellanos, 2007) postulates that patterns of spontaneous very low frequency brain activity, typical of the resting brain, cause attention lapses in ADHD when they remain unattenuated following the transition from rest to active task performance. Here we test this hypothesis using DC-EEG. METHODS: DC-EEG recordings of very low frequency brain activity (

Posttraumatic stress disorder (PTSD) has been related to a number of functional and structural brain alterations. This chapter aims to review the current understanding of the role of functional brain asymmetries for negative (PTSD) and positive posttraumatic outcomes (posttraumatic growth) and for the successful treatment of PTSD. Theoretically, this chapter is based on theories of brain asymmetry and emotion which propose that asymmetries of brain activation are related to certain features of human emotion (e.g. valence, approach or withdrawal tendencies, arousal). These theories are supported by asymmetries found in the alpha frequency of the electroencephalogram (EEG). Recent findings of EEG alpha asymmetry in patients with PTSD are reviewed and implications for its theoretical understanding, treatment and further research are discussed. © 2010 Nova Science Publishers, Inc. All rights reserved.

Despite its hypothesized role in the etiology of posttraumatic stress disorder (PTSD), little research has investigated neural correlates of episodic memory impairment in trauma survivors. This pilot study utilized a correlational design to investigate the association between PTSD symptom severity, hippocampal volume, episodic memory, and brain activation during the Remember-Know task. Eleven non-medicated, righthanded survivors of civilian trauma participated in the study. Significant positive correlations were found between PTSD symptom severity and the activation of brain areas implicated in the episodic recognition network such as hippocampus, precuneus, and occipital gyrus. Higher PTSD symptoms were also significantly negatively correlated with brain activations in areas associated with episodic memory but also visuospatial attention such as the superior parietal lobule and the supramarginal gyrus. The pattern of results indicates specific alterations in the recruitment of the episodic memory network, possibly with a focus on internal mental imagery at the cost of integration between internal processes and external visuospatial online monitoring. © 2010 Hogrefe Publishing.

Objectives Treatment effects on post-traumatic growth (PTG) and its subdomains were investigated together with predictors of the Janus-face model of PTG. Design Effects were investigated within a randomized controlled trial of cognitive-behavioural theropy (CBT) for post-traumatic stress disorder (PTSD). Method Forty motor vehicle accident survivors were randomly assigned to a treatment or waiting condition. PTG was measured by the Post-traumatic Growth Inventory and complemented by its possible predictors (optimism, openness). Results the CBT treatment proved to be highly effective in terms of PTSD symptom reduction. In contrast to previous findings, however, there was no treatment effect on PTG in general. The CBT group showed, however, increases in PTG subdomains 'new possiblities' and 'personal strength'. Conclusions the results of this study caution researchers to naively expect PTG as a uniformly positive outcome to evaluate treatment effectiveness.

In this study, we examined the psychometric properties of the 33-item Posttraumatic Cognitions
Inventory (Foa, Ehlers, Clark, Tolin, & Orsillo, 1999) in 213 individuals with accident-related trauma and
190 individuals with interpersonal trauma. Confirmatory factor analyses generally supported the scale’s
original three-factor structure—Negative Cognitions About Self (SELF), Negative Cognitions About
World (WORLD), and Self-Blame (BLAME)—after four redundant items were excluded. However, in
line with previous findings, results for BLAME remained inconclusive because the scale performed
poorly with the individuals with accident-related trauma, whereas its fit with those with interpersonal
trauma was acceptable. BLAME might possibly relate to trauma type. Our results indicate that the
proposed 29-item version shows acceptable psychometric properties and that the role of BLAME should be further investigated.

Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.

Chronic pain (CP) and posttraumatic stress disorder (PTSD) are both frequent and often comorbid in refugees. To date, few controlled trials have studied the efficacy of treatments targeting this comorbidity; no treatment guidelines yet exist. The authors examined the feasibility and efficacy of short-term cognitive behavioural biofeedback (BF) addressing CP in traumatised refugees. The sample comprised 11 severely traumatised refugees with CP and PTSD (mean age = 36 years, SD = 6), who underwent assessment with the Mini International Neuropsychiatric Interview, Posttraumatic Diagnostic Scale, Pain Disability Index, and Visual Rating Scale. Additionally, coping with pain and psychotherapy tolerance were assessed. Acceptance of BF was high. Pre-post effects were small to medium for increased pain management and associated heart rate reactivity but large for coping with pain. The results encourage further research to confirm whether BF is indicated as a treatment component, but not a stand-alone treatment, for traumatised refugees with comorbid CP and PTSD.

Current models of recognition memory performance postulate that there are two fundamentally distinct retrieval processes, i.e. recollection and familiarity. This view has been challenged and little is known from human research about the functional connectivity of the brain areas involved in these processes. In our study we used a Remember-Know procedure to assess the functional connectivity of brain regions under recognition memory in 30 healthy adults. Using functional magnetic resonance imaging, we analysed the blood oxygen level-dependent responses during correct Remember, correct Know, correct Rejection and missed responses of the subjects during recognition of non-emotional nouns. One activation cluster was found in the left precuneus associated with both recollection and familiarity answers. To acquire information about the way in which activity in one brain region modulates activity in another brain region in response to the active task, we performed a psychophysiological interaction analysis with the left precuneus as a seed region. This analysis revealed functionally distinct networks of brain areas underlying recollection and familiarity. Furthermore, we discuss the differential involvement of the hippocampus in a recollection network as compared with a familiarity network. In summary, our results further strengthen the assumptions of a dual-process view of recognition memory [e.g. H. Eichenbaum et al. (2007) Annual Review of Neuroscience, 30, 123-152; A.P. Yonelinas (2001) Philosophical Transactions of the Royal Society London B Biological Sciences, 356, 1363-1374] and add empirical findings about the functional interconnectivity of brain regions supporting either recollection or familiarity.

Recent cognitive models stress the impact that negative appraisals have on the maintenance of posttraumatic stress disorder (PTSD). The aim of this study was to investigate the role of posttraumatic negative cognitions in 110 survivors of motor vehicle accidents (MVAs) and to examine the effect of cognitive-behavioral treatment on negative appraisals in a sample of 42 patients with full or sub-syndromal PTSD. We investigated whether posttraumatic negative cognitions predicted PTSD diagnosis and symptom severity, and whether treatment-related changes in negative appraisals were associated with PTSD symptom reduction. Negative posttraumatic cognitions were significantly associated with PTSD diagnosis and severity, and explained 54% of the variance of the PTSD severity. Furthermore, treatment-related reductions in negative appraisals about the self were highly associated with PTSD-symptom-reduction. Our results raise question about whether there are factors that make the self more vulnerable in some people but not in others.

Background: the default mode interference hypothesis (Sonuga-Barke & Castellanos, 2007) predicts (1) the attenuation of very low frequency oscillations (VLFO; e.g.. 05 Hz) in brain activity within the default mode network during the transition from rest to task, and (2) that failures to attenuate in this way will lead to an increased likelihood of periodic attention lapses that are synchronized to the VLFO pattern. Here, we tested these predictions using DC-EEG recordings within and outside of a previously identified network of electrode locations hypothesized to reflect DMN activity (i.e. S3 network; Helps et al. 2008). Method: 24 young adults (mean age 22.3 years; 8 male), sampled to include a wide range of ADHD symptoms, took part in a study of rest to task transitions. Two conditions were compared: 5 min of rest (eyes open) and a 10-min simple 2-choice RT task with a relatively high sampling rate (ISI 1 s). DC-EEG was recorded during both conditions, and the low-frequency spectrum was decomposed and measures of the power within specific bands extracted. Results: Shift from rest to task led to an attenuation of VLFO activity within the S3 network which was inversely associated with ADHD symptoms. RT during task also showed a VLFO signature. During task there was a small but significant degree of synchro-nization between EEG and RT in the VLFO band. Attenuators showed a lower degree of synchrony than nonattenuators. Discussion: the results provide some initial EEG-based support for the default mode interference hypothesis and suggest that failure to attenuate VLFO in the S3 network is associated with higher synchrony between low-frequency brain activity and RT fluctuations during a simple RT task. Although significant, the effects were small and future research should employ tasks with a higher sampling rate to increase the possibility of extracting robust and stable signals. © 2009 Federation of European Psychophysiology Societies.

OBJECTIVES: Spinal cord injury (SCI) is a severe, traumatic event and recently research into the role of post-traumatic stress disorder (PTSD) subsequent to the injury has become of increasing interest. This study has been conducted in order to investigate potential risk factors for the development of post-traumatic stress disorder symptoms in those with SCI. DESIGN: This cross-sectional study used multiple regression analysis to look for associations between post-traumatic stress symptom severity, SCI-related factors and previously identified risk factors for PTSD such as dysfunctional cognitions, demographic factors and personality predispositions (neuroticism, alexithymia). METHOD: a total of 102 participants with SCI completed measures of post-traumatic stress severity, acceptance of injury, post-traumatic cognitions, social support, neuroticism and alexithymia. In addition, information about type, level and cause of the SCI was assessed. RESULTS: High levels of post-traumatic stress symptoms were found. Potential risk factors for the development of PTSD were negative cognitions of self and neuroticism. Variables that added to the variance explained by the models included time since injury and difficulty identifying feelings. Acceptance of injury was mediated by negative cognitions of the self and neuroticism. CONCLUSIONS: the study highlights the need for services to be aware of the psychological difficulties experienced by this client group. An important finding is that the acceptance of the injury is mediated by negative cognitions of the self which need to be identified as potential risk factors in order to prevent the development of post-traumatic symptoms in this population.

OBJECTIVE: to explore changes for the first time in neural processing due to effective cognitive behavioral therapy (CBT) in posttraumatic stress disorder (PTSD) after severe motor vehicle accidents. Recent studies have highlighted the role of right hemisphere activation during withdrawal-related emotions (e.g. anxiety). There has been little research on changes in brain function due to cognitive-behavioral interventions in anxiety disorders. METHODS: We conducted a randomized, controlled trial comparing cognitive-behavioral therapy with an assessment-only Wait-list condition. Spontaneous electroencephalographic activity was recorded from left and right anterior and posterior regions in participants with PTSD/subsyndromal PTSD receiving CBT (n = 17) before and after a CBT program. Wait-list controls (n = 18) were investigated before and after 3 months. RESULTS: at the pretreatment assessment, a pattern of increased right-sided activation during exposure to a trauma-related picture (relative to a neutral picture) was observed in both CBT and Wait-list participants. At posttreatment, there was a greater reduction of right anterior activation in the CBT group as compared with Wait-list controls. Across both groups, PTSD symptom reduction was significantly positively correlated with a decrease in right anterior activation to the trauma stimulus. CONCLUSIONS: These findings suggest that effective CBT treatment of PTSD may be accompanied by adaptive changes in asymmetrical brain function. Future studies are needed to confirm our findings.

To investigate the role of a general coping style in the development and maintainance of PTSD-like symptoms, we investigated 44 survivors of severe motor vehicle accidents. Coping was assessed using a German instrument. We also included personality traits such as neuroticism and extraversion, peritraumatic and cognitive factors that are linked to both PTSD and coping in daily life. Stepwise regressions were computed to explain overall PTSD symptoms and symptom clusters (intrusion, avoidance, hyperarousal). Extraversion and neuroticism, cognitive factors, and subjective trauma characteristics predicted total PTSD severity and the symptom clusters, respectively. Additionally, the results indicate that the coping of a person in daily life plays a role in the development and maintenance of PTSD symptoms. We identified both protective factors such as situation control and self-aggrandizement and risk factors such as avoidance and self-blame.

Posttraumatic growth (PTG), the phenomenon of self-reported positive outcomes of trauma, is assumed to consist of two sides: a constructive and an illusory side. This study investigates the relationship between PTG and its possible illusory and constructive predictors, as well as the moderating role of posttraumatic stress disorder (PTSD) severity. One-hundred two motor vehicle accident (MVA) survivors with full, subsyndromal, and without PTSD were assessed by multiple psychometric measures targeting PTSD severity, posttraumatic growth, optimism, and openness to experience. Hierarchical regression analysis yielded differential interaction effects between PTSD severity and optimism, as well as openness facets pointing to the moderating role of PTSD severity in the prediction of an illusory and a constructive factor in PTG.

The diagnostic process and treatment of victims of war and torture is associated with a number of difficulties. This article will provide an overview of three different approaches on how the new media may be integrated into the treatment of survivors of torture and war to face some of the challenges. Illiteracy is a common problem and makes it difficult to apply standardized psychological assessment procedures. Also, the majority of survivors of torture and war do not have access to any psychotherapeutic treatment due to geographical limitations or limitations concerning psychotherapeutic treatment capacity. Furthermore, chronic psychological disorders such as (complex) Posttraumatic Stress Disorder (PTSD) are often seen with comorbid chronic pain disorders, which present a therapeutic challenge. The Treatment Center for Torture Victims, Berlin, in cooperation with the University of Zurich, developed a number of approaches to address these challenges: 1) MultiCASI - to standardize the diagnostic process an audiovisual diagnostic tool was developed which allows illiterate individuals to answer standardized psychological questionnaires whithout the help of interpreters; 2) a virtual treatment center for posttraumatic stress disorder for traumatized patients in Iraq and other Arab speaking postconflict countries; 3) Utility of Biofeedback (BF) in chronic (somatoform) pain and in traumatized patients: to address the chronic pain syndrome presented by most survivors, a biofeedback supported cognitive-behavioral therapy approach was developed and successfully tested in a pilot study.

This series of meta-analyses examined structural abnormalities of the hippocampus and other brain regions in persons with PTSD compared to trauma-exposed and non-exposed control groups. The findings were significantly smaller hippocampal volumes in persons with PTSD compared to controls with and without trauma exposure, but group differences were moderated by MRI methodology, PTSD severity, medication, age and gender. Trauma-exposed persons without PTSD also showed significantly smaller bilateral hippocampal compared to non-exposed controls. Meta-analyses also found significantly smaller left amygdala volumes in adults with PTSD compared to both healthy and trauma-exposed controls, and significantly smaller anterior cingulate cortex compared to trauma-exposed controls. Pediatric samples with PTSD exhibited significantly smaller corpus callosum and frontal lobe volumes compared to controls, but there were no group differences in hippocampal volume. The overall findings suggested a dimensional, developmental psychopathology systems model in which: (1) hippocampal volumetric differences covary with PTSD severity; (2) hippocampal volumetric differences do not become apparent until adulthood; and (3) PTSD is associated with abnormalities in multiple frontal-limbic system structures.

Persons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.

BACKGROUND: We translated, modified, and extended a cognitive behavioral treatment (CBT) protocol by Blanchard and Hickling (2003) for the purpose of treating survivors of MVA with full or subsyndromal posttraumatic stress disorder (PTSD) whose native language is German. The treatment manual included some additional elements, e. g. cognitive procedures, imaginal reliving, and facilitating of posttraumatic growth. The current study was conducted in order to test the efficacy of the modified manual by administering randomized controlled trial in which a CBT was compared to a wait-list control condition. METHODS: Forty-two motor vehicle accident survivors with chronic or severe subsyndromal posttraumatic stress disorder (PTSD) completed the treatment trial with two or three detailed assessments (pre, post, and 3-month follow-up). RESULTS: CAPS-scores showed significantly greater improvement in the CBT condition as compared to the wait list condition (group x time interaction effect size d = 1.61). Intent-to-treat analysis supported the outcome (d = 1.34). Categorical diagnostic data indicated clinical recovery of 67% (post-treatment) and 76% (3 months FU) in the treatment group. Additionally, patients of the CBT condition showed significantly greater reductions in co-morbid major depression than the control condition. At follow-up the improvements were stable in the active treatment condition. CONCLUSION: the degree of improvement in our treatment group was comparable to that in previously reported treatment trials of PTSD with cognitive behavioral therapy. TRIAL REGISTRATION: ISRCTN66456536.

In recent years there has been an accumulation of studies that have utilized the measurement of event-related potentials (ERP) to examine the neuroelectric correlates of hypothesized alterations in information processing in persons with post-traumatic stress disorder (PTSD). The objective of this meta-analysis was to summarize the findings of ERP PTSD research, including studies that have examined P50 auditory sensory gating, augmenting-reducing P200, and P300 in target detection oddball tasks. The results suggest that persons with PTSD exhibit alterations in the amplitude and latency of ERP within these paradigms that support the hypothesis that changes in information processing can accompany PTSD. The results were also consistent with recent cognitive neuropsychological findings in PTSD research.

Frontal brain asymmetry has been associated with emotion- and motivation-related constructs. The authors examined the relationship between frontal brain asymmetry and subjective perception of posttraumatic growth (PTG) after severe motor vehicle accidents (MVAs). Eighty-two survivors of MVAs completed self-report measures of PTG, trait and state affect, and diagnostic interviews assessing clinical status, and underwent measurement of resting electroencephalographic activity. As predicted, increased relative left frontal activation was significantly related to PTG, even when statistically controlling for dispositional positive affect. The authors assume that approach-related motivational tendencies associated with higher relative left frontal brain activity may be involved in the process and outcome of PTG.

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information.

Since its first description in the Diagnostic and Statistical Manual for Mental Disorders, post-traumatic stress disorder (PTSD) has been characterized as a disorder of altered affective functioning which causes tremendous distress. In addition, it has been recognized that PTSD is not only accompanied by ''poor health'' but also by a number of specific and non-specific ''somatic'' pathologies, such as cardiovascular, autoimmune and physical complaints/chronic pain. It has been hypothesized that alterations of the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic-adrenal-medullary (SAM) and the immune system may mediate or facilitate these somatic conditions. The aims of this review are to summarize studies that report altered somatic functioning in PTSD and to review how endocrine and immune function differentially affect PTSD-related somatic malfunction. It is hypothesized that alterations of HPA axis and SAM system permit disinhibition of inflammatory mechanisms, which in turn foster the development of somatic diseases as well as self-reported physical complaints.

This study examined verbal-subjective, peripheral and central physiological responses of motor vehicle accident (MVA) survivors with subclinical posttraumatic stress disorder (PTSD), without PTSD symptoms as well as healthy controls. Seven persons of each group were exposed to positive, neutral, accident-related and negative, non-accident-related slides. The verbal-subjective ratings of the slides did not differ between the groups. In contrast to the verbal ratings of the trauma-related materials, the behavioral and physiological responses showed a remarkable dissociation from these reports. The startle responses were enhanced to accident-related slides only in the PTSD group and MVA survivors with PTSD had a significantly lower response to the neutral slides than MVA survivors without PTSD. P200 was lower to positive, neutral and negative slides in the PTSD group compared to both other groups. The late positive complex showed no group-related effects. The data suggest that traumatized persons with PTSD show exaggerated emotional responses to trauma-related stimuli and reduced cognitive responses to several types of stimuli that may interfere with the extinction of the emotional trauma memory.

Whereas several studies reported a close relationship between changes in the somatotopic organization of primary somatosensory cortex and phantom limb pain, the relationship between alterations in the motor cortex and amputation-related phenomena has not yet been explored in detail. This study used steady-state movement-related cortical potentials (MRCPs) combined with neuroelectric source imaging to assess the relationship of changes in motor cortex and amputation-related phenomena such as painful and non-painful phantom and residual limb sensations, telescoping, and prosthesis use. Eight upper limb amputees were investigated. A significant positive relationship between reorganization of the motor cortex (distance of the MRCP source location from the mirrored source for hand movement) and phantom limb pain was found. Non-painful phantom sensations as well as painful and non-painful residual limb sensations were unrelated to motor cortical reorganization. A higher amount of motor reorganization was associated with less daily prosthesis use, which also tended to be related to more severe phantom limb pain. These results extend previous findings of a positive relationship between somatosensory reorganization and phantom limb pain to the motor domain and suggest a potential positive effect of prosthesis use on phantom limb pain and cortical reorganization.

The aim of the study was to investigate to what extent cortical hyper-reactivity to visual stimuli is present in upper limb amputees. Five amputees with phantom limb pain (PLP), five amputees without PLP (Non-PLP) and 10 healthy controls (HC) were investigated using a visual oddball paradigm. Two hundred visual stimuli were presented with target stimuli occurring at a probability of 25% and standard stimuli at a probability of 75%. Event-related potentials were recorded from nine scalp positions (F3, F4, Fz, C3, C4, Cz, P3, P4, Pz). The PLP-patients had significantly higher P300-amplitudes to both types of stimuli compared to the non-PLP-patients. The HC were not significantly different from both amputee groups. P300-amplitude to targets at frontal sites in the hemisphere contralateral to the amputation was higher in the PLP patients. P300-latencies to target stimuli differed only at frontal sites with PLP-patients showing significantly longer latencies than non-PLP-patients. To standard stimuli, however, they showed significantly shorter latencies at central and parietal scalp positions. The HC had significantly shorter latencies than both amputee groups. The size of the P300-amplitude was positively correlated with the intensity of PLP. These findings suggest a higher magnitude of non-specific cortical excitability in amputees with PLP and a reduced excitability in amputees without PLP. This extends previous findings of differences in cortical excitability in PLP and non-PLP patients in the sensorimotor domain.

The present study investigated the test-retest reliability of magnetoencephalography (MEG) source localization of somatosensory evoked fields (SEFs) over an extended time period. Five healthy subjects were stimulated pneumatically at the first and fifth digit in two sessions spaced several months apart. At each location 400 stimuli were presented. The validation of the results was performed by overlay of the dipole localizations into the individual anatomic structure of the subjects' cortex by the use of magnetic resonance images (MRIs). The source localizations of the SEF component were found to be highly reproducible. The mean standard deviation of the dipole locations of the first digit was 1.55 mm in the x-, 1.55 mm in the y- and 3.49 mm in the z-direction. The mean standard deviation of the fifth digit was 3.69 mm in the x-, 4.27 mm in the y- and 6.60 mm in the z-direction. These results support the use of MEG recordings combined with MRI as an adequate method to define the organization of the human primary somatosensory cortex and provide a useful approach to the rapid detection of neuroplasticity.

The aim of the present study was to investigate startle responses in motor vehicle accident (MVA) survivors to trauma-related, startle, and neutral sounds. Participants were 17 MVA survivors, 11 of whom participated in a controlled treatment study comparing cognitive-behavioral treatment (CBT) and supportive therapy (ST) versus a waitlist condition. Though participants differed significantly in their pretreatment clinical status and symptom severity, these differences were not reflected by group differences in EMG (at orbicularis oculi) to the stimuli at the initial assessment. Some cue-specificity was found, as all participants showed larger startle responses to trauma-related sounds, compared to startle and neutral sounds. At posttreatment, a significant reduction in EMG reactivity to all stimuli was observed in participants who received active treatment (either CBT or ST), compared to waitlist controls. The use of startle responses as a PTSD treatment outcome index is discussed.

Age at exposure to trauma has been identified as a risk factor for severity of trauma sequelae due to the developmental vulnerability of several brain structures involved in trauma processing. To investigate whether persons traumatized in adolescence show elevated arousal and startle reaction parameters, we studied persons traumatized by political imprisonment in the former East Germany either in their late adolescence or young adulthood (17-22 years, n = 9) or middle adulthood (35-50 years, n = 6). Physiological reactions (skin conductance, heart rate) to loud tones and self-report tests were measured. Covariance analysis yielded one significant difference, mean skin conductance response, with a higher mean for the younger group. Results are discussed in light of its limitations and further prospects.

Age at exposure to trauma has been identified as a risk factor for severity of trauma sequelae due to the developmental vulnerability of several brain structures involved in trauma processing. To investigate whether persons traumatized in adolescence show elevated arousal and startle reaction parameters, we studied persons traumatized by political imprisonment in the former East Germany either in their late adolescence or young adulthood (17-22 years, n=9) or middle adulthood (35-50 years, n=6). Physiological reactions (skin conductance, heart rate) to loud tones and self-report tests were measured. Covariance analysis yielded one significant difference, mean skin conductance response, with a higher mean for the younger group. Results are discussed in light of its limitations and further prospects.

In the United States, motor vehicle accidents are the leading cause of accidental death and injury. Aggressive driving, which has been identified as a major risk factor for motor vehicle accidents by transportation authorities, is thus an important topic of study. This study compared the physiological reactivity of self-referred aggressive and nonaggressive drivers. Heart rate, blood pressure, facial muscle activity, and skin resistance were monitored as participants listened to idiosyncratic vignettes of driving and fear-provoking scenarios, as well as during a standard stressor task (mental arithmetic). The results were that aggressive drivers exhibited significant increases in muscle tension and blood pressure during the driving vignettes, relative to controls. They also responded to the fear vignette and mental arithmetic in a qualitatively different fashion from that of controls. The aggressive drivers responded to these stimuli with less overall heart rate and electrodermal reactivity, but increased blood pressure and muscle tension. In contrast, the controls responded to the fear vignette and mental arithmetic primarily with increased heart rates and decreased skin resistance. The findings suggest that both physiological hyperarousal as well as differential responses to stressful stimuli may contribute to aggressive driving. Implications for interventions with this population are discussed.

Phantom limb pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom limb pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom limb pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom limb pain had larger motor-evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom limb pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom limb pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom limb pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom limb pain.

Research question. A structured German-language interview was developed for the assessment of painful and non-painful phantom and stump phenomena after amputation. The aim was a thorough assessment of the quality, quantity and time course of these phenomena, which is of scientific as well as therapeutic relevance. Methods. Each phenomenon was assessed using visual analogue scales as well as qualitative descriptors adapted from the McGill Pain Inventory and from literature reports. The factor structure and psychometric properties of the interview were evaluated in a sample of 139 upper and lower limb amputees. Test-retest coefficients were obtained in a subset of 20 amputees. Results. As expected, all pain-related scales showed a two-dimensional internal structure with the factors "affective pain" and "sensory pain". For the non-painful phantom sensations, three factors "general/kinesthetic phantom sensations,", "phantom movements" and "paresthesiase" were obtained, while for non-painful stump sensations only one general factor emerged. The internal consistency was high with respect to the pain-related scales and was still satisfying for the scales that cover nonpainful phantom and stump phenomena. All scales have sufficient validity. Test-retest coefficients suggest a satisfactory stability of all scales that assess present phenomena, while the stability of the retrospective scales is markedly lower and in some cases insufficient. Conclusions. The phantom and stump phenomena interview is a highly reliable and valid instrument to assess present perceptual phenomena after amputation. Only the included retrospective scales apparently show low stability scores over time. This raises the more general question of the validity of retrospective pain reports.

In this study 16 unilateral upper extremity amputees participated in a comprehensive psychophysiological examination that included the assessment of painful and non-painful phantom and stump sensations, thermal and electric perception as well as two-point discrimination thresholds, the detailed analysis of referred sensation and the measurement of reorganizational changes in primary somatosensory cortex using neuroelectric source imaging. Reorganization of the primary somatosensory cortex was associated with increased habitual phantom limb pain, telescoping, non-painful stump sensations and painful referred sensation induced by painful stimulation. It was unrelated to non-painful phantom sensations, non-painful referred sensation elicited by painful or non-painful stimulation, painful referred sensation elicited by non-painful stimulation, perception thresholds and stump pain. These data substantiate the hypothesis that painful and non-painful phantom phenomena are mediated by different neural substrates.

RESEARCH QUESTION: a structured German-language interview was developed for the assessment of painful and non-painful phantom and stump phenomena after amputation. The aim was a thorough assessment of the quality, quantity and time course of these phenomena, which is of scientific as well as therapeutic relevance. METHODS: Each phenomenon was assessed using visual analogue scales as well as qualitative descriptors adapted from the McGill Pain Inventory and from literature reports. The factor structure and psychometric properties of the interview were evaluated in a sample of 139 upper and lower limb amputees. Test-retest coefficients were obtained in a subset of 20 amputees. RESULTS: As expected, all pain-related scales showed a two-dimensional internal structure with the factors "affective pain" and "sensory pain". For the non-painful phantom sensations, three factors "general/kinesthetic phantom sensations", "phantom movements" and "paresthesias" were obtained, while for non-painful stump sensations only one general factor emerged. The internal consistency was high with respect to the pain-related scales and was still satisfying for the scales that cover nonpainful phantom and stump phenomena. All scales have sufficient validity. Test-retest coefficients suggest a satisfactory stability of all scales that assess present phenomena, while the stability of the retrospective scales is markedly lower and in some cases insufficient. CONCLUSIONS: the phantom and stump phenomena interview is a highly reliable and valid instrument to assess present perceptual phenomena after amputation. Only the included retrospective scales apparently show low stability scores over time. This raises the more general question of the validity of retrospective pain reports.

Activity in the cerebral cortex associated with non-painful phantom limb sensation was studied in 14 upper extremity amputees. In four subjects, repetitive tactile stimulation of the digits or the lower corner of the mouth elicited non-painful phantom sensation in the amputated limb, in the remaining 10 patients no sensation could be evoked. Neuroelectric source imaging revealed significantly elevated activity in SI and posterior parietal cortex, and significantly decreased activity in ipsilateral SII cortex when referred sensations were present. However, nonpainful referred phantom sensations were not associated with a shift of the cortical representation of the mouth into the hand region, as previously suggested. Nonpainful phantom limb experiences seem to have widely distributed neural networks in multiple cortical regions.