Publications by year
Barnhofer T, Dunn BD, Strauss C, Ruths F, Barrett B, Ryan M, Ladwa A, Stafford F, Fichera R, Baber H, et al
(2023). A randomised controlled trial to investigate the clinical effectiveness and cost effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol. Trials
A randomised controlled trial to investigate the clinical effectiveness and cost effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol.
BACKGROUND: Major depression represents a pressing challenge for health care. In England, Increasing Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies in a stepped-care approach to patients with depression. While introduction of these services has successfully increased access to therapy, estimates suggest that about 50% of depressed patients who have come to the end of the IAPT pathway still show significant levels of symptoms. This study will investigate whether Mindfulness-Based Cognitive Therapy (MBCT), a group intervention combining training in mindfulness meditation and elements from cognitive therapy, can have beneficial effects in depressed patients who have not responded to high-intensity therapy in IAPT. It will seek to establish the effectiveness and cost-effectiveness of MBCT as compared to the treatment these patients would usually receive. METHODS: in a 2-arm randomised controlled trial, patients who currently meet the criteria for major depressive disorder and who have not sufficiently responded to at least 12 sessions of IAPT high-intensity therapy will be allocated, at a ratio of 1:1, to receive either MBCT (in addition to treatment as usual [TAU]) or continue with TAU only. Assessments will take place at baseline, 10 weeks and 34 weeks post-randomisation. The primary outcome will be reduction in depression symptomatology 34 weeks post-randomisation as assessed using the Public Health Questionnaire-9 (PHQ-9). Secondary outcomes will include depressive symptomatology at 10 weeks post-randomisation and other clinical outcomes measured at 10-week and 34-week follow-up, along with a series of binarised outcomes to indicate clinically significant and reliable change. Evaluations of cost-effectiveness will be based on assessments of service use costs collected using the Adult Service Use Schedule and health utilities derived from the EQ-5D. DISCUSSION: This trial will add to the evidence base for the use of MBCT in depressed treatment non-responders. It will constitute the first trial to test MBCT following non-response to psychological therapy, with results providing a direct estimate of efficacy within the IAPT pathway. As such, its results will offer an important basis for decisions regarding the adoption of MBCT for non-responders within IAPT. TRIAL REGISTRATION: ClinicalTrials.gov NCT05236959. Registered on 11 February 2022. ISRCTN 17755571. Registered on 2 February 2021. Abstract
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Barnhofer T, Dunn BD, Strauss C, Ruths F, Barrett B, Ryan M, Ladwa A, Stafford F, Fichera R, Baber H, et al (2022). A randomised controlled trial to investigate the clinical effectiveness and cost-effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol.
Wright K, Mostazir M, Bailey E, Dunn BD, O’Mahen H, Sibsey M, Thomas Z
(2022). Adapted Behavioural Activation for Bipolar Depression: a Randomised Multiple Baseline Case Series. Brain Sciences
Adapted Behavioural Activation for Bipolar Depression: a Randomised Multiple Baseline Case Series
Behavioural Activation (BA) is associated with a substantial evidence base for treatment of acute unipolar depression, and has promise as an easily disseminable psychological intervention for bipolar depression. Using a randomised multiple baseline case series design we examined the feasibility and acceptability of an adapted version of BA in a U.K. outpatient sample of 12 adults with acute bipolar depression. Participants were allocated at random to a 3–8 week wait period before being offered up to 20 sessions of BA. They completed outcome measures at intake, pre- and post-treatment and weekly symptom measures across the study period. Retention in therapy was high (11/12 participants completed the target minimum number of sessions), and all participants returning acceptability measures reported high levels of satisfaction with the intervention. No therapy-related serious adverse events were reported, nor were there exacerbations in manic symptoms that were judged to be a result of the intervention. The pattern of change on outcome measures is consistent with the potential for clinical benefit; six of the nine participants with a stable baseline showed clinically significant improvement on the primary outcome measure. The findings suggest adapted BA for bipolar depression is a feasible and acceptable approach that merits further investigation. Abstract
Alsayednasser B, Widnall E, O'Mahen H, Wright K, Warren F, Ladwa A, Khazanov GK, Byford S, Kuyken W, Watkins E, et al (2022). How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? a secondary analysis of the COBRA randomized controlled trial. Behaviour Research and Therapy, 159
Dunn BD, Wiedemann H, Kock M, Peeters F, Wichers M, Hayes R, Kuyken W, Geschwind N (2022). Increases in External Sensory Observing Cross-Sectionally Mediate the Repair of Positive Affect Following Mindfulness-Based Cognitive Therapy in Individuals with Residual Depression Symptoms. Mindfulness, 14(1), 113-127.
Higson-Sweeney N, Mikkola A, Smith L, Shafique J, Draper L, Cooper K, Dunn BD, Loades ME (2022). Nonpharmacological interventions for treating fatigue in adolescents: a systematic review and narrative synthesis of randomised controlled trials. Journal of Psychosomatic Research, 163, 111070-111070.
Russell A, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T
(2022). Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol. Systematic Reviews
Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol
Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome. Abstract
Methods: a systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components.
Discussion: This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD.
Pile V, Smith P, Leamy M, Oliver A, Bennett E, Blackwell SE, Meiser-Stedman R, Stringer D, Dunn BD, Holmes EA, et al
(2021). A feasibility randomised controlled trial of a brief early intervention for adolescent depression that targets emotional mental images and memory specificity (IMAGINE). Behav Res Ther
A feasibility randomised controlled trial of a brief early intervention for adolescent depression that targets emotional mental images and memory specificity (IMAGINE).
Brief, evidence-based interventions for adolescent depression are urgently required, particularly for school-settings. Cognitive mechanisms research suggests dysfunctional mental imagery and overgeneral memory could be promising targets to improve mood. This feasibility randomised controlled trial with parallel symptomatic groups (n = 56) compared a novel imagery-based cognitive behavioural intervention (ICBI) to non-directive supportive therapy (NDST) in school settings. Blind assessments (of clinical symptoms and cognitive mechanisms) took place pre-intervention, post-intervention and follow-up three months later. The trial aimed to evaluate the feasibility and acceptability of the methodology and interventions, and estimate the likely range of effects of the intervention on self-reported depression. The pre-defined criteria for proceeding to a definitive RCT were met: full recruitment occurred within eleven months; retention was 89%; ICBI acceptability was above satisfactory; and no harm was indicated. Intention-to-treat analysis found large effects in favour of ICBI (relative to NDST) at post-intervention in reducing depressive symptoms (d = -1.34, 95% CI [-1.87, -0.80]) and improving memory specificity (d = 0.79 [0.35, 1.23]), a key cognitive target. The findings suggest that ICBI may not only improve mood but also strengthen abilities associated with imagining and planning the future, critical skills at this life stage. A fully powered evaluation of ICBI is warranted. Trial Registration: https://www.isrctn.com/; ISRCTN85369879. Abstract
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Khazanov GK, Forbes CN, Dunn B, Thase ME
(2021). Addressing anhedonia to increase depression treatment engagement. British Journal of Clinical Psychology
Addressing anhedonia to increase depression treatment engagement
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective. Abstract
Yilmaz M, Psychogiou L, Ford T, Dunn B
(2021). Examining the Relationship Between Anhedonia Symptoms and Trait Positive Appraisal Style in Adolescents: a Longitudinal Survey Study. Journal of Adolescence
Examining the Relationship Between Anhedonia Symptoms and Trait Positive Appraisal Style in Adolescents: a Longitudinal Survey Study
Introduction: Anhedonia, defined as a loss of interest and pleasure in previously enjoyable activities, is a core symptom of depression that predicts a poor treatment response in adolescents. We know little about the cognitive vulnerability factors that contribute to the development of anhedonia in youth. This cross-sectional and longitudinal survey study investigated the link between anhedonia symptoms and cognitive appraisal of positive affect. Abstract
Results: at baseline, greater anhedonia was significantly associated with increased levels of dampening and reduced levels of amplifying but was not significantly related to fear of positive emotion. Prospectively, greater baseline levels of amplifying uniquely predicted lower anhedonia severity at three-month follow-up, and vice-versa. There was no evidence for reciprocal prospective associations between anhedonia and, appraisal styles of dampening and fear of positive emotion.
Conclusion: These results indicate that cognitive appraisal of positive affect is associated with concurrent and to some extent can predict future symptoms of anhedonia in youth.
Pile V, Smith P, Leamy M, Oliver A, Blackwell SE, Meiser-Stedman R, Dunn BD, Holmes EA, Lau JYF
(2021). Harnessing Mental Imagery and Enhancing Memory Specificity: Developing a Brief Early Intervention for Depressive Symptoms in Adolescence. COGNITIVE THERAPY AND RESEARCH
(5), 885-901. Author URL
Mars B, Gibson J, Dunn BD, Gordon C, Heron J, Kessler D, Wiles N, Moran P
(2021). Personality difficulties and response to community-based psychological treatment for anxiety and depression. J Affect Disord
Personality difficulties and response to community-based psychological treatment for anxiety and depression.
BACKGROUND: Previous research suggests that comorbid personality disorder may be associated with a less favourable treatment outcome for individuals with depression and anxiety disorder. However, little is known about whether personality difficulties are associated with treatment outcomes within Improving Access to Psychological Therapies (IAPT) services-the largest platform for treating depression and anxiety in England, UK. Secondary aims were to investigate i) whether individual personality difficulties are associated with treatment outcome and ii) whether findings are moderated by treatment type. METHODS: the sample included 3,689 adults who accessed community-based psychological treatment (cognitive behavioural therapy, emotional skills training, or other psychological therapy) for depression and/or anxiety disorder. Associations between personality difficulties (assessed with the Standardised Assessment of Personality-Abbreviated Scale (SAPAS)) and treatment outcomes (recovery and reliable improvement in depression/anxiety symptom scores, assessed using questionnaire-based measures) were investigated using logistic/linear regression. RESULTS: Personality difficulties were associated with a reduced likelihood of recovery (adjusted OR per unit increase on SAPAS: depression=0.87, 95%CI 0.84, 0.91; anxiety=0.86, 95%CI 0.82, 0.90) and reliable improvement (adjusted OR per unit increase on SAPAS: depression=0.88, 95%CI 0.84, 0.92; anxiety=0.85, 95%CI 0.82, 0.89). Those with three or more difficulties were over 30% less likely to recover/reliably improve. LIMITATIONS: Personality difficulties data were collected via self-report and were not available for all participants. CONCLUSION: Patients with personality difficulties have a less favourable response to psychological treatment for depression/anxiety disorder. If replicated, the findings highlight a major challenge to the way community-based psychological therapy services in England (IAPT services) are presently constituted. Abstract
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Wright K, Dodd A, Warren F, Medina-Lara A, Dunn B, Harvey J, Javaid M, Jones S, Owens C, Taylor R, et al (2021). Psychological Therapy for Mood Instability within Bipolar Spectrum Disorder: a Randomised, Controlled Feasibility Trial of a Dialectical Behaviour Therapy-Informed Approach (the ThrIVe-B Programme). International Journal of Bipolar Disorders, 9
(2021). Putting the Spotlight (of Attention) on Affect: Does the Valence of the Focus of Attention Modulate Affective State?.
Putting the Spotlight (of Attention) on Affect: Does the Valence of the Focus of Attention Modulate Affective State?
Putting the Spotlight (of Attention) on Affect: Does the Valence of the Focus of Attention Modulate Affective State? Abstract
Literature review: Background: to better treat anhedonia (reduced positive emotional experience) in depression, it is important to identify which psychological mechanisms drive anhedonia and whether simple manipulations can correct these mechanisms. One candidate mechanism is biases in attentional processing, including both the content of attention (the extent to which positive versus negative aspects of experience are focused on) and the quality of attention (the extent to which, that when attention is directed to positive aspects of experience, this is elaborated and savoured).
Objectives: This systematic review will evaluate empirical evidence investigating whether manipulating the content and quality of attention alters positive emotion experience in adult (healthy and depressed) populations.
Method: Experimental studies in adults manipulating the quality or content of positive attention and measuring its impact using a valid measurement of positive affect were identified, via a systematic search of Web of Knowledge and PsycInfo databases. 1,583 non-duplicate articles were found. A full text screen of 60 articles yielded 19 eligible articles (reporting 20 studies) for inclusion in the analysis (four manipulating the content of attention and 16 manipulating the quality of attention).
Results: Nearly all studies were in healthy rather than dysphoric/depressed samples. of four studies manipulating the content of attention (predominantly using valenced dot probe training paradigms), one showed robust changes in positive affect in the expected direction and three found no significant effects. of 16 studies manipulating the quality of attention (including savouring, imagery and processing mode manipulations), 12 showed robust changes in positive affect in the expected direction and four found no significant effects.
Conclusions: This review provides clear evidence that manipulating the quality of attention modifies positive affect. There was mixed evidence that changing the content of attention modifies positive affect. These null results may partly reflect limitations in
the dot probe manipulation used and further research is warranted. It is premature to translate these findings into clinical application as a majority of studies have been conducted on healthy populations, but the results nevertheless suggest modifying positive attention remains a promising potential future treatment target to enhance psychological interventions for depression.
Empirical Study: Background: the manner in which individuals focus their attention may modulate affective experience during positive activity scheduling. Focusing on the most positive elements of an activity may enhance positive affect (PA) and reduce negative affect (NA), whereas focusing on the most negative elements of an activity may reduce PA and elevate NA, but this possibility remains untested.
Objectives: the study implements a novel manipulation of the valence of focus of attention deployed using a smartphone application, and evaluates the impact on PA and NA.
Method: 68 unselected participants from the University of Exeter online recruitment portal completed all three conditions in a randomised control crossover study. Attention was manipulated during a pleasant walk to either the positive, negative, or no instruction control, using verbal prompts listened to via a smartphone application in an event contingent experience sampling protocol. Change in PA and NA from before to after the walk was recorded using an adapted Positive and Negative Affect Scale (PANAS).
Results: Attending to the positive enhanced PA and reduced NA during positive activity scheduling, relative to a no instruction control condition. Attending to the negative increased NA and reduced PA during positive activity scheduling, compared to a no-instruction control condition. The benefit of the positive attention manipulation on increasing PA was more marked in individuals with a more marked negative attentional bias and in those with higher depression symptoms.
Conclusions: This supports the view that reduced positive and enhanced negative attentional biases may be one mechanism driving anhedonia and suggests that the beneficial effects of positive activity scheduling during treatment for conditions characterised by anhedonia may be encouraging the cultivation of positive attentional bias when engaging with activities. This possibility now requires further testing in a clinical population.
Dunn BD, German RE, Khazanov G, Xu C, Hollon SD, DeRubeis RJ
(2020). Changes in Positive and Negative Affect During Pharmacological Treatment and Cognitive Therapy for Major Depressive Disorder: a Secondary Analysis of Two Randomized Controlled Trials. Clinical Psychological Science
Changes in Positive and Negative Affect During Pharmacological Treatment and Cognitive Therapy for Major Depressive Disorder: a Secondary Analysis of Two Randomized Controlled Trials
The cardinal symptoms of major depressive disorder (MDD) are heightened depressed mood (negative affectivity, or NA) and diminished interest or pleasure (positive affectivity, or PA). It is unknown how well treatments for MDD repair either symptom. Two secondary analyses of randomized controlled trials were therefore conducted. In Study 1, 180 adult outpatients with MDD received 16 weeks of antidepressant medication (ADM; n = 120) or cognitive therapy (CT; n = 60). In Study 2, adult outpatients with MDD were treated until remission with ADM (n = 225) or ADM and CT (n = 227). Across trials and treatments, intake disturbances were more marked in PA than NA, there was smaller repair of PA than NA during treatment, and disturbances remained more pronounced for PA than NA after treatment. Greater change in PA and NA were independently associated with depression symptom change. These findings suggest that depression treatments more effectively repair NA than PA and that outcomes may be improved with more effective targeting of the latter. Abstract
Khazanov GK, Xu C, Dunn BD, Cohen ZD, DeRubeis RJ, Hollon SD
(2020). Distress and anhedonia as predictors of depression treatment outcome: a secondary analysis of a randomized clinical trial. Behav Res Ther
Distress and anhedonia as predictors of depression treatment outcome: a secondary analysis of a randomized clinical trial.
Two core features of depression include depressed mood (heightened distress) and anhedonia (reduced pleasure). Despite their centrality to depression, studies have not examined their contribution to treatment outcomes in a randomized clinical trial providing mainstream treatments like antidepressant medications (ADM) and cognitive therapy (CT). We used baseline distress and anhedonia derived from a factor analysis of the Mood and Anxiety Symptom Questionnaire to predict remission and recovery in 433 individuals with recurrent/chronic major depressive disorder. Patients were provided with only ADM or both ADM and CT. Overall, higher baseline distress and anhedonia predicted longer times to remission within one year and recovery within three years. When controlling for treatment condition, distress improved prediction of outcomes over and above anhedonia, while anhedonia did not improve prediction of outcomes over and above distress. Interactions with treatment condition demonstrated that individuals with higher distress and anhedonia benefited from receiving CT in addition to ADM, whereas there was no added benefit of CT for individuals with lower distress and anhedonia. Assessing distress and anhedonia prior to treatment may help select patients who will benefit most from CT in addition to ADM. For the treatments and outcome measures tested, utilizing distress to guide treatment planning may yield the greatest benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00057577. Abstract
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Alsubaie M, Dickens C, Dunn BD, Gibson A, Ukoumunne OC, Evans A, Vicary R, Gandhi M, Kuyken W
(2020). Feasibility and Acceptability of Mindfulness-based Cognitive Therapy Compared with Mindfulness-based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a Three-Arm Randomised Controlled Trial. Mindfulness
Feasibility and Acceptability of Mindfulness-based Cognitive Therapy Compared with Mindfulness-based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a Three-Arm Randomised Controlled Trial
Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention. Abstract
Widnall E, Price A, Trompetter H, Dunn BD
(2020). Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing. Cognitive Therapy and Research
Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing
The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT. Abstract
Roberts H, Moberly NJ, Cull T, Gow H, Honeysett M, Dunn BD
(2020). Short-term affective consequences of specificity of rumination about unresolved personal goals. Journal of Behavior Therapy and Experimental Psychiatry
Short-term affective consequences of specificity of rumination about unresolved personal goals
Background and objectives: Rumination is a form of repetitive thinking that has been associated with both helpful and unhelpful consequences for mood and self-regulation. It has been suggested that the specificity of ruminative thought content may be one factor that determines whether state rumination about personal goals is adaptive. The present study tested the hypothesis that state rumination about unresolved personal goals is associated with unhelpful affective consequences only when rumination is low in specificity. Methods: We measured the extent and specificity of uninstructed rumination following the cueing of resolved and unresolved personal goals using a 30-min go/no-go task with thought probes. Changes in state positive and negative affect from before to after cueing goals, and before to after rumination during the go/no-go task were assessed. Results: Cueing unresolved goals resulted in a significant increase in negative affect, and subsequent affective recovery during the go/no-go task. Cueing unresolved goals resulted in more goal-focused rumination than cueing resolved goals. When ruminative thoughts were low in specificity, rumination mediated the association between goal discrepancies and negative affect: greater rumination about unresolved goals significantly impaired affective recovery and perpetuated negative affect. Limitations: the findings await replication in clinical populations, where rumination is more commonly associated with unhelpful outcomes. Conclusions: Greater levels of goal-focused rumination were associated with unhelpful affective consequences only when rumination was low in specificity. Specificity of thought content may be an important determinant of whether goal-focused rumination has helpful or unhelpful effects. Abstract
Dunn BD, O'Mahen H, Wright K, Brown G
(2019). A commentary on research rigour in clinical psychological science: How to avoid throwing out the innovation baby with the research credibility bath water in the depression field. Behav Res Ther
A commentary on research rigour in clinical psychological science: How to avoid throwing out the innovation baby with the research credibility bath water in the depression field.
Proponents of the research credibility movement make a number of recommendations to enhance research rigour in psychology. These represent positive advances and can enhance replicability in clinical psychological science. This article evaluates whether there are any risks associated with this movement. We argue that there is the potential for research credibility principles to stifle innovation and exacerbate type II error, but only if they are applied too rigidly and beyond their intended scope by funders, journals and scientists. We outline ways to mitigate these risks. Further, we discuss how research credibility issues need to be situated within broader concerns about research waste. A failure to optimise the process by which basic science findings are used to inform the development of novel treatments (the first translational gap) and effective treatments are then implemented in real-world settings (the second translational gap) are also significant sources of research waste in depression. We make some suggestions about how to better cross these translational gaps. Abstract
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(2019). Augmenting Cognitive Behavioural Therapy to Build Positive Mood in Depression. In Gruber J (Ed) The Oxford Handbook of Positive Emotion and Psychopathology
, Oxford University Press.
Augmenting Cognitive Behavioural Therapy to Build Positive Mood in Depression
Dunn BD, Widnall E, Reed N, Owens C, Campbell J, Kuyken W (2019). Bringing light into darkness: a multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behaviour Research and Therapy, 120, 103418-103418.
(2019). Dampening and Amplifying Cognitive Appraisals in Anhedonia: an investigation of which psychological mechanisms build or hinder positive affect in adolescence.
Dampening and Amplifying Cognitive Appraisals in Anhedonia: an investigation of which psychological mechanisms build or hinder positive affect in adolescence.
There is an increasing interest in understanding the psychological mechanisms that drive reduced positive emotion experience in depression (anhedonia). The adult literature has demonstrated that engaging with dampening appraisals during positive events (e.g. think ‘this is too good last’) reduces positive emotion experience (Burr, Javiad, Jell, Werner-Seidler, & Dunn, 2017; Dunn et al. 2018). Conversely, there is less evidence that the tendency to engage in amplifying appraisals during positive events (e.g. think ‘this is a sign of good things to come’) increases positive emotion experience. It is less well understood whether positive appraisal style also modulates positive emotion experience in young people. The present thesis investigated this question through four studies. First, a systematic review and meta-analyses were conducted which focused on the role of positive appraisal styles in relation to positive affect (PA) deficits in youth and adults. Second, a survey study examined whether trait levels of dampening and amplifying appraisal styles were cross-sectionally (n = 367) and prospectively (n = 170) associated with anhedonia symptoms in young people. Third, an experimental study (n = 89) sought to establish a causal association between induced use of dampening and amplifying appraisals, and PA during positive memory recall in young people. A final experimental study conducted at naturalistic settings with adolescent participants (n = 24) examined the impact of induced use of dampening and amplifying appraisals on PA during scheduled positive activities over four consecutive days. Findings from this PhD collectively indicated that dampening appraisal style is a potential anhedonia driving mechanism in adolescents. Future studies investigating the role of positive appraisal styles as a mediator of therapeutic change are now needed before developing interventions targeting dysfunctional positive appraisals when working with depressed adolescents. Abstract
Dunn BD, Widnall E, Reed N, Taylor R, Owens C, Spencer A, Kraag G, Kok G, Geschwind N, Wright K, et al (2019). Evaluating Augmented Depression Therapy (ADepT): Study protocol for a pilot randomised controlled trial. Pilot and Feasibility Studies, 27, 63-63.
Kennedy D, Goshko C-B, Murch S, Limbrick-Oldfield E, Dunn B, Clark L (2019). Interoception and Respiratory Sinus Arrhythmia in Gambling Disorder. Psychophysiology, 56, e13333-e13333.
Yilmaz M, Psychogiou L, Javaid M, Ford T, Dunn B (2019). Making the worst of a good job: Induced dampening appraisals blunt happiness and increase sadness in adolescents during pleasant memory recall. Behaviour Research and Therapy
Dunn B, Shirley R, James B, Abigail B, Eleanor C, Cathy C, Lauren C, Zaid H, Pamela J, Taf K, et al (2019). Turning research ideas into reality: How can we better support 'on the ground' clinicians to become research active?. CBT Today, 47(4), 18-20.
Pile V, Smith P, Leamy M, Blackwell SE, Meiser-Stedman R, Stringer D, Ryan EG, Dunn BD, Holmes EA, Lau JYF, et al
(2018). A brief early intervention for adolescent depression that targets emotional mental images and memories: protocol for a feasibility randomised controlled trial (IMAGINE trial). Pilot and Feasibility Studies
A brief early intervention for adolescent depression that targets emotional mental images and memories: protocol for a feasibility randomised controlled trial (IMAGINE trial).
Background: Adolescent depression is common and impairing. There is an urgent need to develop early interventions to prevent depression becoming entrenched. However, current psychological interventions are difficult to access and show limited evidence of effectiveness. Schools offer a promising setting to enhance access to interventions, including reducing common barriers such as time away from education. Distressing negative mental images and a deficit in positive future images, alongside overgeneral autobiographical memories, have been implicated in depression across the lifespan, and interventions targeting them in adults have shown promise. Here, we combine techniques targeting these cognitive processes into a novel, brief psychological intervention for adolescent depression. This feasibility randomised controlled trial will test the feasibility and acceptability of delivering this imagery-based cognitive behavioural intervention in schools. Methods/design: Fifty-six adolescents (aged 16-18) with high symptoms of depression will be recruited from schools. Participants will be randomly allocated to the imagery-based cognitive behavioural intervention (ICBI) or the control intervention, non-directive supportive therapy (NDST). Data on feasibility and acceptability will be recorded throughout, including data on recruitment, retention and adherence rates as well as adverse events. In addition, symptom assessment will take place pre-intervention, post-intervention and at 3-month follow-up. Primarily, the trial aims to establish whether it is feasible and acceptable to carry out this project in a school setting. Secondary objectives include collecting data on clinical measures, including depression and anxiety, and measures of the mechanisms proposed to be targeted by the intervention. The acceptability of using technology in assessment and treatment will also be evaluated. Discussion: Feasibility, acceptability and symptom data for this brief intervention will inform whether an efficacy randomised controlled trial is warranted and aid planning of this trial. If this intervention is shown in a subsequent definitive trial to be safe, clinically effective and cost-effective, it has potential to be rolled out as an intervention and so would significantly extend the range of therapies available for adolescent depression. This psychological intervention draws on cognitive mechanism research suggesting a powerful relationship between emotion and memory and uses imagery as a cognitive target in an attempt to improve interventions for adolescent depression. Trial registration: ISRCTN85369879. Abstract
Wright K, Dodd A, Warren FC, Medina-Lara A, Taylor R, Jones S, Owens C, Javaid M, Dunn B, Harvey JE, et al
(2018). The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study. Trials
The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study.
BACKGROUND: in bipolar spectrum disorder, some individuals experience ongoing, frequent fluctuations in mood outside of affective episodes. There are currently no evidence-based psychological interventions designed to address this. This feasibility study is a phase II evaluation of a dialectical behavioural therapy-informed approach (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). It seeks to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. METHODS/DESIGN: Patients will be randomised 1:1 to either treatment as usual only (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points will be at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point for the candidate primary outcome measures. We aim to recruit 48 individuals meeting diagnostic criteria for a bipolar spectrum disorder and reporting frequent mood swings outside of acute episodes, through primary and secondary care services and self-referral. To evaluate feasibility and acceptability, we will examine recruitment and retention rates, completion rates for study measures and feedback from participants on their experience of study participation and therapy. DISCUSSION: Proceeding to a definitive trial will be indicated if the following criteria are met: (1) trial participation does not lead to serious negative consequences for our participants; (2) any serious concerns about the acceptability and feasibility of the trial procedures can be rectified prior to a definitive trial; (3) follow-up data at 9 months are available for at least 60% of participants; (4) at least 60% of patients in the ThrIVe-B arm complete treatment. TRIAL REGISTRATION: ISRCTN, ISRCTN54234300. Registered on 20 July 2017. Abstract
. Author URL
Dunn BD, Burr L, Bunker-Smith H, Hunt A, Dadgostar D, Dalglish L, Smith S, Attree E, Jell G, Martyn J, et al (2018). Turning gold into lead: Dampening appraisals reduce happiness and pleasantness and increase sadness during anticipation and recall of pleasant activities in the laboratory. Behaviour Research and Therapy, 107, 19-33.
Dudas RB, Mole TB, Morris LS, Denman C, Hill E, Szalma B, Evans D, Dunn B, Fletcher P, Voon V, et al
(2017). Amygdala and dlPFC abnormalities, with aberrant connectivity and habituation in response to emotional stimuli in females with BPD. Journal of Affective Disorders
Amygdala and dlPFC abnormalities, with aberrant connectivity and habituation in response to emotional stimuli in females with BPD
Background Little is known about the frontolimbic abnormalities thought to underlie borderline personality disorder (BPD). We endeavoured to study regional responses, as well as their connectivity and habituation during emotion processing. Methods 14 BPD patients and 14 normal female controls (NC) controlled for menstrual phase underwent emotion-induction during an fMRI task using standardised images in a block design. We then performed psychophysiological interaction (PPI) analysis to investigate functional connectivity. Results BPD patients reported more disgust in questionnaires compared to controls. Relative to NC, they showed reduced left amygdala and increased dorsolateral prefrontal cortex (dlPFC) activation to all emotions collapsed versus neutral. Habituation of ventral striatal activity to repeated emotional stimuli was observed in controls but not in BPD. Finally, in the context of disgust (but not other emotions) versus neutral, BPD patients displayed enhanced left amygdala coupling with the dlPFC and ventral striatum. Limitations Strict inclusion criteria reduced the sample size. Conclusions in summary, BPD showed abnormal patterns of activation, habituation and connectivity in regions linked to emotion regulation. Amygdala deactivation may be mediated by abnormal top-down regulatory control from the dorsolateral prefrontal cortex. Aberrant emotion processing may play a unique role in the pathophysiology of BPD. Abstract
Travers-Hill E, Dunn BD, Hoppitt L, Hitchcock C, Dalgleish T (2017). Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression. Behaviour Research and Therapy, 95, 19-28.
Gadeikis D, Bos N, Schweizer S, Murphy F, Dunn B (2017). Engaging in an experiential processing mode increases positive emotional response during recall of pleasant autobiographical memories. Behaviour Research and Therapy, 92, 68-76.
Alsubaie M, Abbbott R, Dunn BD, Dickens C, Keil T, Henley W, Kuyken W (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clinical Psychology Review, 55, 74-91.
Dunn BD (2017). Opportunities and challenges for the emerging field of positive emotion regulation: a commentary on the special edition on positive emotions in psychopathology. Cognitive Therapy and Research, 41, 469-478.
Dalgleish T, Walsh ND, Mobbs D, Schweizer S, Van Harmelen AL, Dunn B, Dunn V, Goodyer I, Stretton J
(2017). Social pain and social gain in the adolescent brain: a common neural circuitry underlying both positive and negative social evaluation. Scientific Reports
Social pain and social gain in the adolescent brain: a common neural circuitry underlying both positive and negative social evaluation
Social interaction inherently involves the subjective evaluation of cues salient to social inclusion and exclusion. Testifying to the importance of such social cues, parts of the neural system dedicated to the detection of physical pain, the dorsal anterior cingulate cortex (dACC) and anterior insula (AI), have been shown to be equally sensitive to the detection of social pain experienced after social exclusion. However, recent work suggests that this dACC-AI matrix may index any socially pertinent information. We directly tested the hypothesis that the dACC-AI would respond to cues of both inclusion and exclusion, using a novel social feedback fMRI paradigm in a population-derived sample of adolescents. We show that the dACC and left AI are commonly activated by feedback cues of inclusion and exclusion. Our findings suggest that theoretical accounts of the dACC-AI network as a neural alarm system restricted within the social domain to the processing of signals of exclusion require significant revision. Abstract
Burr L, Javiad M, Jell G, Werner-Seidler A, Dunn BD (2017). Turning lemonade into lemons: Dampening appraisals reduce positive affect and increase negative affect during positive activity scheduling. Behaviour Research and Therapy, 91, 91-101.
Dunn BD, Roberts H (2016). Improving the capacity to treat depression using talking therapies: Setting a positive clinical psychology agenda. In Wood A, Johnson J (Eds.) Handbook of Positive Clinical Psychology.
Evans D, Dalgleish T, Dudas RB, Denman C, Howard M, Dunn BD
(2015). Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression. Cognitive Therapy and Research
Examining the Shared and Unique Features of Self-Concept Content and Structure in Borderline Personality Disorder and Depression
© 2015, Springer Science+Business Media New York. A number of clinical theories emphasise self-concept disturbance as central to borderline personality disorder (BPD). To date, however, there has been limited empirical examination of exactly how BPD changes the content and structure of self-concept. Moreover, it is unclear if patterns of self-concept disturbance are unique to BPD or are driven by axis-I comorbidities such as depression. To examine this issue, the present study adopted a dimensional design, examining how performance on a novel adaptation of a well-validated measure of self-concept (the Psychological Distance Scaling Task) was related to BPD and depression symptoms in a sample of 93 individuals with a wide range of symptom severity. While greater BPD severity was associated with less positive and more negative content of self-concept, this was driven by depression symptoms. Similarly, positive content was more diffuse and negative content more interconnected at higher levels of BPD severity, but for positive content, this was most clearly linked to comorbid depression features. In contrast, BPD severity (over and above depression symptoms) was uniquely associated with greater ‘clustering’ for positive and negative content (i.e. a more fragmented self-concept). This pattern of results lends support to clinical theories arguing that self-concept fragmentation is core to BPD and also supports the utility of dimensional analyses to identify patterns of cognitive-affective disturbance unique to BPD versus those shared with comorbid conditions like depression. Abstract
Farb N, Daubenmier J, Price CJ, Gard T, Kerr C, Dunn BD, Klein AC, Paulus MP, Mehling WE (2015). Interoception, Contemplative Practice, and Health. Frontiers in Psychology, 6, 763-763.
Parkin L, Morgan R, Rosselli A, Howard M, Shepherd A, Evans D, Hawkins A, Martinelli M, Golden AM, Dalgleish T, et al (2014). Exploring the relationship between mindfulness and cardiac perception. Mindfulness(3), 298-313.
Hoppitt L, Illingworth J, MacLeod C, Hampshire A, Dunn BD, Mackintosh B (2014). Modifying social anxiety related to a real-life stressor using online Cognitive Bias Modification for Interpretation. Behaviour Research and Therapy, 52, 45-45.
McLaren IPL, Dunn BD, Lawrence NS, Milton FN, Verbruggen F, Stevens T, McAndrew A, Yeates F (2014). Why decision making may not require awareness. Behavioral and Brain Sciences, 37(1), 35-36.
Werner-Seidler A, Banks R, Dunn BD, Moulds ML
(2013). An investigation of the relationship between positive affect regulation and depression. Behaviour Research and Therapy
An investigation of the relationship between positive affect regulation and depression
There is preliminary evidence that dysphoric symptoms are associated with maladaptive regulation of positive emotion. We investigated to what extent this pattern is unique to depression symptoms, persists in recovery, and extends to apprehension of intense emotion experience. In Study 1, in a sample of undergraduates (N = 112), dysphoria was associated with apprehension about experiencing intense emotion and dampening of positive emotion. Reductions in the amplification of positive emotion experience were uniquely associated with anhedonic depressive symptoms. Study 2 compared a recovered depressed and never-depressed student sample (N = 123), and found that recovered individuals reported using more maladaptive responses to positive affect. In Study 3 we examined community-recruited depressed, recovered and never-depressed groups (N = 50), and found that depressed individuals reported a greater tendency to dampen positive emotion than their never-depressed counterparts, but did not significantly differ from recovered depressed individuals. Greater dampening and reduced amplification of positive experience were again uniquely associated with anhedonic depressive symptoms. Our findings converge on the proposal that current depressive symptoms, rather than a history of depression, are more strongly linked to difficulties with emotion regulation, and suggest that targeting positive emotion could reduce anhedonia and improve treatment outcomes. Abstract
Evans D, Howard M, Dudas R, Denman C, Dunn BD
(2013). Emotion Regulation in Borderline Personality Disorder: Examining the Consequences of Spontaneous and Instructed Use of Emotion Suppression and Emotion Acceptance when Viewing Negative Films. Journal of Experimental Psychopathology
Emotion Regulation in Borderline Personality Disorder: Examining the Consequences of Spontaneous and Instructed Use of Emotion Suppression and Emotion Acceptance when Viewing Negative Films
Central to models of Borderline Personality Disorder (BPD) is the notion that dysfunctional application of avoidant emotion regulation strategies results in elevated emotional reactivity. To test this account, participants (N = 87) with varying severity of BPD underwent two negative mood inductions, the first with no particular instructions and the second following suppress or accept instructions. While BPD severity was associated with greater avoidance, this did not lead to differential emotional baseline, reactivity or recovery in the uninstructed film. Both instructed suppression and acceptance reduced emotional reactivity and accelerated recovery in the second film. While BPD severity did not influence how effectively instructed regulation could manage self- reported affect, those with more marked symptoms were trend less effective at regulating electrodermal response. Overall, these data provide little support for the notion that avoidant regulation strategies might lead to emotional hyper-reactivity in BPD, inconsistent with emotional dysregulation accounts of the disorder. Abstract
Clark L, Liu R, Mckavanagh R, Garrett A, Dunn BD, Aitken MRF
(2013). Learning and Affect Following Near-Miss Outcomes in Simulated Gambling. Journal of Behavioral Decision Making
Learning and Affect Following Near-Miss Outcomes in Simulated Gambling
Gambling near-misses are non-rewarded events that resemble a winning configuration. Past research using slot machines has shown that moderate rates of near-misses increase gambling persistence, but the mechanisms supporting this persistence are unclear. One hypothesis is that near-misses are mistakenly interpreted as signals of skill acquisition, supporting learning and fuelling the 'illusion of control'. A slot machine simulation was administered to 60 volunteers, with ratings of the perceived chances of winning, pleasure and motivation to play following particular outcomes. Psychophysiological measures (electrodermal activity and heart rate) were taken, and gambling persistence was measured after 30 trials. Near-misses were similar to full-miss outcomes in that they were regarded as unpleasant. However, near-misses were akin to win outcomes in that they increased motivations to play and electrodermal activity. Learning was evidenced by the expectancy of winning increasing following wins and decreasing after losses. Although there was no overall change in expectancy of winning after near-misses across all participants, those subjects reporting a greater increase in the expectancy of winning following a near-miss showed more persistent play, consistent with the learning hypothesis. Greater heart rate acceleration following near-misses was also associated with persistence. We also observed differential effects of near-misses where the reel stopped either side of the winning position ('payline'): motivational effects were restricted to near-misses stopping before the payline, whereas near-misses that stopped after the payline were primarily aversive. The payline effects are not predicted by the learning hypothesis and may indicate an affective component to near-misses, possibly linked to counterfactual processing. © 2012 John Wiley & Sons, Ltd. Abstract
Dalgleish T, Navrady L, Bird L, Hill E, Dunn BD, Golden AM
(2013). Method-of-Loci as a mnemonic device to facilitate access to self-affirming personal
memories for individuals with depression. Clinical Psychological Science
Method-of-Loci as a mnemonic device to facilitate access to self-affirming personal
memories for individuals with depression
Depression impairs the ability to retrieve positive, self-affirming autobiographical Abstract
memories. To counteract this difficulty, we trained individuals with depression, either in
episode or remission, to construct an accessible mental repository for a pre-selected set of
positive, self-affirming memories using an ancient mnemonic technique – the Method-of-Loci
(MoL). Participants in a comparison condition underwent a similar training protocol where
they chunked the memories into meaningful sets and rehearsed them (Rehearsal). Both
protocols enhanced memory recollection to near ceiling levels after 1 week of training.
However, on a surprise follow-up recall test a further week later, recollection was maintained
only in the MoL condition, relative to a significant decrease in memories recalled in the
Rehearsal group. There were no significant performance differences between those currently
in episode and those in remission. The results support use of the MoL as a tool to facilitate
access to self-affirming memories in those with depression.
Murphy F, Macpherson K, Jeyabalasingham T, Manly T, Dunn BD (2013). Modulating mind-wandering in dysphoria. Frontiers in Psychology: Perception Science, 4
Bowler J, Mackintosh B, Dunn BD, Mathews, A. Dalgleish T, Hoppitt L
(2012). A Comparison of Cognitive Bias Modification for Interpretation and Computerized Cognitive Behavior Therapy: Effects on Anxiety, Depression, Attentional Control and Interpretive Bias. Journal of Consulting and Clinical Psychology
A Comparison of Cognitive Bias Modification for Interpretation and Computerized Cognitive Behavior Therapy: Effects on Anxiety, Depression, Attentional Control and Interpretive Bias.
Objective. Computerized cognitive behavioral therapy (cCBT) and Cognitive Bias Modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare to each other has not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. Method. Sixty-three primarily Caucasian adults (mean age = 22.7, SD = 5.87; 68.3 % female) with high social anxiety, randomly allocated to three groups: CBM-I (n = 21); cCBT (n = 21); and a no-intervention control group (n = 21), provided complete data for analysis. Pre and post intervention (4 sessions lasting two weeks, control participants only attended the pre-post sessions) self-report measures of anxiety, depression, attentional control and threat-related interpretive bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using a scrambled sentences test. Results. Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety and depression and improved attentional control, relative to the control group, with no clear superiority of either active intervention. While both active conditions reduced negative bias on the scrambled sentences test completed under mental load, CBM-I was significantly more effective at doing so. Conclusions. The results suggest that while not differing in therapeutic efficacy, CBM-I and cCBT might differ in the residence of their effects when under mental load. Abstract
Dunn BD, Evans D, Makarova D, White J, Clark L
(2012). Gut feelings and the reaction to perceived inequity: the interplay between bodily responses, regulation, and perception shapes the rejection of unfair offers on the ultimatum game. Cognitive, Affective and Behavioral Neuroscience
Gut feelings and the reaction to perceived inequity: the interplay between bodily responses, regulation, and perception shapes the rejection of unfair offers on the ultimatum game
It has been robustly demonstrated using the ultimatum game (UG) that individuals frequently reject unfair financial offers even if this results in a personal cost. One influential hypothesis for these rejections is that they reflect an emotional reaction to unfairness that overrides purely economic decision processes. In the present study, we examined whether the interplay between bodily responses, bodily regulation, and bodily perception ("interoception") contributes to emotionally driven rejection behavior on the UG. Offering support for bodily feedback theories, interoceptive accuracy moderated the relationship between changes in electrodermal activity to proposals and the behavioral rejection of such offers. Larger electrodermal responses to rejected relative to accepted offers predicted greater rejection in those with accurate interoception but were unrelated to rejection in those with poor interoception. Although cardiovascular responses during the offer period were unrelated to rejection rates, greater resting heart rate variability (linked to trait emotion regulation capacity) predicted reduced rejection rates of offers. These findings help clarify individual differences in reactions to perceived unfairness, support previous emotion regulation deficit accounts of rejection behavior, and suggest that the perception and regulation of bodily based emotional biasing signals ("gut feelings") partly shape financial decision making on the UG. Abstract
(2012). Helping depressed clients reconnect to positive emotion experience: Current insights and future directions. Clinical Psychology & Psychotherapy
Helping depressed clients reconnect to positive emotion experience: Current insights and future directions.
A deficit in the ability to experience pleasure (anhedonia) is one of the core symptoms of depression. However, therapy to date has predominantly focused on understanding elevations in negative emotion experience in depression and relatively neglected ways to reconnect individuals to positive experience. Abstract
This article reviews current insights into blunted positivity in depression, evaluating evidence that depression leads to disturbances in anticipation (positive emotion experience when approaching a goal or a rewarding stimulus) and consummation (positive emotion experience when attaining a goal or rewarding
stimulus), as well as impaired positive emotion recognition. The case is made that existing treatments are only partially effective and that therapy outcomes are likely to be improved by focusing on augmenting positivity, capitalizing on emerging insights from positive affective neuroscience. Existing and emerging
therapeutic techniques that may aid the promotion of positivity are critiqued, and some suggestions for future research and clinical practice are outlined.
Clark L, Liu R, McKavanagh R, Garrett A, Dunn BD, Aitken M
(2012). Learning and Affect Following Near-Miss Outcomes in Simulated Gambling. Journal of Behavioral Decision Making
Learning and Affect Following Near-Miss Outcomes in Simulated Gambling
Gambling near-misses are non-rewarded events that resemble a winning configuration. Past research using slot machines has shown that moderate rates of near-misses increase gambling persistence, but the mechanisms supporting this persistence are unclear. One hypothesis is that near-misses are mistakenly interpreted as signals of skill acquisition, supporting learning and fuelling the ‘illusion of control’. A slot-machine simulation was administered to 60 volunteers, with ratings of the perceived chances of winning, and pleasure and motivation to play following particular outcomes. Psychophysiological measures (electrodermal activity and heart rate) were taken, and gambling persistence was measured after 30 trials. Near-misses were similar to full-miss outcomes in that they were regarded as unpleasant. However, near-misses were akin to win outcomes in that they increased motivations to play and electrodermal activity. Learning was evidenced by the expectancy of winning increasing following wins, and decreasing after losses. Although there was no overall change in expectancy of winning after near-misses across all participants, those subjects reporting a greater increase in the expectancy of winning following a near-miss showed more persistent play, consistent with the learning hypothesis. Greater heart rate acceleration following near-misses was also associated with persistence. We also observed differential effects of near-misses that fell either side of the winning line (‘payline’): the motivational effects were restricted to near-misses before the payline, whereas near-misses after the payline were primarily aversive. The payline effects are difficult to reconcile with the learning hypothesis, but may indicate a further affective component to near-misses, putatively linked to counterfactual processing. Abstract
Clark L, Crooks B, Clarke R, Aitken MRF, Dunn BD
(2012). Physiological Responses to Near-Miss Outcomes and Personal Control During Simulated Gambling. Journal of Gambling Studies
Physiological Responses to Near-Miss Outcomes and Personal Control During Simulated Gambling
Near-miss outcomes during gambling are non-win outcomes that fall close to a pay-out. While objectively equivalent to an outright miss, near-misses motivate ongoing play and may therefore be implicated in the development of disordered gambling. Given naturalistic data showing increases in heart rate (HR) and electrodermal activity (EDA) during periods of real gambling play, we sought to explore the phasic impact of win, near-miss and full-miss outcomes on physiological arousal in a controlled laboratory environment. EDA and HR were monitored as healthy, student participants (n = 33) played a simulated slot-machine task involving unpredictable monetary wins. A second gambling distortion, perceived personal control, was manipulated within the same task by allowing the participant to select the play icon on some trials, and having the computer automatically select the play icon on other trials. Near-misses were rated as less pleasant than full-misses. However, on trials that involved personal choice, near-misses produced higher ratings of 'continue to play' than full-misses. Winning outcomes were associated with phasic EDA responses that did not vary with personal choice. Compared to full-misses, near-miss outcomes also elicited an EDA increase, which was greater on personal choice trials. Near-misses were also associated with greater HR acceleration than other outcomes. Near-miss outcomes are capable of eliciting phasic changes in physiological arousal consistent with a state of subjective excitement, despite their objective non-win status. © 2011 Springer Science+Business Media, LLC. Abstract
Clark L, Li R, Wright CM, Rome F, Fairchild G, Dunn BD, Aitken MRF
(2012). Risk-avoidant decision making increased by threat of electric shock. Psychophysiology
Risk-avoidant decision making increased by threat of electric shock
Threat cues elicit defensive reactions mediated by limbic brain circuitry that is also implicated in risk-sensitive decision making. Building upon research looking at stress effects on decision making, a gambling task was administered to 65 healthy adults, comparing decision making on trials on which a red screen background signalled threat of shocks against trials when shocks could not occur. The threat cues elicited increased electrodermal activity and a sustained decrease in heart rate, consistent with defensive vigilance. The threat condition was associated with risk-avoidant choices, on trials where the risky option involved moderate losses and when choosing between options involving only losses. These effects were not explained by changes in latency. Threat exerts immediate effects on decision making and physiological arousal, biasing subjects towards safer alternatives, potentially through a magnified processing of loss information. © 2012 Society for Psychophysiological Research. Abstract
Park RJ, Dunn BD, Barnard PJ
(2012). Schematic models and modes of mind in anorexia nervosa II: Implications for Treatment and Course. International Journal of Cognitive Therapy
Schematic models and modes of mind in anorexia nervosa II: Implications for Treatment and Course
The Interacting Cognitive Subsystems (ICS) account of anorexia nervosa (AN) Abstract
emphasizes how attention to different aspects of experience combined with the impact
of cognitive, emotional, and bodily inputs can lead to a novel understanding
of AN maintenance and routes for recovery. The hallmark of a useful theory is that
it should be capable not only of generating new ways of explaining clinical course
and understanding phenomenology, but that it should also generate detailed ideas
about how to improve clinical practice and develop new treatments. ICS predicts
that cultivating a “being embodied” mode of mind, involving a shift in quality of
attention to emotional and somatic experience, as a common route to recovery. The
processes involved in the course of AN and theoretical and clinical implications of
the account are elaborated in this sequel paper. Therapeutic strategies to remodel
relationships between thoughts, emotions, and bodily states in AN following directly
from this theoretical analysis are discussed.
Verdejo-Garcia A, Clark LC, Dunn BD
(2012). The Role of Interoception in Addiction: a Critical Review. Neuroscience and Biobehavioral Reviews
The Role of Interoception in Addiction: a Critical Review
Interoception refers to a collection of processes by which the state of the body is transmitted back to the brain, giving rise to awareness of the internal milieu, and motivating behavioural responses to homeostatically regulate internal state. Recent work has begun to explore the relevance of this construct to drug addiction: drugs of abuse and drug-related stimuli induce pronounced peripheral changes, and damage to a brain region known to support interoception (the insula) disrupts nicotine dependence. This article critically reviews existing accounts of addiction that suggest impaired interoception contributes to drug abuse. Conceptually, we argue that existing addiction interoception models could be usefully extended by considering (i) the multiple components of the bodily feedback system (signal, perception, and appraisal) and (ii) how individual differences in these three components impact on cognitive-affective processing in addiction. Empirically, while no studies have examined direct behavioural measures of interoception in addicted populations, several indirect lines of experimental work that pertain to this altered interoception hypothesis are presented. Clinical implications are discussed. Abstract
Andrews L, Joseph S, Troop N, Van Royen T, Dunn BD, Dalgleish T
(2012). The structure of avoidance following trauma: Development and validation of the Posttraumatic Avoidance Scale (PAS). Traumatology
The structure of avoidance following trauma: Development and validation of the Posttraumatic Avoidance Scale (PAS).
Avoidance is a key maintenance factor in traumatic reactions but currently no satisfactory measures of it exist. Previous factor analytic studies have demonstrated a distinction between conscious attempts to avoid trauma-related stimuli (e.g. trying not to talk or think about the event) versus non-conscious avoidance processes (e.g. emotional numbing, amnesia). Here we develop and validate a multi-dimensional measure of trauma-related avoidance across two samples. In sample 1, 485 emergency service personnel completed a 44-item self-report measure of avoidance in relation to an identified occupational trauma. Principal components analysis provided evidence for a distinction between controlled and automatic avoidance. On the basis of these results a 20-item measure, the Posttraumatic Avoidance Scale (PAS), was constructed. The predictive validity of the PAS was established in a longitudinal study utilizing six month follow up data from the emergency service personnel sample. Test re-test reliability was found to be very good for this six month period (correlations >. 70) for both PAS controlled and automatic avoidance subscales. Sample 2 illustrated the transdiagnostic potential of the PAS in an eating disordered sample, all of whom reported to have experienced at least one traumatic event. Support was found for the two factor structure of the PAS as well as for the convergent validity within this sample. The internal consistency of the PAS was assessed within both samples (Cronbach’s alphas >. 80) for both controlled and automatic avoidance subscales. This measure of trauma-related avoidance is the first to intentionally assess trauma-related avoidance symptoms in this bi-dimensional manner. Abstract
Dunn BD (2012). When should you follow your heart?. In Totterdell P, Niven K (Eds.) Should I Strap a Battery to My Head? (And Other Questions About Emotion), CreateSpace Independent Publishing Platform.
Indovina I, Robbins TW, Nunez-Elizalde AO, Dunn BD, Bishop SJ
(2011). Fear conditioning mechanisms associated with trait vulnerability to anxiety in humans. Neuron
Fear conditioning mechanisms associated with trait vulnerability to anxiety in humans
Investigations of fear conditioning in rodents and humans have illuminated the neural mechanisms underlying cued and contextual fear. A critical question is how personality dimensions such as trait anxiety act through these mechanisms to confer vulnerability to anxiety disorders, and whether humans' ability to overcome acquired fears depends on regulatory skills not characterized in animal models. In a neuroimaging study of fear conditioning in humans, we found evidence for two independent dimensions of neurocognitive function associated with trait vulnerability to anxiety. The first entailed increased amygdala responsivity to phasic fear cues. The second involved impoverished ventral prefrontal cortical (vPFC) recruitment to downregulate both cued and contextual fear prior to omission (extinction) of the aversive unconditioned stimulus. These two dimensions may contribute to symptomatology differences across anxiety disorders; the amygdala mechanism affecting the development of phobic fear and the frontal mechanism influencing the maintenance of both specific fears and generalized anxiety. Abstract
Park RJ, Dunn BD, Barnard PJ
(2011). Schematic models and modes of mind in anorexia nervosa I: a novel process account. International Journal of Cognitive Therapy
Schematic models and modes of mind in anorexia nervosa I: a novel process account
A deeper understanding of the cognitive-affective mechanisms maintaining anorexia nervosa (AN) is required to develop more effective interventions. Clinical challenges posed by AN are reviewed and a novel model of AN is offered to account for these phenomena, framed within an established cognitive architecture (Interacting Cognitive Subsystems). It is proposed that AN is maintained by oscillations between two extreme yet mutually reinforcing states of mind. In “doing” mode there is a focus on specific conceptual meanings about the control of eating, shape, and weight, with a neglect of broader emotional meaning and bodily states associated with starvation. When control cannot be maintained, individuals move into “mindless bodily emoting” mode. Here attention flips between aversive bodily sensations and emotional beliefs, resulting in feeling out of control, afraid, and self-disgusted. Novel implications for course, recovery, and treatment of AN following directly from this theoretical analysis are discussed in a separate sequel paper. Abstract
Dalgleish T, Hill E, Golden AM, Morant N, Dunn BD
(2011). The structure of past and future lives in depression. J Abnorm Psychol
The structure of past and future lives in depression.
This study assessed the organization of past autobiographical knowledge in individuals with either current major depressive disorder (MDD), MDD in remission, or no history of MDD (the control group). Participants generated personal lists of "life chapters," dividing both their past and potential future into subjectively meaningful episodes or themes (e.g. "married life"). They were then given a list of potentially chapter-descriptive positive or negative attributes and sorted them according to the different chapters. Results revealed that, relative to the control group, MDD participants selected more negative attributes overall, showed greater redundancy for negative attributes (i.e. using the same ones repeatedly across chapters) and reduced redundancy for positive attributes, and exhibited greater compartmentalization (i.e. the negative and positive attributes were clustered separately across different chapters). A similar pattern emerged for the remitted MDD group relative to controls, with the exception of negative redundancy, which was not elevated. For future chapters, there were no group differences. Finally, a greater number of past depressive episodes was associated with increasingly reduced positive redundancy. These data reveal a "depressogenic" structuring of past (but not future) knowledge in MDD that is also evident in a remitted MDD group, with the exception of negative redundancy, which appears to be a marker of the acute state. These findings shed light on important aspects of the organization of past knowledge that are likely to be linked to maladaptive processing biases in those with a depression history. Abstract
Dunn BD, Makarova D, Evans D, Clark L
(2010). "I'm worth more than that": trait positivity predicts increased rejection of unfair financial offers. PLoS One
"I'm worth more than that": trait positivity predicts increased rejection of unfair financial offers.
Humans react strongly to unfairness, sometimes rejecting inequitable proposals even if this sacrifices personal financial gain. Here we explored whether emotional dispositions--trait tendencies to experience positive or negative feelings--shape the rejection of unfair financial offers. Participants played an Ultimatum Game, where the division of a sum of money is proposed and the player can accept or reject this offer. Individuals high in trait positivity and low in trait negativity rejected more unfair offers. These relationships could not be explained by existing accounts which argue that rejection behaviour results from a failure to regulate negative emotions, or serves to arbitrate social relationships and identity. Instead, the relationship between dispositional affect and rejection behaviour may be underpinned by perceived self worth, with those of a positive disposition believing that they are "worth more than that" and those of a negative disposition resigning themselves to "taking the crumbs from under the table". Abstract
Dunn BD, Stefanovitch I, Evans D, Oliver C, Hawkins A, Dalgleish T
(2010). Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions. Behav Res Ther
Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions.
Delineating the differential effects of anxiety versus depression on patterns of information processing has proved challenging. The tripartite model of mood disorders (Clark & Watson, 1991) suggests that one way forward is to adopt a dimensional rather than categorical approach, making it possible to explore the main and interaction effects of depression- and anxiety-specific symptoms on a given cognitive-affective process. Here we examined how the interplay of anxiety-specific arousal and depression-specific anhedonia symptoms in the same individuals relate to interoceptive (bodily) awareness. 113 participants with varying levels of mood disorder symptoms completed a heartbeat perception task to assess interoceptive accuracy. Superior interoception was associated with anxiety-specific arousal symptoms, and this relationship held when controlling for depression-specific anhedonia symptoms and shared general distress symptoms. This main effect was qualified by an interaction between anhedonia and arousal. As anhedonia symptoms increased in severity, the relationship between arousal and interoceptive accuracy became less strong. These results further validate the tripartite framework, help clarify the mixed existing literature on interoception in mood disorders, and suggest that considering the unique and interactive effects of different symptom dimensions is a useful strategy to help identify the cognitive-affective profiles associated with anxiety and depression. Abstract
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Dalgleish T, Golden A-MJ, Yiend J, Dunn BD
(2010). Differential predictions about future negative events in seasonal and non-seasonal depression. Psychol Med
Differential predictions about future negative events in seasonal and non-seasonal depression.
BACKGROUND: Previous research indicates that individuals with seasonal depression (SD) do not exhibit the memory biases for negative self-referent information that characterize non-seasonal depression (NSD). The current study extended this work by examining processing of self-referent emotional information concerning potential future events in SD. METHOD: SD and NSD patients, along with never-depressed controls, completed a scenario-based measure of likelihood estimation for future positive and negative events happening either to the self or to another person. RESULTS: SD patients estimated future negative events as more likely to happen to both the self and others, relative to controls. In contrast, in the NSD sample this bias was specific to self-referred material. There were no group differences for positive events. CONCLUSIONS: These data provide further evidence that the self-referent bias for processing negative information that characterizes NSD can be absent in SD, this time in the domain of future event processing. Abstract
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Dunn BD, Galton HC, Morgan R, Evans D, Oliver C, Meyer M, Cusack R, Lawrence AD, Dalgleish T
(2010). Listening to your heart. How interoception shapes emotion experience and intuitive decision making. Psychol Sci
Listening to your heart. How interoception shapes emotion experience and intuitive decision making.
Theories proposing that how one thinks and feels is influenced by feedback from the body remain controversial. A central but untested prediction of many of these proposals is that how well individuals can perceive subtle bodily changes (interoception) determines the strength of the relationship between bodily reactions and cognitive-affective processing. In Study 1, we demonstrated that the more accurately participants could track their heartbeat, the stronger the observed link between their heart rate reactions and their subjective arousal (but not valence) ratings of emotional images. In Study 2, we found that increasing interoception ability either helped or hindered adaptive intuitive decision making, depending on whether the anticipatory bodily signals generated favored advantageous or disadvantageous choices. These findings identify both the generation and the perception of bodily responses as pivotal sources of variability in emotion experience and intuition, and offer strong supporting evidence for bodily feedback theories, suggesting that cognitive-affective processing does in significant part relate to "following the heart." Abstract
Dunn BD, Stefanovitch I, Buchan K, Lawrence AD, Dalgleish T
(2009). A reduction in positive self-judgment bias is uniquely related to the anhedonic symptoms of depression. Behav Res Ther
A reduction in positive self-judgment bias is uniquely related to the anhedonic symptoms of depression.
Identifying patterns of biased cognitive processing specific to depression has proved difficult. The tripartite model of mood disorders [Clark, L. A. & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336] suggests that a clearer processing 'blueprint' may emerge if depression is viewed dimensionally rather than categorically and by focusing on variations in the degree of positive, rather than negative, processing bias. To investigate this possibility, the present study examined the extent to which a reduced positive self-judgment bias previously found in depressed individuals relates to depression-specific anhedonic symptoms. Sixty participants with varying levels of anxiety and depression symptoms evaluated their own performance on a working memory task in the absence of external feedback. Overall, participants showed a positive self-judgment bias, overestimating the number of trials they had performed correctly relative to objective criteria. Consistent with the tripartite framework, the extent of this positive self-judgment bias was significantly and uniquely related to depression-specific symptoms, with the positive bias reducing as anhedonia severity increased across three different symptom measures. Abstract
Dalgleish T, Dunn BD, Mobbs D
(2009). Affective neuroscience: Past, present and future. Emotion Review
Affective neuroscience: Past, present and future
The discipline of affective neuroscience is concerned with the underlying neural substrates of emotion and mood. This review presents an historical overview of the pioneering work in affective neuroscience of James and Lange, Cannon and Bard, and Hess, Papez, and MacLean before summarizing the current state of research on the brain regions identified by these seminal researchers. We also discuss the more recent strides made in the field of affective neuroscience. A final section considers different hypothetical organizations of affective neuroanatomy and highlights future directions for the discipline. Abstract
Yiend J, Mathews A, Weston B, Dunn BD, Cusack R, Mackintosh B
(2009). An Investigation of the Implicit Control of the Processing of Negative Pictures. Emotion
An Investigation of the Implicit Control of the Processing of Negative Pictures
The implicit control of emotion processing was investigated by varying encoding instructions for both negative and neutral pictures while measuring psychophysiological responses. Participants made comparative judgments about consecutive pictures for blocks of neutral or negative content. The highly specified judgment task was designed to minimize variance in the implementation of implicit control of processing. Affective modulation of startle amplitude was significantly reduced during judgments involving nonnegative content (how "planned" an image was compared to its predecessor), compared to those that involved negative content (how "frightening" an image was compared to its predecessor), indicating successful implicit control of processing. The more attenuated affect modulation was, the less anxious individuals became during the task, suggesting that the implicit control of emotion processing is significantly associated with emotional experience. These data provide convergent evidence for a companion neuroimaging study because of the similar neural substrates thought to underlie affective modulation of startle. This supports the view that higher-level top-down pathways modulate activation of the amygdala. Abstract
Dalgleish T, Yiend J, Schweizer S, Dunn BD
(2009). Ironic effects of emotion suppression when recounting distressing memories. Emotion
Ironic effects of emotion suppression when recounting distressing memories.
Theories of ironic mental control posit that under conditions in which effortful control is compromised, for example, in laboratory manipulations of mental load or in those suffering from clinical levels of negative affect, attempts to suppress negative emotions can lead to a paradoxical increase in such feelings, relative to conditions in which no suppression is attempted. In line with this, we showed that high negative affect participants, when asked to suppress (downregulate) their negative feelings while writing about a distressing personal memory, exhibited an ironically greater increase in negative emotions compared with a no-instruction condition, in contrast to low negative affect controls who were able to suppress their emotions. Comparable ironic effects were not associated with instructions to experience emotions. This first demonstration of ironic effects of emotion suppression in response to personal material in those with emotional problems sheds light into how certain emotion regulation strategies may maintain and exacerbate such conditions. Abstract
Schartau PE, Dalgleish T, Dunn BD
(2009). Seeing the bigger picture: training in perspective broadening reduces self-reported affect and psychophysiological response to distressing films and autobiographical memories. J Abnorm Psychol
Seeing the bigger picture: training in perspective broadening reduces self-reported affect and psychophysiological response to distressing films and autobiographical memories.
Appraising negative experiences in ways that reduce associated distress is a key component of successful emotion regulation. In 4 studies, the authors examined the effects of systematically practicing appraisal skills using a computer-mediated cognitive bias modification (CBM) methodology. In Studies 1-3, healthy participants practiced applying appraisal themes linked to the idea of seeing the bigger picture to a series of distressing training films, either during each film (Study 1) or immediately after each film (Studies 2 and 3). Control participants watched the same films with no appraisal instructions. Participants who practiced appraisal, compared with controls, exhibited reduced levels of self-reported negative emotional (Studies 1-3) and electrodermal (Study 1) responses to a final test film that all participants were instructed to appraise. In Study 4, a comparable effect of appraisal practice was found using distressing autobiographical memories for participants with higher levels of negative affect. Appraisal practice also led to reduced intrusion and avoidance of the target memories in the week poststudy, compared with prestudy levels, and relative to the no-practice controls. The findings are discussed in terms of the broader literature on CBM. Abstract
Dunn BD, Billotti D, Murphy V, Dalgleish T
(2009). The consequences of effortful emotion regulation when processing distressing material: a comparison of suppression and acceptance. Behav Res Ther
The consequences of effortful emotion regulation when processing distressing material: a comparison of suppression and acceptance.
The present study investigated the consequences of different forms of emotion regulation. Eighty nine healthy participants viewed a distressing video of the aftermath of road traffic accidents under either suppression (of both felt and expressed affect), acceptance, or no-regulation control instructions and the immediate and longer-term consequences on emotion, mood, and memory were examined. Suppression (relative to control) led to reduced subjective experience of fear when viewing the video, but did not alter electrodermal (EDA) or heart rate (HR) response. Subsequently, suppression led to a less marked subjective emotional reaction to positive but not negative emotional images, reduced free recall memory of the video, and a greater likelihood of experiencing zero intrusions of the video's content. Acceptance (relative to control) had no impact when viewing the video, was associated with a less marked increase in EDA activity in the 5 min period immediately after viewing the video, a more marked HR deceleration and EDA response to both positive and negative images, and elevated negative affect at one week follow-up. These findings suggest, contrary to the current clinical zeitgeist, that emotion suppression can successfully lead to an ongoing down-regulation of emotion and memory, whereas acceptance may elevate subsequent emotionality. Abstract
Dalgleish T, Rolfe J, Golden AM, Dunn BD, Barnard PJ
(2008). Reduced autobiographical memory specificity and posttraumatic stress: exploring the contributions of impaired executive control and affect regulation. J Abnorm Psychol
Reduced autobiographical memory specificity and posttraumatic stress: exploring the contributions of impaired executive control and affect regulation.
Reduced specificity of autobiographical memories retrieved to word cues on the Autobiographical Memory Test (AMT) is associated with increased posttraumatic stress in traumatized samples. Theoretical debates concerning the dominant influences on this effect have focused on affect regulation, whereby specific personal information is avoided more by those experiencing greater distress, versus compromised executive control, whereby increased distress is associated with an inability to set aside inappropriately general responses on the AMT. The present study compared these 2 views in a correlational design using a reversed version of the AMT (the AMT-R) for which trauma-exposed participants (N=36) had to generate general memories from the past and avoid specific memories. An emphasis on the role of affect regulation would predict that distress would be associated with reduced specificity (as in the standard AMT), whereas emphasis on the role of executive control would predict that this relationship would be reversed. The data supported the affect regulation account, with greater posttraumatic stress being associated with reduced memory specificity. Abstract
Dunn BD, Dalgleish T, Ogilvie AD, Lawrence AD
(2007). Heartbeat perception in depression. Behav Res Ther
Heartbeat perception in depression.
Alterations in bodily awareness have been implicated in depression but there has been little detailed empirical characterisation of the degree and accuracy of body perception in the disorder. The present study examined the objective accuracy of heartbeat perception (using the Schandry mental tracking task) and the subjective degree of bodily focus (using the Bodily Consciousness Questionnaire; BCQ) in healthy control volunteers, a moderately depressed community sample, and a more severely depressed clinic sample (n=18 in each group). The community sample showed less accurate heartbeat perception than the control group as expected. Counter to prediction, however, the more severely depressed clinic sample performed better than the community depressed sample and equivalently to control volunteers on the Schandry task. There were no group differences on subjective bodily awareness. Implications for theories of depression are discussed. Abstract
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Dunn BD, Dalgleish T, Lawrence AD, Ogilvie AD
(2007). The accuracy of self-monitoring and its relationship to self-focused attention in dysphoria and clinical depression. J Abnorm Psychol
The accuracy of self-monitoring and its relationship to self-focused attention in dysphoria and clinical depression.
The accuracy with which dysphoric (Study 1) and clinically depressed (Study 2) individuals make self-regulatory judgments about their own performance in the absence of external feedback and the extent to which this relates to trait self-focused attention (SFA) were examined. Relative to objective criteria, both dysphoric and depressed participants showed a positive judgment bias, overestimating the number of trials they had performed correctly. Relative to control participants, the dysphoric and depressed groups showed a reduction in the extent of this positive bias in that they judged error trials more accurately and correct trials less accurately. Although the dysphoric and depressed groups both reported elevated trait SFA, this did not correlate significantly with accuracy of self-judgment on the performance-monitoring task. Implications for self-regulation models of depression are discussed. Abstract
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Dunn BD, Dalgleish T, Lawrence AD
(2006). The somatic marker hypothesis: a critical evaluation. Neuroscience and Biobehavioural Reviews
The somatic marker hypothesis: a critical evaluation.
The somatic marker hypothesis (SMH; [Damasio, A. R. Tranel, D. Damasio, H. 1991. Somatic markers and the guidance of behaviour: theory and preliminary testing. In Levin, H.S. Eisenberg, H.M. Benton, A.L. (Eds.), Frontal Lobe Function and Dysfunction. Oxford University Press, New York, pp. 217-229]) proposes that emotion-based biasing signals arising from the body are integrated in higher brain regions, in particular the ventromedial prefrontal cortex (VMPFC), to regulate decision-making in situations of complexity. Evidence for the SMH is largely based on performance on the Iowa Gambling Task (IGT; [Bechara, A. Tranel, D. Damasio, H. Damasio, A.R. 1996. Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex. Cerebral Cortex 6 (2), 215-225]), linking anticipatory skin conductance responses (SCRs) to successful performance on a decision-making paradigm in healthy participants. These 'marker' signals were absent in patients with VMPFC lesions and were associated with poorer IGT performance. The current article reviews the IGT findings, arguing that their interpretation is undermined by the cognitive penetrability of the reward/punishment schedule, ambiguity surrounding interpretation of the psychophysiological data, and a shortage of causal evidence linking peripheral feedback to IGT performance. Further, there are other well-specified and parsimonious explanations that can equally well account for the IGT data. Next, lesion, neuroimaging, and psychopharmacology data evaluating the proposed neural substrate underpinning the SMH are reviewed. Finally, conceptual reservations about the novelty, parsimony and specification of the SMH are raised. It is concluded that while presenting an elegant theory of how emotion influences decision-making, the SMH requires additional empirical support to remain tenable. Abstract
Blackwell A, Dunn BD, Owen AM, Sahakian BJ (2005). Neuropsychological Assessment of Dementia. In Burns A, O'Brien J, Ames D (Eds.) Dementia, a Hodder Arnold Publication.
Dunn BD, Dalgleish T, Lawrence AD, Cusack R, Ogilvie AD
(2004). Categorical and dimensional reports of experienced affect to emotion-inducing pictures in depression. J Abnorm Psychol
Categorical and dimensional reports of experienced affect to emotion-inducing pictures in depression.
Self-reported affect to positive and negative emotional pictures was contrasted in people with major depressive disorder (MDD) and never-depressed control participants (n = 25 in each group). The results revealed significant differences in response to positive images (reduced arousal, less pleasant valence, decreased happiness, increased sadness) in MDD but no clear group differences in response to negative stimuli. Extending earlier findings of reduced responsiveness to positive, but not negative, stimuli in MDD (D. M. Sloan, M. E. Strauss, S. W. Quirk, & M. Satajovik, 1997; D. M. Sloan, M. E. Strauss, & K. L. Wisner, 2001), the data indicate that blunted response to positive stimuli is found when both categorical and dimensional ratings are elicited. Further, the data replicate earlier findings of elevated sadness reports to positive stimuli (J. Rottenberg, K. L. Kasch, J. J. Gross, & I. H. Gotlib, 2002), which may reflect broader difficulties in regulating emotions in MDD. Abstract
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Dunn BD, Bolton W
(2004). The impact of borderline personality traits on challenging behaviour: implications for learning disabilities services. British Journal of Forensic Practice
The impact of borderline personality traits on challenging behaviour: implications for learning disabilities services
This case study describes how threats to stab people, in a client with learning disabilities, may have been inadvertently reinforced during detention in a medium secure unit by over-looking borderline personality traits. Formulating the case from the biopsychosocial model of borderline personality disorder (Linehan, 1993), the article illustrates how an invalidating environment provided by learning disability services may have interacted with underlying difficulties in emotion regulation to reinforce challenging behaviour. Explaining threats to stab purely in terms of learning disability accidentally invalidated the client's emotional distress, so the only way he could convey how he was feeling was by escalating challenging behaviour. Risk management procedures also strengthened the client's belief that he was a dangerous person, and reinforced the challenging behaviour by gaining interpersonal attention. The need for learning disability services to be aware of how personality features contribute to learning disability presentations and to formulate from an interactive perspective is highlighted. Abstract
Swainson R, Hodges JR, Galton CJ, Semple J, Dunn BD, Iddon JL, Robbins TW, Sahakian BJ (2001). Early detection and differential diagnosis of Alzheimer's Disease and Depression with neuropsychological tests. Dementia and Geriatric Cognitive Disorders, 12, 265-280.