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  • 1.
    Adams, Sally
    et al.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Penton-Voak, Ian S.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Harmer, Catherine J.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge CB2 7EF, England.
    Munafo, Marcus R.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Effects of emotion recognition training on mood among individuals with high levels of depressive symptoms: study protocol for a randomised controlled trial2013In: Trials, E-ISSN 1745-6215, Vol. 14, article id 161Article in journal (Refereed)
    Abstract [en]

    Background: We have developed a new paradigm that targets the recognition of facial expression of emotions. Here we report the protocol of a randomised controlled trial of the effects of emotion recognition training on mood in a sample of individuals with depressive symptoms over a 6-week follow-up period. Methods/Design: We will recruit 190 adults from the general population who report high levels of depressive symptoms (defined as a score >= 14 on the Beck Depression Inventory-II). Participants will attend a screening session and will be randomised to intervention or control procedures, repeated five times over consecutive days (Monday to Friday). A follow-up session will take place at end-of -treatment, 2-weeks and 6-weeks after training. Our primary study outcome will be depressive symptoms, Beck Depression Inventory- II (rated over the past two weeks). Our secondary outcomes are: depressive symptoms, Hamilton Rating Scale for Depression; anxiety symptoms, Beck Anxiety Inventory (rated over the past month); positive affect, Positive and Negative Affect Schedule (rated as 'how you feel right now'); negative affect, Positive and Negative Affect Schedule (rated as 'how you feel right now'); emotion sensitivity, Emotion Recognition Task (test phase); approach motivation and persistence, the Fishing Game; and depressive interpretation bias, Scrambled Sentences Test. Discussion: This study is of a novel cognitive bias modification technique that targets biases in emotional processing characteristic of depression, and can be delivered automatically via computer, Internet or Smartphone. It therefore has potential to be a valuable cost-effective adjunctive treatment for depression which may be used together with more traditional psychotherapy, cognitive-behavioural therapy and pharmacotherapy.

  • 2.
    Almeida, Osvaldo P.
    et al.
    Univ Western Australia, Perkins Inst Med Res, Med Res Ctr, Western Australian Ctr Hlth & Ageing M573, Crawley, WA 6009, Australia;Univ Western Australia, Sch Psychiat & Clin Neurosci, Crawley, WA 6009, Australia;Royal Perth Hosp, Dept Psychiat, Perth, WA 6000, Australia.
    MacLeod, Colin
    Univ Western Australia, Sch Psychol, Crawley, WA 6009, Australia.
    Ford, Andrew
    Univ Western Australia, Perkins Inst Med Res, Med Res Ctr, Western Australian Ctr Hlth & Ageing M573, Crawley, WA 6009, Australia;Univ Western Australia, Sch Psychiat & Clin Neurosci, Crawley, WA 6009, Australia;Royal Perth Hosp, Dept Psychiat, Perth, WA 6000, Australia.
    Grafton, Ben
    Univ Western Australia, Sch Psychol, Crawley, WA 6009, Australia.
    Hirani, Varsha
    Univ Western Australia, Perkins Inst Med Res, Med Res Ctr, Western Australian Ctr Hlth & Ageing M573, Crawley, WA 6009, Australia;Univ Western Australia, Sch Psychiat & Clin Neurosci, Crawley, WA 6009, Australia.
    Glance, David
    Univ Western Australia, Ctr Software Practice, Crawley, WA 6009, Australia.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, Cambridge CB2 7EF, England.
    Cognitive bias modification to prevent depression (COPE): study protocol for a randomised controlled trial2014In: Trials, E-ISSN 1745-6215, Vol. 15, article id 282Article in journal (Refereed)
    Abstract [en]

    Background: Depression is a leading cause of disability worldwide and, although efficacious treatments are available, their efficacy is suboptimal and recurrence of symptoms is common. Effective preventive strategies could reduce disability and the long term social and health complications associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that addresses attentional and interpretive biases associated with anxiety, dysphoria, and depression. The primary aim of this trial is to determine if CBM decreases the one-year onset of a major depressive episode among adults with subsyndromal depression. Design and methods: This randomised controlled trial will recruit 532 adults with subsyndromal symptoms of depression living in the Australian community (parallel design, 1:1 allocation ratio). Participants will be free of clinically significant symptoms of depression and of psychotic disorders, sensory and cognitive impairment, and risky alcohol use. The CBM intervention will target attentional and interpretive biases associated with depressive symptoms. The sessions will be delivered via the internet over a period of 52 weeks. The primary outcome of interest is the onset of a major depressive episode according the DSM-IV-TR criteria over a 12-month period. Secondary outcomes of interest include change in the severity of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9), use of antidepressants or benzodiazepines, and changes in attention and interpretive biases. The assessment of outcomes will take place 3, 6, 9, and 12 months after randomisation and will occur via the internet. Discussion: We propose to test the efficacy of an innovative intervention that is well grounded in theory and for which increasing empirical evidence for an effect on mood is available. The intervention is simple, inexpensive, easy to access, and could be easily rolled out into practice if our findings confirm a role for CBM in the prevention of depression.

  • 3.
    Alozkan Sever, C
    et al.
    Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria.
    Cuijpers, P
    Department of Clinical, Neuro and Developmental Psychology, VU Amsterdam, Amsterdam, Netherlands.
    Bryant, R
    UNSW Traumatic Stress Clinic, University of New South Wales, Sydney, Australia.
    Dawson, K
    School of psychology, University of New South Wales, Sydney, Australia.
    Mittendorfer-Rutz, E
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Holmes, E
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sijbrandi, M
    Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.
    Adaptation of the Problem Management Plus programme for Syrian, Eritrean and Afghan refugee youth2020In: The European Journal of Public Health, ISSN 1101-1262, Vol. 30, no Supplement_5Article in journal (Refereed)
  • 4.
    Alozkan Sever, Cansu
    et al.
    Vrije Univ Amsterdam, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands.;Vrije Univ Amsterdam, WHO Collaborating Ctr Res & Disseminat Psychol In, Amsterdam, Netherlands.;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands..
    Cuijpers, Pim
    Vrije Univ Amsterdam, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands.;Vrije Univ Amsterdam, WHO Collaborating Ctr Res & Disseminat Psychol In, Amsterdam, Netherlands.;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands..
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Bryant, Richard A.
    Univ New South Wales, Sch Psychol, Sydney, NSW, Australia..
    Dawson, Katie S.
    Univ New South Wales, Sch Psychol, Sydney, NSW, Australia..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Mooren, Trudy
    Univ Utrecht, Dept Clin Psychol, Utrecht, Netherlands..
    Norredam, Marie Louise
    Univ Copenhagen, Sect Hlth Serv Res, Dept Publ Hlth, Danish Res Ctr Migrat Ethn & Hlth, Copenhagen, Denmark..
    Sijbrandij, Marit
    Vrije Univ Amsterdam, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands.;Vrije Univ Amsterdam, WHO Collaborating Ctr Res & Disseminat Psychol In, Amsterdam, Netherlands.;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands..
    Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM plus EP) for refugee youth living in the Netherlands: study protocol2021In: European Journal of Psychotraumatology, ISSN 2000-8198, E-ISSN 2000-8066, Vol. 12, no 1, article id 1947003Article in journal (Refereed)
    Abstract [en]

    Background Refugee youth experience hardships associated with exposure to trauma in their homelands and during and after displacement, which results in higher rates of common mental disorders. The World Health Organization (WHO) developed Problem Management Plus (PM+), a non-specialist-delivered brief psychological intervention, for individuals who have faced adversity. PM+ comprises problem-solving, stress management, behavioural activation and strengthening social support. However, it does not include an emotional processing component, which is indicated in trauma-exposed populations. Objective This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and acceptability of PM+, adapted to Syrian, Eritrean and Iraqi refugee youth residing in the Netherlands, with and without a newly developed Emotional Processing (EP) Module. Methods Refugee youth (N = 90) between 16 and 25 years of age will be randomized into PM+ with care-as-usual (CAU), (n = 30), PM+ with Emotional Processing (PM+EP) with CAU (n = 30) or CAU only (n = 30). Inclusion criteria are self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 > 16). Participants will be assessed at baseline, one-week post-intervention and three-month follow-up. The main outcome is the feasibility and acceptability of the adapted PM+ and PM+EP. The secondary outcomes are self-reported psychological distress, functional impairment, post-traumatic stress disorder (PTSD) symptom severity and diagnosis, social support, and self-identified problems. The pilot RCT will be succeeded by a process evaluation including trial participants, participants' significant others, helpers, and mental health professionals (n = 20) to evaluate their experiences with the PM+ and PM+EP programmes. Results and Conclusion This is the first study that evaluates the feasibility of PM+ for this age range with an emotional processing module integrated. The results may inform larger RCTs and implementation of PM+ interventions among refugee youth.

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  • 5.
    Amin, R.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Mittendorfer-Rutz, E.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Mehlum, L.
    Univ Oslo, Natl Ctr Suicide Res & Prevent, Inst Clin Med, Sognsvannsveien 21, N-0374 Oslo, Norway..
    Runeson, B.
    Karolinska Inst, Ctr Psychiat Res, Stockholm Cty Council, Dept Clin Neurosci, S-11281 Stockholm, Sweden..
    Helgesson, M.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Tinghög, P.
    Swedish Red Cross Univ Coll, Halsovagen 11, S-14157 Huddinge, Sweden.;Karolinska Inst, Dept Clin Neurosci, Div Psychol, SE-17177 Stockholm, Sweden..
    Björkenstam, E.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci, Div Psychol, SE-17177 Stockholm, Sweden.
    Qin, P.
    Univ Oslo, Natl Ctr Suicide Res & Prevent, Inst Clin Med, Sognsvannsveien 21, N-0374 Oslo, Norway..
    Does country of resettlement influence the risk of suicide in refugees?: A case-control study in Sweden and Norway2021In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 2045-7979, Vol. 30, article id e62Article in journal (Refereed)
    Abstract [en]

    Aims

    Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries.

    Methods

    Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country.

    Results

    The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5–0.6) and 0.3 (95% CI 0.3–0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7–1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18–24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries.

    Conclusions

    Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

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  • 6. Amin, Ridwanul
    et al.
    Helgesson, Magnus
    Runeson, Bo
    Tinghög, Petter
    Mehlum, Lars
    Qin, Ping
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study2021In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 51, no 2, p. 254-263Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.

    METHODS: Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.

    RESULTS: In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.

    CONCLUSIONS: Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

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  • 7.
    Amin, Ridwanul
    et al.
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Rahman, Syed
    Karolinska Inst, Dept Global Publ Hlth, S-17177 Stockholm, Sweden.
    Tinghög, Petter
    Swedish Red Cross Univ Coll, S-14157 Huddinge, Sweden.
    Helgesson, Magnus
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Runeson, Bo
    Karolinska Inst, Ctr Psychiat Res, St Görans Hosp, Dept Clin Neurosci, Stockholm Cty Council, S-11281 Stockholm, Sweden.
    Björkenstam, Emma
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Qin, Ping
    Univ Oslo, Natl Ctr Suicide Res & Prevent, N-0374 Oslo, Norway.
    Mehlum, Lars
    Univ Oslo, Natl Ctr Suicide Res & Prevent, N-0374 Oslo, Norway.
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci CNS, Psychol, K8, S-17177 Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.
    Healthcare use before and after suicide attempt in refugees and Swedish-born individuals2021In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, no 2, p. 325-338Article in journal (Refereed)
    Abstract [en]

    Purpose

    There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.

    Methods

    All refugees and Swedish-born individuals, 20–64 years of age, treated for suicide attempt in specialised healthcare during 2004–2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y − 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.

    Results

    Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23–28%) refugees and 30% (95% CI 29–30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.

    Conclusion

    Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

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  • 8. Andersson, Erik
    et al.
    Holmes, Emily A.
    Department of Clinical Neuroscience, Division of Psychology, Karolinska institute, Stockholm, Sweden..
    Kavanagh, David
    Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science.2018In: mHealth, ISSN 2306-9740, Vol. 4, article id 47Article in journal (Refereed)
    Abstract [en]

    A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.

  • 9.
    Andersson, Gerhard
    et al.
    Linkoping Univ, S-58183 Linkoping, Sweden.
    Carlbring, Per
    Stockholm Univ, S-10691 Stockholm, Sweden.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge, England.
    Special Issue in Honour of Lars-Goran Ost2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 259-259Article in journal (Other academic)
  • 10.
    Andersson, Gerhard
    et al.
    Linkoping Univ, Dept Behav Sci & Learning, SE-58183 Linkoping, Sweden;Linkoping Univ, Swedish Inst Disabil Res, SE-58183 Linkoping, Sweden;Karolinska Inst, Dept Clin Neurosci, Psychiat Sect, Stockholm, Sweden.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge, England.
    Carlbring, Per
    Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden.
    Lars-Goran Ost2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 260-264Article in journal (Refereed)
    Abstract [en]

    Lars-Goran ost is one of the most eminent clinical researchers in the field of cognitive behaviour therapy (CBT) and a founder of CBT in Sweden. He has recently retired from his position as professor in clinical psychology at Stockholm University, Sweden. In this paper, we sketch a brief description of the body of work by ost. Examples of his innovative and pioneering new treatment methods include the one-session treatment for specific phobias, as well as applied relaxation for a range of anxiety disorders and health conditions. While ost remains active in the field, he has contributed significantly to the development and dissemination of CBT in Sweden as well as in the world.

  • 11. Arditi, A.
    et al.
    Holmes, Emily A.
    Whitehouse, R.
    Interactive tactile maps, visual disability and accessibility of building interiors.1999In: Visual Impairment Research, Vol. 1, p. 11-21Article in journal (Refereed)
  • 12. Ashraf, Nava
    et al.
    Bryan, Gharad
    Delfino, Alexia
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Iacovone, Leonardo
    Pople, Ashley
    Learning to See the World’s Opportunities:: The Impact of Visualization on Entrepreneurial Success2021In: The 2021 Behavioral Economics Annual Meeting (BEAM 2021). Virtual Meeting, May 17-19, 2021., 2021Conference paper (Other academic)
    Abstract [en]

    Recent work in neuroscience and psychology has explored the impact of visualizing future sce-narios on decision making, and suggests that there is heterogeneity in how well and how oftenpeople use mental imagery. We explore the importance of imagery for economic outcomes.First, using a data set of over 1,201 Colombian would-be micro-entrepreneurs, we show thatmeasures of imagery use correlate strongly and positively with economic outcomes. Second,we design a training curriculum to teach visualization skills, and test it using a randomizedcontrol trial in which the same entrepreneurs were given access to either the imagery-basedentrepreneurial training program, or a more traditional (placebo) program. In follow-up sur-veys conducted 8 and 14 months after the intervention, those who participated in the imagerytraining demonstrate a strengthened capacity for using visualization and significantly improvedeconomic outcomes including higher revenue prior to the COVID pandemic. Our results sug-gest that the ability to vividly and precisely imagine the future is an important determinantof entrepreneurial success.

  • 13.
    Asselbergs, Joost
    et al.
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands..
    van Bentum, Jael
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Univ Utrecht, Fac Social & Behav Sci, Dept Clin Psychol, Heidelberglaan 1, NL-3584 CS Utrecht, Netherlands.;Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Heidelberglaan 1, NL-3584 CS Utrecht, Netherlands..
    Riper, Heleen
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ Amsterdam Med Ctr, Amsterdam Med Ctr, Dept Psychiat, Amsterdam, Netherlands.;Univ Southern Denmark, Fac Hlth Sci, Dept Clin Res, Res Unit Telepsychiat & E Mental Hlth, JB Winslows Vej 19, DK-5000 Odense, Denmark..
    Cuijpers, Pim
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Babes Bolyai Univ, Int Inst Psychotherapy, Cluj Napoca, Romania.;WHO, Collaborating Ctr Res & Disseminat Psychol Interve, Amsterdam, Netherlands..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sijbrandij, Marit
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;WHO, Collaborating Ctr Res & Disseminat Psychol Interve, Amsterdam, Netherlands..
    A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm2023In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 159, p. 116-129Article, review/survey (Refereed)
    Abstract [en]

    There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g =-0.46, 95% CI [-0.61 to-0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g =-0.31, 95% CI [-0.46 to-0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer in-trusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive in-terventions and test their clinical translation to reduce intrusive memories of real trauma.

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  • 14.
    Berna, Chantal
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Lang, Tamara J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Goodwin, Guy M.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Developing a measure of interpretation bias for depressed mood: An ambiguous scenarios test2011In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 51, no 3, p. 349-354Article in journal (Refereed)
    Abstract [en]

    The tendency to interpret ambiguous everyday situations in a relatively negative manner (negative interpretation bias) is central to cognitive models of depression. Limited tools are available to measure this bias, either experimentally or in the clinic. This study aimed to develop a pragmatic interpretation bias measure using an ambiguous scenarios test relevant to depressed mood (the AST-D).(1) In Study 1, after a pilot phase (N = 53), the AST-D was presented via a web-based survey (N = 208). Participants imagined and rated each AST-D ambiguous scenario. As predicted, higher dysphoric mood was associated with lower pleasantness ratings (more negative bias), independent of mental imagery measures. In Study 2, self-report ratings were compared with objective ratings of participants' imagined outcomes of the ambiguous scenarios (N = 41). Data were collected in the experimental context of a functional Magnetic Resonance Imaging scanner. Consistent with subjective bias scores, independent judges rated more sentences as negatively valenced for the high versus low dysphoric group. Overall, results suggest the potential utility of the AST-D in assessing interpretation bias associated with depressed mood. (C) 2011 Elsevier Ltd. All rights reserved.

  • 15.
    Berna, Chantal
    et al.
    Univ Oxford, Dept Clin Neurol, Ctr Funct Magnet Resonance Imaging Brain, Oxford OX3 9DU, England;Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 9DU, England.
    Leknes, Siri
    Univ Oxford, Dept Clin Neurol, Ctr Funct Magnet Resonance Imaging Brain, Oxford OX3 9DU, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 9DU, England.
    Edwards, Robert R.
    Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Anesthesiol, Chestnut Hill, MA USA.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 9DU, England.
    Tracey, Irene
    Univ Oxford, Dept Clin Neurol, Ctr Funct Magnet Resonance Imaging Brain, Oxford OX3 9DU, England.
    Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness2010In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 67, no 11, p. 1083-1090Article in journal (Refereed)
    Abstract [en]

    Background: Depressed mood alters the pain experience. Yet, despite its clear clinical relevance, little is known about the cognitive and neural mechanisms underlying this phenomenon. We tested an experimental manipulation to unravel the interaction between depressed mood and pain. We hypothesized that dysregulation of the neural circuitry underlying emotion regulation is the mechanism whereby pain processing is affected during depressed mood. Methods: Using functional magnetic resonance imaging, we compared the effects of sad and neutral cognitive mood inductions on affective pain ratings, pain-specific cognitions, and central pain processing of a tonic noxious heat stimulus in 20 healthy volunteers. Results: The increase in negative pain-specific cognitions during depressed mood predicted the perceived increase in pain unpleasantness. Following depressed mood induction, brain responses to noxious thermal stimuli were characterized by increased activity in a broad network including prefrontal areas, subgenual anterior cingulate cortex, and hippocampus, as well as significantly less deactivation when compared with pain responses in a neutral mood. The participants who reported the largest increase in pain unpleasantness after the sad mood induction showed greater inferior frontal gyrus and amygdala activation, linking changes in emotion regulation mechanisms with enhancement of pain affect. Conclusions: Our results inform how depressed mood and chronic pain co-occur clinically and may serve to develop and translate effective interventions using pharmacological or psychological treatment.

  • 16. Berna, Chantal
    et al.
    Tracey, Irene
    Holmes, Emily A.
    Department of Psychiatry, University of Oxford..
    How a Better Understanding of Spontaneous Mental Imagery Linked to Pain Could Enhance Imagery-Based Therapy in Chronic Pain.2012In: Journal of Experimental Psychopathology, E-ISSN 2043-8087, Vol. 3, no 2, p. 258-273Article in journal (Refereed)
    Abstract [en]

    Therapy with mental images is prevalent in the field of chronic pain, and this has been the case for centuries. Yet few of the recent advances in the cognitive behavioural understanding of spontaneous (i.e. intrusive) mental imagery have been translated to this field. Such advances include imagery as a component of a psychopathological process, as an emotional amplifier and as a cognitive therapeutic target in its own right. Hence very little is known about the contents, prevalence and emotional impact of spontaneous mental imagery in the context of chronic pain. This article discusses the evidence in favour of spontaneous imagery being a potentially important part of patients' pain experience, and makes a case, based on neurophysiological findings, for imagery having an impact on pain perception. Furthermore, it presents how mental imagery has been used in the treatment of chronic pain. A case report illustrates further how spontaneous negative imagery linked to pain can be distressing, and how this might be addressed in therapy. Additionally, the case report demonstrates the spontaneous use of coping imagery, and raises a discussion of how this might be enhanced.

  • 17.
    Berna, Chantal
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, EPACT Grp, Oxford OX3 7JX, England;Univ Oxford, Ctr Funct Magnet Resonance Imaging Brain FMRIB, Dept Clin Neurol, Oxford OX3 7JX, England;Univ Oxford, Nuffield Dept Anaesthet, Oxford OX3 7JX, England.
    Vincent, Katy
    Univ Oxford, Ctr Funct Magnet Resonance Imaging Brain FMRIB, Dept Clin Neurol, Oxford OX3 7JX, England;Univ Oxford, Nuffield Dept Anaesthet, Oxford OX3 7JX, England;Univ Oxford, Nuffield Dept Obstet & Gynaecol, John Radcliffe Hosp, Oxford OX3 7JX, England.
    Moore, Jane
    Univ Oxford, Nuffield Dept Obstet & Gynaecol, John Radcliffe Hosp, Oxford OX3 7JX, England.
    Tracey, Irene
    Univ Oxford, Ctr Funct Magnet Resonance Imaging Brain FMRIB, Dept Clin Neurol, Oxford OX3 7JX, England;Univ Oxford, Nuffield Dept Anaesthet, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Holmes, Emily A.
    Presence of Mental Imagery Associated with Chronic Pelvic Pain: A Pilot Study2011In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 12, no 7, p. 1086-1093Article in journal (Refereed)
    Abstract [en]

    Objective. To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Patients. Ten women with chronic pelvic pain consecutively referred from a tertiary referral center by the physicians in charge of their treatment. Outcome measures. An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of Inventory (BPI), Pain Catastrophizing Scale (PCS), Spontaneous Use of Imagery Scale (SUIS), and Hospital Anxiety and Depression Scale (HADS) were completed. Results. In a population of patients with a prolonged duration of pain and high distress, all patients reported experiencing cognitions about pain in the form of mental images. For each patient, the most significant image was both negative in valence and intrusive. The associated emotional-behavioral pattern could be described within a cognitive behavioral therapy framework. Eight patients also reported coping imagery. Conclusion. Negative pain-related cognitions in the form of intrusive mental imagery were reported by women with chronic pelvic pain. Targeting such imagery has led to interesting treatment innovation in the emotional disorders. Thus, imagery, hitherto neglected in pain phenomenology, could provide a novel target for cognitive behavioral therapy in chronic pain. These exciting yet preliminary results require replication and extension in a broader population of patients with chronic pain.

  • 18.
    Bilderbeck, Amy C.
    et al.
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Atkinson, Lauren Z.
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    McMahon, Hannah C.
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Voysey, Merryn
    Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford, England.
    Simon, Judit
    Med Univ Vienna, Dept Hlth Econ, Ctr Publ Hlth, Vienna, Austria.
    Price, Jonathan
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Rendell, Jennifer
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Hinds, Chris
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Geddes, John R.
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Holmes, Emily A.
    Univ Oxford, Univ Dept Psychiat, Oxford, England;MRC Cognit & Brain Sci Unit, Cambridge, England.
    Miklowitz, David J.
    Univ Oxford, Univ Dept Psychiat, Oxford, England;Univ Calif Los Angeles, Semel Inst, Los Angeles, CA USA.
    Goodwin, Guy M.
    Univ Oxford, Univ Dept Psychiat, Oxford, England.
    Psychoeducation and online mood tracking for patients with bipolar disorder: A randomised controlled trial2016In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 205, p. 245-251Article in journal (Refereed)
    Abstract [en]

    Background: Psychoeducation is an effective adjunct to medications in bipolar disorder (BD). Brief psychoeducational approaches have been shown to improve early identification of relapse. However, the optimal method of delivery of psychoeducation remains uncertain. Here, our objective was to compare a short therapist-facilitated vs. self-directed psychoeducational intervention for BD. Methods: BD outpatients who were receiving medication-based treatment were randomly assigned to 5 psychoeducation sessions administered by a therapist (Facilitated Integrated Mood Management; FIMM; n=60), or self-administered psychoeducation (Manualized Integrated Mood Management; MIMM; n=61). Follow-up was based on patients' weekly responses to an electronic mood monitoring programme over 12 months. Results: Over follow-up, there were no group differences in weekly self-rated depression symptoms or relapse/readmission rates. However, knowledge of BD (assessed with the Oxford Bipolar Knowledge questionnaire (OBQ)) was greater in the FIMM than the MIMM group at 3 months. Greater illness knowledge at 3 months was related to a higher proportion of weeks well over 12 months. Limitations: Features of the trial may have reduced the sensitivity to our psychoeducation approach, including that BD participants had been previously engaged in self-monitoring. Conclusions: Improved OBQ score, while accelerated by a short course of therapist-administered psychoeducation (FIMM), was seen after both treatments. It was associated with better outcome assessed as weeks well. When developing and testing a new psychosocial intervention, studies should consider proximal outcomes (e.g., acquired knowledge) and their short-term impact on illness course in bipolar disorder. (C) 2016 Elsevier B.V. All rights reserved.

  • 19.
    Bjork Thordardottir, Edda
    et al.
    University of Iceland.
    Yin, Li
    Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Hollander, Anna-Clara
    Karolinska Institutet.
    Hultman, Christina M.
    Karolinska Institutet; Icahn School of Medicine, Mount Sinai Hospital, New York.
    Lichtenstein, Paul
    Karolinska Institutet.
    Ye, Weimin
    Karolinska Institutet.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Stress Research Institute, Stockholm University.
    Fang, Fang
    Karolinska Institutet.
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdottir, Unnur Anna
    Karolinska Institutet; University of Iceland; Harvard T.H. Chan School of Public Health.
    Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study2020In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 17, no 12, article id e1003392Article in journal (Refereed)
    Abstract [en]

    Background

    In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period.

    Methods and findings

    We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration.

    Conclusions

    Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

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  • 20.
    Blackwell, Simon E.
    et al.
    Med Res Council Cognit & Brain Sci Unit, 15 Chaucer Rd, Cambridge CB2 7EF, England.
    Browning, Michael
    Univ Oxford, Dept Psychiat, Oxford, England.
    Mathews, Andrew
    Univ Calif Davis, Dept Psychol, Davis, CA 95616 USA;Kings Coll London, Inst Psychiat, London, England.
    Pictet, Arnaud
    Univ Oxford, Dept Psychiat, Oxford, England;Univ Geneva, Dept Psychol, Geneva, Switzerland.
    Welch, James
    Univ Oxford, Dept Comp Sci, Oxford, England.
    Davies, Jim
    Univ Oxford, Dept Comp Sci, Oxford, England.
    Watson, Peter
    Med Res Council Cognit & Brain Sci Unit, 15 Chaucer Rd, Cambridge CB2 7EF, England.
    Geddes, John R.
    Univ Oxford, Dept Psychiat, Oxford, England.
    Holmes, Emily A.
    Med Res Council Cognit & Brain Sci Unit, 15 Chaucer Rd, Cambridge CB2 7EF, England;Univ Oxford, Dept Psychiat, Oxford, England.
    Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial2015In: Clinical Psychological Science, ISSN 2167-7026, E-ISSN 2167-7034, Vol. 3, no 1, p. 91-111Article in journal (Refereed)
    Abstract [en]

    Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work.

  • 21.
    Blackwell, Simon E.
    et al.
    Ruhr Univ Bochum, Bochum, Germany;MRC, Cognit & Brain Sci Unit, Cambridge, England.
    Holmes, Emily A.
    Karolinska Inst, Stockholm, Sweden;MRC, Cognit & Brain Sci Unit, Cambridge, England.
    Brightening the Day With Flashes of Positive Mental Imagery: A Case Study of an Individual With Depression2017In: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 73, no 5, p. 579-589Article in journal (Refereed)
    Abstract [en]

    This article presents a case example of an individual with current major depression engaging in a positive mental imagery intervention, specifically a computerized cognitive training paradigm involving repeated practice in generating positive imagery in response to ambiguous scenarios. The patient's reported experience of the intervention suggests the potential of the positive imagery intervention to "brighten" everyday life via promoting involuntary "flashes" of positive mental imagery in situations related to the scenarios, with associated beneficial effects on positive affect, future expectations, and behavior. Enhancing this aspect of the training-i.e., involuntary positive imagery in contexts where it is adaptive-may hold particular promise for reducing anhedonic symptoms of depression. Developing simple computerized interventions to increase the experience of positive mental imagery in everyday life could therefore provide a useful addition to the drive to improve treatment outcomes. (C) 2017 Wiley Periodicals, Inc.

  • 22.
    Blackwell, Simon E.
    et al.
    Univ Oxford, Oxford Doctoral Course Clin Psychol, Oxford, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford, England.
    Modifying Interpretation and Imagination in Clinical Depression: A Single Case Series Using Cognitive Bias Modification2010In: Applied Cognitive Psychology, ISSN 0888-4080, E-ISSN 1099-0720, Vol. 24, no 3, p. 338-350Article in journal (Refereed)
    Abstract [en]

    The current cognitive bias modification (CBM) paradigm targets interpretation bias (CBM-I) in depression via promoting positive imagery. We investigated the impact of repeated sessions of this CBM-I on interpretation bias, mood and mental health in participants currently experiencing a major depressive episode. Seven participants completed daily sessions of CBM-I at home for one week in a single case series. Outcome measures were completed pre and post a one-week baseline period, and after the week of daily CBM-I. Depressive symptoms were also assessed at a 2-week follow-up. Four of seven participants demonstrated improvements in mood, bias and/or mental health after one week of CBM-I, with improvements in depressive symptoms maintained at follow-up. Discussion of the remaining three highlights difficulties involved in translating CBM-I interventions from the laboratory to the clinic. To bridge this gap, we suggest that it is critical to examine the failures as well as the successes. Copyright (C) 2010 John Wiley & Sons, Ltd.

  • 23.
    Blackwell, Simon E.
    et al.
    MRC Cognit & Brain Sci Unit, Cambridge, England;Univ Oxford, Dept Psychiat, Oxford, England.
    Rius-Ottenheim, Nathaly
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Schulte-van Maaren, Yvonne W. M.
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Carlier, Ingrid V. E.
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Middelkoop, Victor D.
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Zitman, Frans G.
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Spinhoven, Philip
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands;Leiden Univ, Inst Psychol, Leiden, Netherlands.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge, England;Univ Oxford, Dept Psychiat, Oxford, England.
    Giltay, Erik J.
    Leiden Univ, Med Ctr, Dept Psychiat, Leiden, Netherlands.
    Optimism and mental imagery: A possible cognitive marker to promote well-being?2013In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 206, no 1, p. 56-61Article in journal (Refereed)
    Abstract [en]

    Optimism is associated with a range of benefits not only for general well-being, but also for mental and physical health. The development of psychological interventions to boost optimism derived from cognitive science would have the potential to provide significant public health benefits, yet cognitive markers of optimism are little understood. The current study aimed to take a first step in this direction by identifying a cognitive marker for optimism that could provide a modifiable target for innovative interventions. In particular we predicted that the ability to generate vivid positive mental imagery of the future would be associated with dispositional optimism. A community sample of 237 participants completed a survey comprising measures of mental imagery and optimism, and socio-demographic information. Vividness of positive future imagery was significantly associated with optimism, even when adjusting for socio-demographic factors and everyday imagery use. The ability to generate vivid mental imagery of positive future events may provide a modifiable cognitive marker of optimism. Boosting positive future imagery could provide a cognitive target for treatment innovations to promote optimism, with implications for mental health and even physical well-being. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

  • 24.
    Boettcher, Johanna
    et al.
    Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden;Free Univ Berlin, Berlin, Germany.
    Leek, Linda
    Umea Univ, Dept Psychol, S-90187 Umea, Sweden.
    Matson, Lisa
    Umea Univ, Dept Psychol, S-90187 Umea, Sweden.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge, England.
    Browning, Michael
    Univ Oxford, Funct MRI Brain Ctr, Oxford, England.
    MacLeod, Colin
    Univ Western Australia, Sch Psychol, Perth, WA 6009, Australia.
    Andersson, Gerhard
    Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden;Karolinska Inst, Dept Clin Neurosci, Psychiat Sect, Stockholm, Sweden.
    Carlbring, Per
    Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden.
    Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues2013In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 9, article id e71760Article in journal (Refereed)
    Abstract [en]

    Biases in attention processes are thought to play a crucial role in the aetiology and maintenance of Social Anxiety Disorder (SAD). The goal of the present study was to examine the efficacy of a programme intended to train attention towards positive cues and a programme intended to train attention towards negative cues. In a randomised, controlled, double-blind design, the impact of these two training conditions on both selective attention and social anxiety were compared to that of a control training condition. A modified dot probe task was used, and delivered via the internet. A total of 129 individuals, diagnosed with SAD, were randomly assigned to one of these three conditions and took part in a 14-day programme with daily training/control sessions. Participants in all three groups did not on average display an attentional bias prior to the training. Critically, results on change in attention bias implied that significantly differential change in selective attention to threat was not detected in the three conditions. However, symptoms of social anxiety reduced significantly from pre- to follow-up-assessment in all three conditions (d(within) = 0.63-1.24), with the procedure intended to train attention towards threat cues producing, relative to the control condition, a significantly greater reduction of social fears. There were no significant differences in social anxiety outcome between the training condition intended to induce attentional bias towards positive cues and the control condition. To our knowledge, this is the first RCT where a condition intended to induce attention bias to negative cues yielded greater emotional benefits than a control condition. Intriguingly, changes in symptoms are unlikely to be by the mechanism of change in attention processes since there was no change detected in bias per se. Implications of this finding for future research on attention bias modification in social anxiety are discussed. Trial Registration: ClinicalTrials.gov NCT01463137

  • 25.
    Bonsall, M. B.
    et al.
    Univ Oxford, Dept Zool, Math Ecol Res Grp, Oxford OX1 3PS, England;St Peters Coll, Oxford OX1 2DL, England.
    Wallace-Hadrill, S. M. A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Geddes, J. R.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, G. M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Nonlinear time-series approaches in characterizing mood stability and mood instability in bipolar disorder2012In: Proceedings of the Royal Society of London. Biological Sciences, ISSN 0962-8452, E-ISSN 1471-2954, Vol. 279, no 1730, p. 916-924Article in journal (Refereed)
    Abstract [en]

    Bipolar disorder is a psychiatric condition characterized by episodes of elevated mood interspersed with episodes of depression. While treatment developments and understanding the disruptive nature of this illness have focused on these episodes, it is also evident that some patients may have chronic week-to-week mood instability. This is also a major morbidity. The longitudinal pattern of this mood instability is poorly understood as it has, until recently, been difficult to quantify. We propose that understanding this mood variability is critical for the development of cognitive neuroscience-based treatments. In this study, we develop a time-series approach to capture mood variability in two groups of patients with bipolar disorder who appear on the basis of clinical judgement to show relatively stable or unstable illness courses. Using weekly mood scores based on a self-rated scale (quick inventory of depressive symptomatology-self-rated; QIDS-SR) from 23 patients over a 220-week period, we show that the observed mood variability is nonlinear and that the stable and unstable patient groups are described by different nonlinear time-series processes. We emphasize the necessity in combining both appropriate measures of the underlying deterministic processes (the QIDS-SR score) and noise (uncharacterized temporal variation) in understanding dynamical patterns of mood variability associated with bipolar disorder.

  • 26.
    Bonsall, Michael B.
    et al.
    Univ Oxford, Dept Zool, Oxford OX1 3PS, England;St Peters Coll, Oxford OX1 2DL, England.
    Geddes, John R.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX1 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX1 7JX, England.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, Cambridge CB2 7EF, England;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Bipolar disorder dynamics: affective instabilities, relaxation oscillations and noise2015In: Journal of the Royal Society Interface, ISSN 1742-5689, E-ISSN 1742-5662, Vol. 12, no 112, article id 20150670Article in journal (Refereed)
    Abstract [en]

    Bipolar disorder is a chronic, recurrent mental illness characterized by extreme episodes of depressed and manic mood, interspersed with less severe but highly variable mood fluctuations. Here, we develop a novel mathematical approach for exploring the dynamics of bipolar disorder. We investigate how the dynamics of subjective experience of mood in bipolar disorder can be understood using a relaxation oscillator (RO) framework and test the model against mood time-series fluctuations from a set of individuals with bipolar disorder. We show that variable mood fluctuations in individuals diagnosed with bipolar disorder can be driven by the coupled effects of deterministic dynamics (captured by ROs) and noise. Using a statistical likelihood-based approach, we show that, in general, mood dynamics are described by two independent ROs with differing levels of endogenous variability among individuals. We suggest that this sort of nonlinear approach to bipolar disorder has neurobiological, cognitive and clinical implications for understanding this mental illness through a mechacognitive framework.

  • 27.
    Bonsall, Michael B.
    et al.
    Univ Oxford, Dept Biol, Math Ecol Res Grp, Oxford OX1 3RB, England.;St Peters Coll, Oxford OX1 2DL, England..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Temporal dynamics of trauma memory persistence2023In: Journal of the Royal Society Interface, ISSN 1742-5689, E-ISSN 1742-5662, Vol. 20, no 203, article id 20230108Article in journal (Refereed)
    Abstract [en]

    Traumatic events lead to distressing memories, but such memories are made all the worse when they intrude to mind unbidden and recurrently. Intrusive memories and flashbacks after trauma are prominent in several mental disorders, including post-traumatic stress disorder and can persist for years. Critically, the reduction of intrusive memories provides a treatment target. While cognitive and descriptive models for psychological trauma exist, these lack formal quantitative structure and robust empirical validation. Here, using techniques from stochastic process theory, we develop a mechanistically driven, quantitative framework to extend understanding of the temporal dynamic processes of trauma memory. Our approach is to develop a probabilistic description of memory mechanisms to link to the broader goals of trauma treatment. We show how the marginal gains of treatments for intrusive memories can be enhanced as key properties (intervention strength and reminder strength) of the intervention and memory consolidation (probability memories are labile) vary. Parametrizing the framework with empirical data highlights that while emerging interventions to reduce occurrence of intrusive memories can be effective, counterintuitively, weakening multiple reactivation cues may help reduce intrusive memories more than would stronger cues. More broadly, the approach provides a quantitative framework for associating neural mechanisms of memory with broader cognitive processes.

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  • 28.
    Bourne, C.
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.
    Mackay, C. E.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England;Univ Oxford, FMRIB Ctr, Oxford, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England;MRC Cognit & Brain Sci Unit, Cambridge CB2 7EF, England.
    The neural basis of flashback formation: the impact of viewing trauma2013In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 43, no 7, p. 1521-1532Article in journal (Refereed)
    Abstract [en]

    Background. Psychological traumatic events, such as war or road traffic accidents, are widespread. A small but significant proportion of survivors develop post-traumatic stress disorder (PTSD). Distressing, sensory-based involuntary memories of trauma (henceforth 'flashbacks') are the hallmark symptom of PTSD. Understanding the development of flashbacks may aid their prevention. This work is the first to combine the trauma film paradigm (as an experimental analogue for flashback development) with neuroimaging to investigate the neural basis of flashback aetiology. We investigated the hypothesis that involuntary recall of trauma (flashback) is determined during the original event encoding. Method. A total of 22 healthy volunteers viewed a traumatic film whilst undergoing functional magnetic resonance imaging (fMRI). They kept a 1-week diary to record flashbacks to specific film scenes. Using a novel prospective fMRI design, we compared brain activation for those film scenes that subsequently induced flashbacks with both non-traumatic control scenes and scenes with traumatic content that did not elicit flashbacks ('potentials'). Results. Encoding of scenes that later caused flashbacks was associated with widespread increases in activation, including in the amygdala, striatum, rostral anterior cingulate cortex, thalamus and ventral occipital cortex. The left inferior frontal gyrus and bilateral middle temporal gyrus also exhibited increased activation but only relative to 'potentials'. Thus, these latter regions appeared to distinguish between traumatic content that subsequently flashed back and comparable content that did not. Conclusions. Results provide the first prospective evidence that the brain behaves differently whilst experiencing emotional events that will subsequently become involuntary memories - flashbacks. Understanding the neural basis of analogue flashback memory formation may aid the development of treatment interventions for this PTSD feature.

  • 29.
    Bourne, Corin
    et al.
    Univ Oxford, Dept Psychiat, Warneford Hosp, Oxford OX3 7JX, England.
    Frasquilho, Francisco
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Roth, Anthony D.
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Warneford Hosp, Oxford OX3 7JX, England.
    Is it mere distraction?: Peri-traumatic verbal tasks can increase analogue flashbacks but reduce voluntary memory performance2010In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 41, no 3, p. 316-324Article in journal (Refereed)
    Abstract [en]

    Several experiments have shown that we can reduce the frequency of analogue flashbacks with competing tasks presented during a trauma film (i.e. peri-traumatically). A "distraction" hypothesis suggests that any competing task may reduce flashbacks due to distraction and/or a load on executive control. Alternatively, a "modality" hypothesis based on clinical models of PTSD suggests that certain tasks will not protect against intrusions (Experiment 1) and could actually increase them (Experiment 2). Experiment 1 contrasted two concurrent tasks, Verbal Interference (counting backwards in threes) and Visuospatial tapping, against a no-task Control condition during trauma film viewing. The Visuospatial group had significantly fewer intrusions of the film over 1-week than the Control group. Contrary to a distraction account, the Verbal Interference group did not show this effect. Using a larger sample. Experiment 2 showed that the Verbal Interference group (counting backwards in sevens) had more intrusions (and inferior voluntary memory) than no-task Controls. We propose that this is in line with a modality hypothesis concerning trauma flashbacks. Disrupting verbal/conceptual processing during trauma could be harmful for later flashbacks. (C) 2010 Elsevier Ltd. All rights reserved.

  • 30.
    Bragesjö, Maria
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Holmes, Emily A.
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychiatry, University of Oxford, Oxford, UK.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry. Stress Research Institute, Stockholm University, Sweden.
    Andersson, Erik M.
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Primary prevention and epidemiology of trauma and stress related disorders2020In: The New Oxford Textbook of Psychiatry, Oxford, UK: Oxford University Press, 2020, 3, p. 860-868Chapter in book (Refereed)
    Abstract [en]

    Post-traumatic stress disorder and acute stress disorder are mental health conditions with a known onset, and prevention strategies can therefore be used to try to prevent the emergence of the full-blown disorder. This chapter provides an overview of the current evidence-based prevention strategies for post-traumatic stress disorder and acute stress disorder. In the first part, diagnostic and epidemiological features of these disorders are considered. The second part of the chapter reviews the evidence base of current preventive psychological and pharmacological interventions. Although some early trials on primary intervention have shown promising effects, it appears too soon to provide any definite recommendation in clinical practice. Importantly, many current widely disseminated treatments lack evidence, and some interventions (for example, debriefing) may, in fact, have a negative impact on the natural recovery after trauma. This chapter highlights the importance of using science-driven interventions to prevent post-traumatic stress disorder and acute stress disorder.

  • 31.
    Brennen, Tim
    et al.
    Univ Oslo, Dept Psychol, Postbox 1094 Blindern, N-0317 Oslo, Norway..
    Blix, Ines
    Norwegian Ctr Violence & Traumat Stress Studies, Oslo, Norway..
    Nissen, Alexander
    Norwegian Ctr Violence & Traumat Stress Studies, Oslo, Norway..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Skumlien, Martine
    Univ Oslo, Dept Psychol, Postbox 1094 Blindern, N-0317 Oslo, Norway..
    Solberg, Oivind
    Norwegian Ctr Violence & Traumat Stress Studies, Oslo, Norway..
    Investigating the frequency of intrusive memories after 24 hours using a visuospatial interference intervention: a follow-up and extension2021In: European Journal of Psychotraumatology, ISSN 2000-8198, E-ISSN 2000-8066, Vol. 12, no 1, article id 1953788Article in journal (Refereed)
    Abstract [en]

    Background There is a need for effective, low-cost, readily available measures for reducing trauma symptoms so that people exposed to potentially traumatic events can receive help more quickly. A previous study reported that performing an intervention including a visuospatial task shortly after a reminder of a series of unpleasant film clips seen 24 hours earlier reduced the number of intrusive memories over the following week. Objective This study reports a follow-up and extension of the earlier promising finding. The prediction was that participants performing the visuospatial task immediately after the reminder would report fewer intrusions compared to three other groups who 1) performed no task, and novel conditions who 2) performed the task before the reminder, and 3) performed the task 90 minutes after the reminder. Method A trauma-analogue method was used, where students (N = 200) watched a series of short films with unpleasant material. Over the following week, they were asked to write down any intrusive memories they experienced in a diary. On the second day they returned to the lab and saw static reminders of the films. They were then randomly allocated to condition, recorded intrusive memories over the following days and returned to the lab for final testing on Day 8. Results A total of 49 participants did not report any intrusions and were excluded from the analyses. Two more participants were excluded as outliers, leaving a final sample of n = 149. Despite using largely the same materials as the original study there were no significant differences in the number of intrusive memories between the four groups post intervention. Conclusions Possible explanations include the effect not being as robust as expected, a low number of intrusions across groups, baseline differences in attention, and minor but potentially important differences in procedure between this and the original study.

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  • 32.
    Brewer, Judson
    et al.
    Brown University, Providence, RI, USA.
    Cortese, Aurelio
    Computational Neuroscience Labs, ATR, Kyoto, Japan .
    De Wit, Harriet
    University of Chicago, USA.
    Denys, Damiaan
    Amsterdam UMC, Netherlands Institute for Neuroscience, Netherlands .
    Hanlon, Colleen A.
    Medical University of South Carolina; Wake Forest University School of Medicine, Winston-Salem, NC, US .
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Interventions and Implications2021In: Intrusive Thinking: From Molecules to Free Will / [ed] P. W. Kalivas and M. P. Paulus, MIT Press, 2021, p. 347-377Chapter in book (Refereed)
  • 33. Brewin, C R
    et al.
    Holmes, Emily A.
    MRC Cognition and Brain Sciences Unit, Cambridge, UK; The Traumatic Stress Clinic, London, UK.
    Psychological theories of posttraumatic stress disorder2003In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 23, no 3, p. 339-376Article, review/survey (Refereed)
    Abstract [en]

    We summarize recent research on the psychological processes implicated in posttraumatic stress disorder (PTSD) as an aid to evaluating theoretical models of the disorder. After describing a number of early approaches, including social-cognitive, conditioning, information-processing, and anxious apprehension models of PTSD, the article provides a comparative analysis and evaluation of three recent theories: Foa and Rothbaum's [Foa, E. B. & Rothbaum, B. O. (1998). Treating the trauma of rape: cognitive behavioral therapy for PTSD. New York: Guilford Press] emotional processing theory; Brewin, Dalgleish, and Joseph's [Psychological Review 103 (1996) 670] dual representation theory; Ehlers and Clark's [Behaviour Research and Therapy 38 (2000) 319] cognitive theory. We review empirical evidence relevant to each model and identify promising areas for further research. (C) 2003 Elsevier Science Ltd. All rights reserved.

  • 34. Brewin, CR
    et al.
    Holmes, Emily A.
    Psychology and cognitive processing in PTSD2003In: Psychiatry, Vol. 6, p. 28-31Article in journal (Refereed)
  • 35.
    Bridge, Holly
    et al.
    Univ Oxford, John Radcliffe Hosp, FMRIB Ctr, Oxford OX3 9DU, England.
    Harrold, Stephen
    Univ Oxford, John Radcliffe Hosp, FMRIB Ctr, Oxford OX3 9DU, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford, England.
    Stokes, Mark
    Univ Oxford, Dept Expt Psychol, Oxford OX1 3UD, England.
    Kennard, Christopher
    Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England.
    Vivid visual mental imagery in the absence of the primary visual cortex2012In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 259, no 6, p. 1062-1070Article in journal (Refereed)
    Abstract [en]

    The role of the primary visual cortex in visual mental imagery has provided significant debate in the imagery literature. Functional neuroimaging studies show considerable variation depending on task and technique. Patient studies can be difficult to interpret due to the diverse nature of cortical damage. The type of cortical damage in patient SBR is exceedingly rare as it is restricted to the gray matter of the calcarine sulcus. In this study, we show that in spite of his near-complete cortical blindness, SBR exhibits vivid visual mental imagery both behaviorally and when measured with functional magnetic resonance imaging. The pattern of cortical activation to visual mental imagery in SBR is indistinguishable from individual sighted subjects, in contrast to the visual perceptual responses, which are greatly attenuated.

  • 36.
    Brown, Richard J.
    et al.
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Danquah, Adam N.
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Miles, Eleanor
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.
    Poliakoff, Ellen
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Attention to the body in nonclinical somatoform dissociation depends on emotional state2010In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 69, no 3, p. 249-257Article in journal (Refereed)
    Abstract [en]

    Objective: Unexplained neurological symptoms ("somatoform dissociation") are common in health care settings and associated with disproportionately high levels of distress, disability, and resource utilization. Theory suggests that somatoform dissociation is associated with disturbed attentional processing, but there is a paucity of research in this area and the available evidence is contradictory. Methods: We compared undergraduate participants (n=124) with high and low scores on the Somatoform Dissociation Questionnaire (SDQ-20) on a tactile cueing paradigm measuring the time course of attention to touch, following either a neutral film or a film designed to simulate the emotional effects of trauma exposure. Results: Following the neutral film, high SDQ-20 participants exhibited delayed disengagement from tactile cue stimuli compared to the low SDQ-20 group. Following the "trauma" film, however, the high SDQ-20 group showed attentional effects suggesting avoidance of the tactile stimuli in this condition. Early attention to tactile cues following the trauma film predicted film-related intrusive thoughts after the experiment. Conclusion: These findings suggest that both body vigilance and body avoidance may be involved in the expression of somatoform dissociation. (C) 2010 Elsevier Inc. All rights reserved.

  • 37.
    Browning, Michael
    et al.
    Department of Psychiatry, University of Oxford, UK..
    Blackwell, Simon E
    Department of Psychiatry, University of Oxford, UK..
    Holmes, Emily A.
    Department of Psychiatry, University of Oxford, UK..
    The use of cognitive bias modification and imagery in the understanding and treatment of depression.2013In: Current topics in behavioral neurosciences, ISSN 1866-3370, Vol. 14, p. 243-60Article in journal (Refereed)
    Abstract [en]

    Cognitive models of depression form the natural link between neurobiological and social accounts of the illness. Interest in the role of cognition in depression has recently been stimulated by the advent of simple, computer-based "cognitive bias modification" (CBM) techniques which are able to experimentally alter cognitive habits in clinical and non-clinical populations. In this chapter, we review recent work which has used CBM techniques to address questions of aetiology and treatment in depression with a particular focus on the interface with neurobiological and social processes relevant to the illness. We find that there are early signs that CBM may be a useful tool in exploring the aetiology of depression, particularly in regard to the neural and genetic factors which influence susceptibility to the illness and response to treatment. There is also early evidence suggesting that CBM has promise in the treatment and prevention of depression. This work suggests that the beneficial effects of CBM are mediated by the interaction between cognitive functioning and environmental and social information. In summary, by providing a method for altering habitual cognitive function in experimental and clinical settings CBM techniques have begun to further the understanding of and the treatment for depression.

  • 38.
    Browning, Michael
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Grol, Maud
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Ly, Verena
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Using an Experimental Medicine Model to Explore Combination Effects of Pharmacological and Cognitive Interventions for Depression and Anxiety2011In: Neuropsychopharmacology, ISSN 0893-133X, E-ISSN 1740-634X, Vol. 36, no 13, p. 2689-2697Article in journal (Refereed)
    Abstract [en]

    Selective serotonergic reuptake inhibitors (SSRIs) and cognitive therapies are effective in the treatment of anxiety and depression. Previous research suggests that both forms of treatments may work by altering cognitive biases in the processing of affective information. The current study assessed the effects of combining an SSRI with a cognitive intervention on measures of affective processing bias and resilience to external challenge. A total of 62 healthy participants were randomly assigned to receive either 7 days of citalopram (20 mg) or placebo capsules while also completing either an active or a control version of a computerized cognitive bias training task. After treatment, standard measures of affective processing bias were collected. Participants' resilience to external stress was also tested by measuring the increase in negative symptoms induced by a negative mood induction. Participants who received both citalopram and the active cognitive bias training task showed a smaller alteration in emotional memory and categorization bias than did those who received either active intervention singly. The degree to which memory for negative information was altered by citalopram predicted participants' resistance to the negative mood induction. These results suggest that co-administration of an SSRI and a cognitive training intervention can reduce the effectiveness of either treatment alone in terms of anxiety-and depression-relevant emotional processing. More generally, the findings suggest that pinpointing the cognitive actions of treatments may inform future development of combination strategies in mental health. Neuropsychopharmacology (2011) 36, 2689-2697; doi: 10.1038/npp.2011.159; published online 10 August 2011

  • 39.
    Browning, Michael
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Charles, Matthew
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Cowen, Philip J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Using Attentional Bias Modification as a Cognitive Vaccine Against Depression2012In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 72, no 7, p. 572-579Article in journal (Refereed)
    Abstract [en]

    Background: Negative attentional biases are thought to increase the risk of recurrence in depression, suggesting that reduction of such biases may be a plausible strategy in the secondary prevention of the illness. However, no previous study has tested whether reducing negative attentional bias causally affects risk factors for depressive recurrence. The current experimental medicine study reports the effects of a computerized attentional bias modification (ABM) procedure on intermediate measures of the risk of depressive recurrence (residual depressive symptoms and the cortisol awakening response) in patients with recurrent depression. Methods: Sixty-one patients with at least two previous episodes of depression who were currently in remission were randomized to receive either an active (positive) or placebo computer-based ABM regime. The ABM regime presented either pictures of faces or words. Residual depressive symptoms, measured using the Beck Depression Inventory and the cortisol awakening response were measured immediately before and after completion of the bias modification and then again after 4 weeks' follow-up. Results: Positive, face-based ABM reduced both measures of recurrence risk (Beck Depression Inventory and cortisol awakening response). This effect occurred during the month following completion of bias modification. Word-based modification did not influence the outcome measures. Conclusions: Positive face-based ABM was able to reduce intermediate measures of recurrence risk in previously depressed patients. These results suggest that ABM may provide a "cognitive vaccine" against depression and offer a useful strategy in the secondary prevention of the illness.

  • 40.
    Browning, Michael
    et al.
    Univ Oxford, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Oxford OX3 7JX, England.
    The modification of attentional bias to emotional information: A review of the techniques, mechanisms, and relevance to emotional disorders2010In: Cognitive, Affective, & Behavioral Neuroscience, ISSN 1530-7026, E-ISSN 1531-135X, Vol. 10, no 1, p. 8-20Article in journal (Refereed)
    Abstract [en]

    A negative bias in the deployment of attention to emotional stimuli is commonly found in both anxiety and depression. Recent work has highlighted that such biases are causally related to emotional vulnerability, suggesting that interventions that ameliorate them may be therapeutic. Here, we review the evidence that attentional bias can be modified using both pharmacological and psychological interventions. We highlight the behavioral and neuroimaging studies that suggest that these interventions impact upon attention via alteration of distinct neural mechanisms. Specifically, pharmacological interventions appear to influence the initial deployment of attention via an effect on the amygdala-based stimulus appraisal system, whereas psychological interventions influence attention at later time points and may alter activity in the lateral prefrontal cortex. Finally, we suggest a conceptual framework that embraces both pharmacological and psychological approaches and consider the possible implications of this work for future research and treatment development.

  • 41.
    Browning, Michael
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Murphy, Susannah E.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Lateral Prefrontal Cortex Mediates the Cognitive Modification of Attentional Bias2010In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 67, no 10, p. 919-925Article in journal (Refereed)
    Abstract [en]

    Background: A tendency to orient attention toward threatening stimuli may be involved in the etiology of anxiety disorders. In keeping with this, both psychological and pharmacological treatments of anxiety reduce this negative attentional bias. It has been hypothesized, but not proved, that psychological interventions may alter the function of prefrontal regions supervising the allocation of attentional resources. Methods: The current study examined the effects of a cognitive training regime on attention. Participants were randomly assigned to one of two training conditions: "attend-threat" training, which increases negative attentional bias, or "avoid-threat" training, which reduces it. The behavioral effects of training were assessed using a sample of 24 healthy participants. Functional magnetic resonance imaging data were collected in a further 29 healthy volunteers using a protocol that allowed the influence of both stimuli valence and attention to be discriminated. Results: Cognitive training induced the expected attentional biases in healthy volunteers. Further, the training altered lateral frontal activation to emotional stimuli, with these areas responding specifically to violations of the behavioral rules learned during training. Connectivity analysis confirmed that the identified lateral frontal regions were influencing attention as indexed by activity in visual association cortex. Conclusions: Our results indicate that frontal control over the processing of emotional stimuli may be tuned by psychological interventions in a manner predicted to regulate levels of anxiety. This directly supports the proposal that psychological interventions may influence attention via an effect on the prefrontal cortex.

  • 42.
    Burnett Heyes, Stephanie
    et al.
    Univ Oxford, Oxford OX1 2JD, England;Univ Birmingham, Birmingham B15 2TT, W Midlands, England.
    Jih, Yeou-Rong
    Univ Oxford, Oxford OX1 2JD, England.
    Block, Per
    Univ Oxford, Oxford OX1 2JD, England;Swiss Fed Inst Technol, Zurich, Switzerland.
    Hiu, Chii-Fen
    Univ Oxford, Oxford OX1 2JD, England.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, London W1N 4AL, England;Karolinska Inst, S-10401 Stockholm, Sweden.
    Lau, Jennifer Y. F.
    Univ Oxford, Oxford OX1 2JD, England;Kings Coll London, London WC2R 2LS, England.
    Relationship Reciprocation Modulates Resource Allocation in Adolescent Social Networks: Developmental Effects2015In: Child Development, ISSN 0009-3920, E-ISSN 1467-8624, Vol. 86, no 5, p. 1489-1506Article in journal (Refereed)
    Abstract [en]

    Adolescence is characterized as a period of social reorientation toward peer relationships, entailing the emergence of sophisticated social abilities. Two studies (Study 1: N=42, ages 13-17; Study 2: N=81, ages 13-16) investigated age group differences in the impact of relationship reciprocation within school-based social networks on an experimental measure of cooperation behavior. Results suggest development between mid- and late adolescence in the extent to which reciprocation of social ties predicted resource allocation. With increasing age group, investment decisions increasingly reflected the degree to which peers reciprocated feelings of friendship. This result may reflect social-cognitive development, which could facilitate the ability to navigate an increasingly complex social world in adolescence and promote positive and enduring relationships into adulthood.

  • 43. Clark, I A
    et al.
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Woolrich, M W
    Mackay, C E
    Intrusive memories to traumatic footage: the neural basis of their encoding and involuntary recall.2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 3, p. 505-18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A hallmark symptom after psychological trauma is the presence of intrusive memories. It is unclear why only some moments of trauma become intrusive, and how these memories involuntarily return to mind. Understanding the neural mechanisms involved in the encoding and involuntary recall of intrusive memories may elucidate these questions.

    METHOD: Participants (n = 35) underwent functional magnetic resonance imaging (fMRI) while being exposed to traumatic film footage. After film viewing, participants indicated within the scanner, while undergoing fMRI, if they experienced an intrusive memory of the film. Further intrusive memories in daily life were recorded for 7 days. After 7 days, participants completed a recognition memory test. Intrusive memory encoding was captured by comparing activity at the time of viewing 'Intrusive scenes' (scenes recalled involuntarily), 'Control scenes' (scenes never recalled involuntarily) and 'Potential scenes' (scenes recalled involuntarily by others but not that individual). Signal change associated with intrusive memory involuntary recall was modelled using finite impulse response basis functions.

    RESULTS: We found a widespread pattern of increased activation for Intrusive v. both Potential and Control scenes at encoding. The left inferior frontal gyrus and middle temporal gyrus showed increased activity in Intrusive scenes compared with Potential scenes, but not in Intrusive scenes compared with Control scenes. This pattern of activation persisted when taking recognition memory performance into account. Intrusive memory involuntary recall was characterized by activity in frontal regions, notably the left inferior frontal gyrus.

    CONCLUSIONS: The left inferior frontal gyrus may be implicated in both the encoding and involuntary recall of intrusive memories.

  • 44.
    Clark, I. A.
    et al.
    UCL, Wellcome Trust Ctr Neuroimaging, Inst Neurol, 12 Queen Sq, London WC1N 3BG, England.
    MacKay, C. E.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7NG, England.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, 15 Chaucer Rd, Cambridge CB2 7EF, England;Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden.
    Bourne, C.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7NG, England;Newman Univ, Dept Psychol & Counselling, Birmingham B32 3NT, W Midlands, England.
    A reply - acknowledged reasonable limitations in a secondary analysis but key conclusions remain in 'The neural basis of flashback formation: the impact of viewing trauma'2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 8, p. 1787-1789Article in journal (Other academic)
  • 45.
    Clark, Ian A.
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX3 7NG, England.
    Mackay, Clare E.
    Univ Oxford, Dept Psychiat, Oxford OX3 7NG, England.
    Holmes, Emily A.
    Med Res Council Cognit & Brain Sci Unit, Cambridge, England.
    Low emotional response to traumatic footage is associated with an absence of analogue flashbacks: An individual participant data meta-analysis of 16 trauma film paradigm experiments2015In: Cognition & Emotion, ISSN 0269-9931, E-ISSN 1464-0600, Vol. 29, no 4, p. 702-713Article in journal (Refereed)
    Abstract [en]

    Most people will experience or witness a traumatic event. A common occurrence after trauma is the experience of involuntary emotional memories of the traumatic event, herewith "flashbacks". Some individuals, however, report no flashbacks. Prospective work investigating psychological factors associated with an absence of flashbacks is lacking. We performed an individual participant data meta-analysis on 16 experiments (n = 458) using the trauma film paradigm to investigate the association of emotional response to traumatic film footage and commonly collected baseline characteristics (trait anxiety, current depression, trauma history) with an absence of analogue flashbacks. An absence of analogue flashbacks was associated with low emotional response to the traumatic film footage and, to a lesser extent, low trait anxiety and low current depression levels. Trauma history and recognition memory for the film were not significantly associated with an absence of analogue flashbacks. Understanding why some individuals report an absence of flashbacks may aid preventative treatments against flashback development.

  • 46.
    Clark, Ian A.
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Mackay, Clare E.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England;MRC, Cognit & Brain Sci Unit, Cambridge, England.
    Positive involuntary autobiographical memories: You first have to live them2013In: Consciousness and Cognition, ISSN 1053-8100, E-ISSN 1090-2376, Vol. 22, no 2, p. 402-406Article in journal (Refereed)
    Abstract [en]

    Involuntary autobiographical memories (IAMs) are typically discussed in the context of negative memories such as trauma 'flashbacks'. However, IAMs occur frequently in everyday life and are predominantly positive. In spite of this, surprisingly little is known about how such positive IAMs arise. The trauma film paradigm is often used to generate negative IAMs. Recently an equivalent positive film was developed inducing positive IAMs (Davies, Malik, Pictet, Blackwell, & Holmes, 2012). The current study is the first to investigate which variables (emotional reaction to the film; recognition memory of the film; participant characteristics) would best predict the frequency of positive IAMs. Higher levels of positive mood change to the film were significantly associated with the number of positive IAMs recorded in the subsequent week. Results demonstrate the importance of positive emotional reaction at the time of an event for subsequent positive IAMs. (C) 2013 Elsevier Inc. All rights reserved.

  • 47.
    Clark, Ian A.
    et al.
    Univ Oxford, Warneford Hosp, Univ Dept Psychiat, Oxford OX1 2JD, England.
    Niehaus, Katherine E.
    Univ Oxford, Inst Biomed Engn, Dept Engn Sci, Oxford OX1 2JD, England.
    Duff, Eugene P.
    Univ Oxford, FMRIB Ctr, Nuffield Dept Clin Neurosci, John Radcliffe Hosp, Oxford OX1 2JD, England.
    Di Simplicio, Martina C.
    MRC, Cognit & Brain Sci Unit, Cambridge CB2 7EF, England.
    Clifford, Gari D.
    Univ Oxford, Inst Biomed Engn, Dept Engn Sci, Oxford OX1 2JD, England.
    Smith, Stephen M.
    Univ Oxford, FMRIB Ctr, Nuffield Dept Clin Neurosci, John Radcliffe Hosp, Oxford OX1 2JD, England.
    Mackay, Clare E.
    Univ Oxford, Warneford Hosp, Univ Dept Psychiat, Oxford OX1 2JD, England.
    Woolrich, Mark W.
    Univ Oxford, Dept Psychiat, Warneford Hosp, Oxford Ctr Human Brain Act OHBA, Oxford OX1 2JD, England.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, Cambridge CB2 7EF, England;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    First steps in using machine learning on fMRI data to predict intrusive memories of traumatic film footage2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 62, p. 37-46Article in journal (Refereed)
    Abstract [en]

    After psychological trauma, why do some only some parts of the traumatic event return as intrusive memories while others do not? Intrusive memories are key to cognitive behavioural treatment for post-traumatic stress disorder, and an aetiological understanding is warranted. We present here analyses using multivariate pattern analysis (MVPA) and a machine learning classifier to investigate whether peri-traumatic brain activation was able to predict later intrusive memories (i.e. before they had happened). To provide a methodological basis for understanding the context of the current results, we first show how functional magnetic resonance imaging (fMRI) during an experimental analogue of trauma (a trauma film) via a prospective event-related design was able to capture an individual's later intrusive memories. Results showed widespread increases in brain activation at encoding when viewing a scene in the scanner that would later return as an intrusive memory in the real world. These fMRI results were replicated in a second study. While traditional mass univariate regression analysis highlighted an association between brain processing and symptomatology, this is not the same as prediction. Using MVPA and a machine learning classifier, it was possible to predict later intrusive memories across participants with 68% accuracy, and within a participant with 97% accuracy; i.e. the classifier could identify out of multiple scenes those that would later return as an intrusive memory. We also report here brain networks key in intrusive memory prediction. MVPA opens the possibility of decoding brain activity to reconstruct idiosyncratic cognitive events with relevance to understanding and predicting mental health symptoms. (C) 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).

  • 48.
    Clarke, Patrick J. F.
    et al.
    Univ Western Australia, Sch Psychol, Nedlands, WA 6009, Australia.
    Nanthakumar, Shenooka
    Univ Western Australia, Sch Psychol, Nedlands, WA 6009, Australia.
    Notebaert, Lies
    Univ Western Australia, Sch Psychol, Nedlands, WA 6009, Australia.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, Cambridge, England.
    Blackwell, Simon E.
    MRC, Cognit & Brain Sci Unit, Cambridge, England.
    MacLeod, Colin
    Univ Western Australia, Sch Psychol, Nedlands, WA 6009, Australia;Univ Babes Bolyai, Sch Psychol, R-3400 Cluj Napoca, Romania.
    Simply Imagining Sunshine, Lollipops and Rainbows Will Not Budge the Bias: The Role of Ambiguity in Interpretive Bias Modification2014In: Cognitive Therapy and Research, ISSN 0147-5916, E-ISSN 1573-2819, Vol. 38, no 2, p. 120-131Article in journal (Refereed)
    Abstract [en]

    Imagery-based interpretive bias modification (CBM-I) involves repeatedly imagining scenarios that are initially ambiguous before being resolved as either positive or negative in the last word/s. While the presence of such ambiguity is assumed to be important to achieve change in selective interpretation, it is also possible that the act of repeatedly imagining positive or negative events could produce such change in the absence of ambiguity. The present study sought to examine whether the ambiguity in imagery-based CBM-I is necessary to elicit change in interpretive bias, or, if the emotional content of the imagined scenarios is sufficient to produce such change. An imagery-based CBM-I task was delivered to participants in one of four conditions, where the valence of imagined scenarios were either positive or negative, and the ambiguity of the scenario was either present (until the last word/s) or the ambiguity was absent (emotional valence was evident from the start). Results indicate that only those who received scenarios in which the ambiguity was present acquired an interpretive bias consistent with the emotional valence of the scenarios, suggesting that the act of imagining positive or negative events will only influence patterns of interpretation when the emotional ambiguity is a consistent feature.

  • 49.
    Cortina, Melissa A.
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England;Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Wits Educ Campus,27 St Andrews Rd, ZA-2193 Parktown, South Africa;UCL, EBPU, CAMHS, 4-8 Rodney St, London N1 9JH, England;Anna Freud Ctr, 4-8 Rodney St, London N1 9JH, England.
    Stein, Alan
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England;Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Wits Educ Campus,27 St Andrews Rd, ZA-2193 Parktown, South Africa.
    Kahn, Kathleen
    Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Wits Educ Campus,27 St Andrews Rd, ZA-2193 Parktown, South Africa;Umea Univ, Ctr Global Hlth Res, S-90187 Umea, Sweden.
    Hlungwani, Tintswalo Mercy
    Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, Wits Educ Campus,27 St Andrews Rd, ZA-2193 Parktown, South Africa.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge, England.
    Fazel, Mina
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Cognitive styles and psychological functioning in rural South African school students: Understanding influences for risk and resilience in the face of chronic adversity2016In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 49, p. 38-46Article in journal (Refereed)
    Abstract [en]

    Adverse childhood experiences can show lasting effects on physical and mental health. Major questions surround how children overcome adverse circumstances to prevent negative outcomes. A key factor determining resilience is likely to be cognitive interpretation (how children interpret the world around them). The cognitive interpretations of 1025 school children aged 10-12 years in a rural, socioeconomically disadvantaged area of South Africa were examined using the Cognitive Triad Inventory for Children (CTI-C). These were examined in relation to psychological functioning and perceptions of the school environment. Those with more positive cognitive interpretations had better psychological functioning on scales of depression, anxiety, somatization and sequelae of potentially traumatic events. Children with more negative cognitions viewed the school-environment more negatively. Children living in poverty in rural South Africa experience considerable adversity and those with negative cognitions are at risk for psychological problems. Targeting children's cognitive interpretations may be a possible area for intervention. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of The Foundation for Professionals in Services for Adolescents.

  • 50.
    Crane, Catherine
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Shah, Dhruvi
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Barnhofer, Thorsten
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Suicidal imagery in a previously depressed community sample2012In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 19, no 1, p. 57-69Article in journal (Refereed)
    Abstract [en]

    This study sought to replicate previous findings of vivid suicide-related imagery in previously suicidal patients in a community sample of adults with a history of depression. Twenty-seven participants were interviewed regarding suicidal imagery. Seventeen participants reported prior suicidal ideation or behaviour in the clinical assessment, and the vast majority of these also reported experiencing suicide-related imagery when at their most depressed and despairing, in many cases in the form of flash-forwards to imagined future suicidal acts. Interestingly, five of the 10 participants who did not report suicidal ideation or behaviour in the clinical interview also described prominent imagery related to themes of death and suicide, but in several cases, these images were associated with meanings that seemed to act to reduce the likelihood of subsequent suicidal acts. Severity of prior suicidality was associated with lower levels of imagery-related distress and higher levels of imagery-related comfort. These findings support the idea that suicide-related imagery is an important component in the phenomenology of depression and despair and hint at potentially important differences in the meaning associated with such imagery between those individuals who report experiencing suicidal ideation or behaviour when depressed and those who do not. The findings are consistent with Joiner's model of acquired capability for suicide through habituation to pain and fear of suicide and suggest that it may be useful to tackle such imagery directly in the treatment of suicidal patients. Copyright (C) 2011 John Wiley & Sons, Ltd.

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