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Background Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here, we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the activity planning group (traditional BA), the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The activity engagement group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls. Method This study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs waitlist controls. Adults (≥ 18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation and sense of control over one’s life. Ethics and dissemination The trial has been approved by the Health Research Authority of the NHS in the UK (East of England—Cambridge Central, REF 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations and social media. Trial registration ClinicalTrials.gov, NCT03874650 pre-results. Protocol version 2.1, March 5, 2019

OBJECTIVE: To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). PARTICIPANTS: There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total). DESIGN: Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory. MAIN MEASURES: Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months. RESULTS: The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001). CONCLUSION: This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.

We select and execute extended task episodes (‘make tea’) as one entity and not individually execute their very many components (find kettle, boil water, etc.). Such hierarchical execution is thought to occur in familiar task situations with pre-existing task episode-related scripts that once selected, control the identity and sequence of component steps. Here, in contrast, we show hierarchical execution of extended behavior in situations, where the identity and sequence of component steps were unknown and a predetermined script could not have existed. Participants performed a rule-switching task in which the rule to be applied on each trial could not be predicted. Crucially, they were biased into construing a recurring instance of three or five trials as a single task episode. Behavioral signs of hierarchical execution, identical to those seen during memorized task-sequence executions, were present. These included longer reaction time on the first trial of each episode that was proportionate to the length of that episode, and absence of rule switch costs only between those consecutive trials that crossed episode boundaries. Hierarchical execution thus occurs every time the to-be-executed behavior is construed as one task episode, and is not limited to predictable sequences. We suggest that hierarchical execution occurs because task episodes are controlled and executed through goal-related entities assembled at the beginning of execution that subsume the execution and instantiate purposive control across time until the goal is complete.

Objectives Depression, which is common following acquired brain injury (ABI), has been shown to predict cognitive impairment, rehabilitation outcome, and quality of life. Whilst many studies have examined links between depression and cognitive-affective processing in the non-ABI population, their applicability to this important clinical group, where cognitive difficulties can be marked, remains unknown. Here, we investigated biases in prospective cognition, which is known to be disrupted in (non-ABI) depression yet important for well-being. Design Cross-sectional design with three groups (depressed ABI, non-depressed ABI, and non-ABI control participants). Continuous data were additionally analysed in correlation analyses. Methods Individuals with ABI varying in extent of self-reported depression and matched non-ABI control participants completed assessments of mood and prospective cognition (anticipating and imagining future events), alongside background tests of executive function and fluid intelligence. Results Relative to non-depressed ABI and control participants, depressed ABI individuals demonstrated a reduced positive bias in prospective cognition: whereas non-depressed ABI and control participants generated more examples of likely or possible positive versus negative future events, there was no evidence for such a positive bias in depressed ABI participants. Non-depressed ABI and control participants also reported more vivid mental imagery for positive versus negative future scenarios, whereas such a pattern was not evident in depressed ABI participants. This pattern emerged despite background impairments in fluid intelligence and executive function associated with ABI. Conclusions These findings (1) elucidate depression-linked cognitive-affective processes following ABI, where cognitive difficulties are common, and (2) highlight psychological processes associated with depression that are common to ABI and non-ABI populations. Practitioner points Clinical implications A relative negative bias in future-directed cognition is associated with depressed mood in individuals with chronic ABI. Such processes may contribute to the onset and maintenance of depression following ABI. These findings suggest it may be important to consider a role for prospective cognition in psychological interventions for depression following ABI. Limitations of the study The extent to which depressed mood following ABI is associated with biases in other cognitive domains remains unclear. Whether similar patterns would be observed in acute patients with more profound cognitive difficulties requires further investigation. Despite large effect sizes, our sample size is modest; these effects thus require replication in larger groups.

BackgroundGoal neglect refers to a dissociation between intended and actual action. Although commonly associated with frontal brain damage, this phenomenon is also characteristic of clinical depression. To date, tests of goal neglect typically require individuals to switch between subtasks populated with neutral stimuli. This study examined the impact of affective and personally salient stimulus contexts on goal neglect in clinical depression.MethodsParticipants were randomly allocated to either positively or negatively-valenced versions of the Affective Six Elements Test (A-SET). We hypothesised that depressed individuals (n= 30) would exhibit an overall impairment in A-SET performance by neglecting entire subtasks and allocating suboptimal time to each task, relative to never-depressed peers (n= 30), with effects being strongest for the negatively-valenced version.ResultsFindings showed that depressed individuals exhibited specific deficits, relative to controls on these measures in the negative A-SET only, with a magnitude comparable to that found in brain injured patients.ConclusionsIndividuals with depression are impaired in their ability to monitor performance and implement strategies that are optimal for the purpose of pursuing an overarching goal when the task context is negatively-valenced. Potential mechanisms are discussed.

PUBLISHED, Action errors can occur when routine responses are triggered inappropriately by familiar cues. Here, EEG was recorded as volunteers performed a ?go/no-go? task of long duration that occasionally and unexpectedly required them to withhold a frequent, routine response. EEG components locked to the onset of relevant go trials were sorted according to whether participants erroneously responded to immediately subsequent no-go trials or correctly withheld their responses. Errors were associated with a significant relative reduction in the amplitude of the preceding P300, that is, a judgement could be made bout whether a responseinhibition error was likely before it had actually occurred. Furthermore, fluctuations in P300 amplitude across the task formed a reliable associate of individual error propensity, supporting its use as a marker of sustained control over action., MRC, NIH

Facilitating engagement in rewarding activities is a key treatment target in depression. Mental imagery can increase engagement in planned behaviours, potentially due to its special role in representing emotionally salient experiences. The present study tested the hypothesis that mental imagery promotes motivation and engagement when planning pleasant and rewarding activities. Participants were recruited from a community volunteer panel (N = 72). They self-nominated six activities to complete over the following week, and were randomized to either: a) a single-session Motivational Imagery condition (N = 24); b) an Activity Reminder control condition (N = 24); or c) a No-Reminder control condition (N = 24). As predicted, relative to control groups, the Motivational Imagery group reported higher levels of motivation, anticipated pleasure, and anticipated reward for the planned activities. The Motivational Imagery group also completed significantly more activities than the Activity Reminder group, but not more than the No-Reminder group. Relevance of results to behavioural activation approaches for depression are discussed., Highlights • Mental imagery of planned activities increases motivation to engage in them. • Higher imagery vividness is associated with higher anticipated reward. • Mental imagery of planned activities is associated with higher activity completion.