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Input-matching is a key mechanism by which animals optimally distribute themselves across habitats to maximize net gains based on the changing input values of food supply rate and competition. To examine the neural systems that underlie this rule in humans, we created a continuous-input foraging task where subjects had to decide to stay or switch between two habitats presented on the left and right of the screen. The subject's decision to stay or switch was based on changing input values of reward-token supply rate and competition density. High density of competition or low-reward token rate was associated with decreased chance of winning. Therefore, subjects attempted to maximize their gains by switching to habitats that possessed low competition density and higher token rate. When it was increasingly disadvantageous to be in a habitat, we observed increased activity in brain regions that underlie preparatory motor actions, including the dorsal anterior cingulate cortex and the supplementary motor area, as well as the insula, which we speculate may be involved in the conscious urge to switch habitats. Conversely, being in an advantageous habitat is associated with activity in the reward systems, namely the striatum and medial prefrontal cortex. Moreover, amygdala and dorsal putamen activity steered interindividual preferences in competition avoidance and pursuing reward. Our results suggest that input-matching decisions are made as a net function of activity in a distributed set of neural systems. Furthermore, we speculate that switching behaviors are related to individual differences in competition avoidance and reward drive.

Avoidance is a key maintenance factor in traumatic reactions but currently no satisfactory measures of it exist. Previous factor analytic studies have demonstrated a distinction between conscious a...

Alexithymia, a sub-clinical personality construct associated with disturbances in affect regulation and social functioning, is known to be comorbid with a number of psychiatric conditions. We combined a distressing real-time altruism task with functional magnetic resonance imagining to explore the brain behaviour relationship between alexithymia and prosocial action. Here we show that individuals high on the alexithymia spectrum report less distress at seeing others in pain and behave less altruistically. This behavioural result is mirrored in the brain, where individuals who have difficulty recognizing and experiencing others' emotional distress have reduced neural activation within the anterior insula and temporoparietal junction, key regions in the experience of distress and perspective-taking.

Social interaction inherently involves the subjective evaluation of cues salient to social inclusion and exclusion. Testifying to the importance of such social cues, parts of the neural system dedicated to the detection of physical pain, the dorsal anterior cingulate cortex (dACC) and anterior insula (AI), have been shown to be equally sensitive to the detection of social pain experienced after social exclusion. However, recent work suggests that this dACC-AI matrix may index any socially pertinent information. We directly tested the hypothesis that the dACC-AI would respond to cues of both inclusion and exclusion, using a novel social feedback fMRI paradigm in a population-derived sample of adolescents. We show that the dACC and left AI are commonly activated by feedback cues of inclusion and exclusion. Our findings suggest that theoretical accounts of the dACC-AI network as a neural alarm system restricted within the social domain to the processing of signals of exclusion require significant revision.

Depression impairs the ability to retrieve positive, self-affirming autobiographical memories. To counteract this difficulty, we trained individuals with depression, either in episode or remission, to construct an accessible mental repository for a preselected set of positive, self-affirming memories using an ancient mnemonic technique—the method-of-loci (MoL). Participants in a comparison condition underwent a similar training protocol where they chunked the memories into meaningful sets and rehearsed them (rehearsal). Both protocols enhanced memory recollection to near ceiling levels after 1 week of training. However, on a surprise follow-up recall test a further week later, recollection was maintained only in the MoL condition, relative to a significant decrease in memories recalled in the rehearsal group. There were no significant performance differences between those currently in episode and those in remission. The results support use of the MoL as a tool to facilitate access to self-affirming memories in those with depression.

Four studies examined the relationship between mindfulness and interoception (measured via cardiac per- ception). Studies 1 and 2 compared participants undergoing week long practice (15 m daily) of an audiotaped body-scan, relative to a sound-scan and no-intervention control condi- tion (n=20 per group). No significant differences in change in cardiac perception accuracy, confidence in cardiac accu- racy judgements or the correlation between them (coherence) were found between conditions. Study 3 used an open design to examine the effects of a more intensive meditation training (com pleting an 8-week MBSR or MBCT course; n=19). Cardiac perception accuracy and coherence did not improve, but participants became signif- icantly more confident. Study 4 examined the relationship between cardiac perception and trait mindfulness (n=165). Trait mindfulness did not relate to cardiac perception accu- racy, but more mindful individuals were more confident. Mindful observation was associated with reduced, whereas other components of mindfulness predicted superior, coher- ence. These findings suggest that mindfulness practice does not simply work by improving cardiac perception accuracy but does increase confidence. However, it remains possible that mindfulness increases perceptual accuracy of other bodily systems, which needs to be explored using a wider array of experimental measures (e.g. respiratory awareness) in future research.

Summary Background Persistent moderate or severe unipolar depression is common and expensive to treat. Clinical guidelines recommend combined pharmacotherapy and psychotherapy. Such treatments can take up to 1 year to show an effect, but no trials of suitable duration have been done. We investigated the efficacy and cost-effectiveness of outpatient-based, specialist depression services (SDS) versus treatment as usual (TAU) on depression symptoms and function. Methods We did a multicentre, single-blind, patient-level, parallel, randomised controlled trial (RCT), as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) study, in three mental health outpatient settings in England. Eligible participants were in secondary care, were older than 18 years, had unipolar depression (with a current major depressive episode, a 17-item Hamilton Depression Rating Scale [HDRS 17 ] score of ≥16, and a Global Assessment of Function [GAF] score of ≤60), and had not responded to 6 months or more of treatment for depression. Randomisation was stratified by site with allocation conveyed to a trial administrator, with research assessors masked to outcome. Patients were randomised (1:1) using a computer-generated pseudo-random code with random permuted blocks of varying sizes of two, four, or six to either SDS (collaborative care approach between psychiatrists and cognitive behavioural therapists for 12 months, followed by graduated transfer of care up to 15 months) or to the TAU group. Intention-to-treat primary outcome measures were changes in HDRS 17 and GAF scores between baseline and 6, 12, and 18 months' follow-up. We will separately publish follow-up outcomes for months 24 and 36. Clinical efficacy and cost-effectiveness were examined from health and social care persp ectives at 18 months, as recommended by the National Institute for Health and Care Excellence. This trial is registered at ClinicalTrials.gov (NCT01047124) and the ISRCTN registry (ISRCTN10963342); the trial has ended. Findings 307 patients were assessed for eligibility between Dec 21, 2009, and Oct 31, 2012. 94 patients were assigned to TAU and 93 patients to SDS, and were included in intention-to-treat analyses. The changes from baseline to 6 months in HDRS 17 and GAF scores did not significantly differ between treatment groups (mean change difference in HDRS 17 score −1·01 [95% CI −3·30 to 1·28], p=0·385; and in GAF score 1·33 [–2·92 to 5·57], p=0·538). Primary outcome data were available for 134 (72%) patients at 12 months. We noted no differences at 12 months' follow-up between SDS and TAU for mean HDRS 17 score (14·8 [SD 7·9] in the SDS group vs 17·2 [7·3] in the TAU group, p=0·056) or GAF score (60·4 [11·7] vs 55·8 [12·7], p=0·064), and the changes from baseline to 12 months in HDRS 17 and GAF scores did not significantly differ between treatment groups (mean change difference in HDRS 17 score −2·45 [95% CI −5·04 to 0·14], p=0·064; and in GAF score 4·12 [–0·11 to 8·35], p=0·056). The mean change in HDRS 17 score from baseline to 18 months was significantly improved in the SDS group compared with the TAU group (13·6 [SD 8·8] in the SDS group vs 16·1 [6·6] in the TAU group; mean change difference −2·96 [95% CI −5·33 to −0·59], p=0·015), but the GAF scores showed no significant differences between the groups (61·2 [SD 13·0] vs 57·7 [11·9]; mean change difference 3·82 [–9·3 to 8·57], p=0·113). We reported no deaths, but one (1%) patient was admitted to hospital for myocardial infarction, and three episodes of self-harm were reported in three (2%) patients (two receiving TAU, one receiving SDS care). The incremental cost-effectiveness ratio of SDS versus TAU was £43 603 per quality-adjusted life-year. Interpretation Compared with usual specialist mental health secondary care, SDS might improve depression symptoms for patients with persistent moderate to severe depression, but functional outcomes and economic benefits are equivocal. Funding National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, UK Medical Research Council, Nottinghamshire Healthcare NHS Foundation Trust, Derbyshire Healthcare NHS Foundation Trust, Cambridgeshire and Peterborough NHS Foundation Trust, University of Nottingham.

Moral perceptions of harm and fairness are instrumental in guiding how an individual navigates moral challenges. Classic research documents that the gender of a target can affect how people deploy these perceptions of harm and fairness. Across multiple studies, we explore the effect of an individual’s moral orientations (their considerations of harm and justice) and a target’s gender on altruistic behavior. Results reveal that a target’s gender can bias one’s readiness to engage in harmful actions and that a decider’s considerations of harm—but not fairness concerns—modulate costly altruism. Together, these data illustrate that moral choices are conditional on the social nature of the moral dyad: Even under the same moral constraints, a target’s gender and a decider’s gender can shift an individual’s choice to be more or less altruistic, suggesting that gender bias and harm considerations play a significant role in moral cognition.

Survivors of psychological trauma are frequently troubled by intrusive recollection of the traumatic event. We describe research showing that attempts to suppress such trauma memories can be associated with paradoxically enhanced remembering of the trauma, enhanced access to other negative personal material, and a lack of specificity in the recollection of the personal past. This suggests that attempted suppression is generally a counterproductive approach to the regulation of traumatic memories in distressed trauma survivors. Working with trauma memories, rather than suppressing them, is more adaptive. Copyright © 2008 Association for Psychological Science.

Background Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. We need to develop psychological therapies that prevent depressive relapse/recurrence. A recently developed treatment, Mindfulness-based Cognitive Therapy (MBCT, see http://www.mbct.co.uk) shows potential as a brief group programme for people with recurring depression. In two studies it has been shown to halve the rates of depression recurring compared to usual care. This trial asks the policy research question, is MBCT superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and, secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? An explanatory research question asks is an increase in mindfulness skills the key mechanism of change? Methods/Design The design is a single blind, parallel RCT examining MBCT vs. m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT plus ADM-tapering with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Depressive relapse/recurrence over two years is the primary outcome variable. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre/post-treatment and a qualitative study of service users' views and experiences. Discussion If the results of our exploratory trial are extended to this definitive trial, MBCT will be established as an alternative approach to maintenance anti-depressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. Trial registration number ISRCTN26666654

Background and objectives Involuntary autobiographical memories that spring unbidden into conscious awareness form part of everyday experience. In psychopathology, involuntary memories can be associated with significant distress. However, the cognitive mechanisms associated with the development of involuntary memories require further investigation and understanding. Since involuntary autobiographical memories are image-based, we tested predictions that visuospatial (but not other) established cognitive tasks could disrupt their consolidation when completed post-encoding. Methods In Experiment 1, participants watched a stressful film then immediately completed a visuospatial task (complex pattern tapping), a control-task (verbal task) or no-task. Involuntary memories of the film were recorded for 1-week. In Experiment 2, the cognitive tasks were administered 30-min post-film. Results Compared to both control and no-task conditions, completing a visuospatial task post-film reduced the frequency of later involuntary memories (Expts 1 and 2) but did not affect voluntary memory performance on a recognition task (Expt 2). Limitations Voluntary memory was assessed using a verbal recognition task and a broader range of memory tasks could be used. The relative difficulty of the cognitive tasks used was not directly established. Conclusions An established visuospatial task after encoding of a stressful experience selectively interferes with sensory-perceptual information processing and may therefore prevent the development of involuntary autobiographical memories., Highlights ► Involuntary memories present a transdiagnostic treatment target. ► Completing cognitive tasks after a stressful event may reduce involuntary memories. ► The visuospatial nature of the cognitive task may be critical in modulating effects.

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

Autobiographical memory retrieval is fundamental to the developing self-concept in adolescence, to emotion regulation, and to social problem solving and has been shown to be compromised in adolescents diagnosed with depression (R. J. Park, I. M. Goodyer, and J. D. Teasdale, 2002). The authors of the present study assessed autobiographical memory overgenerality in a sample of depressed adolescent participants with, versus without, a reported history of trauma and never-depressed control participants by using an emotion word-cueing paradigm. The authors' analyses showed for the first time that adolescents with major depression and with no reported history of trauma exhibited an overgeneral memory bias. They also revealed that depressed adolescents who reported a history of trauma retrieved fewer overgeneral memories than did depressed adolescents who reported no history of trauma. Among depressed adolescents who reported a history of trauma, more severe posttraumatic stress symptoms were associated with less overgenerality. Possible accounts of these findings are suggested.

Objective: Computerized cognitive behavioral therapy (cCBT) and cognitive bias modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other has not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. Method: Sixty-three primarily Caucasian adults (mean age = 22.7, SD = 5.87; 68.3% female) with high social anxiety, randomly allocated to 3 groups: CBM-I (n = 21), cCBT (n = 21), and a no-intervention control group (n = 21) provided complete data for analysis. Pre- and postintervention (4 sessions lasting 2 weeks, control participants only attended the pre–post sessions) self-report measures of anxiety, depression, attentional control, and threat-related interpretive bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using the Scrambled Sentences Test. Results: Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety, and depression and improved attentional control, relative to the control group, with no clear superiority of either active intervention. Although both active conditions reduced negative bias on the Scrambled Sentences Test completed under mental load, CBM-I was significantly more effective at doing so. Conclusions: The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load.

The objective of this study was to investigate the efficacy of memory specificity training (MEST) on autobiographical memory recall and depression. Afghan adolescents with depression were randomly assigned to a MEST group or to a control group. At baseline, both groups completed Persian versions of the Autobiographical Memory Test (AMT) and the Mood and Feelings Questionnaire (MFQ). The MEST group then had five weekly group sessions of MEST. The control group had no additional contact. The AMT and MFQ were then readministered to all participants, and the MFQ was readministered at 2-month follow-up. The MEST group retrieved a higher proportion of specific memories following training and had lower levels of depression at 2-month follow-up than did the control group. Change in memory specificity predicted follow-up depression over and above baseline depression and mediated the relationship between receipt of MEST and reduction in later depression. The results suggest that MEST can improve autobiographical memory performance and drive subsequent reduction in depression symptoms.

Highlights ► We show people are unable to appropriately judge outcomes of moral behaviour. ► Moral beliefs have weaker impact when there is a presence of significant self-gain. ► People make highly self-serving choices in real moral situations. ► Real moral choices contradict responses to simple hypothetical moral probes. ► Enhancing context can cause hypothetical decisions to mirror real moral decisions., Moral ideals are strongly ingrained within society and individuals alike, but actual moral choices are profoundly influenced by tangible rewards and consequences. Across two studies we show that real moral decisions can dramatically contradict moral choices made in hypothetical scenarios (Study 1). However, by systematically enhancing the contextual information available to subjects when addressing a hypothetical moral problem—thereby reducing the opportunity for mental simulation—we were able to incrementally bring subjects’ responses in line with their moral behaviour in real situations (Study 2). These results imply that previous work relying mainly on decontextualized hypothetical scenarios may not accurately reflect moral decisions in everyday life. The findings also shed light on contextual factors that can alter how moral decisions are made, such as the salience of a personal gain.

Objective Complicated grief (CG) has been proposed as a psychiatric response to bereavement distinct from established mood and anxiety disorder diagnoses. Little is known about the nature of cognitive-affective processing in CG, nor any similarities or differences compared with the processing profiles associated with other emotional disorders. Three studies therefore investigated 3 broad facets of negative self-processing associated with either elevated symptoms of, or diagnosis of, CG--namely, self-related attributions or blame, self-devaluation, and cognitions about the future self. Method These self-processing domains were assessed using a variety of self-report and scenario-based measures either linked specifically to the bereavement or more general in their focus. Study 1 used a correlational design in a community bereaved sample. Study 2 employed an extreme-groups approach looking at individuals high versus low in CG symptoms, and Study 3 compared those with a CG diagnosis to healthy bereaved controls. Results The data revealed a profile of processing in CG characterized by significant relationships between CG symptoms or diagnosis and both self-devaluation and negative self-related cognitions about the future, but the data provided no support for a similar relationship with negative self-related attributions. Conclusions These findings extend our understanding of self-related cognitive processing in CG. They also suggest that CG is characterized by a cognitive-affective processing profile that is distinct from that associated with other disorders, notably major depression, in the literature. This has potential implications for the psychological treatment of CG and for its nosological status as a post-loss syndrome distinct from depression.

Participants with a lifetime history of posttraumatic stress disorder (PTSD) and trauma-exposed controls with no PTSD history completed an emotional working memory capacity (eWMC) task. The task required them to remember lists of neutral words over short intervals while simultaneously processing sentences describing dysfunctional trauma-related thoughts (relative to neutral control sentences). The task was designed to operationalise an everyday cognitive challenge for those with mental health problems such as PTSD; namely, the ability to carry out simple, routine tasks with emotionally benign material, while at the same time tackling emotional laden intrusive thoughts and feelings. eWMC performance, indexed as the ability to remember the word lists in the context of trauma sentences, relative to neutral sentences, was poorer overall in the PTSD group compared with controls, suggestive of a particular difficulty employing working memory in emotion-related contexts in those with a history of PTSD. The possible implications for developing affective working memory training as an adjunctive treatment for PTSD are explored., Highlights ► We developed a task to measure working memory capacity in emotional contexts. ► Participants with PTSD showed relatively impaired capacity in emotional contexts. ► Executive deficits in PTSD seem to manifest differently across contexts.

This study assessed the organization of past autobiographical knowledge in individuals with either current major depressive disorder (MDD), MDD in remission, or no history of MDD (the control group). Participants generated personal lists of "life chapters," dividing both their past and potential future into subjectively meaningful episodes or themes (e.g., "married life"). They were then given a list of potentially chapter-descriptive positive or negative attributes and sorted them according to the different chapters. Results revealed that, relative to the control group, MDD participants selected more negative attributes overall, showed greater redundancy for negative attributes (i.e., using the same ones repeatedly across chapters) and reduced redundancy for positive attributes, and exhibited greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters). A similar pattern emerged for the remitted MDD group relative to controls, with the exception of negative redundancy, which was not elevated. For future chapters, there were no group differences. Finally, a greater number of past depressive episodes was associated with increasingly reduced positive redundancy. These data reveal a "depressogenic" structuring of past (but not future) knowledge in MDD that is also evident in a remitted MDD group, with the exception of negative redundancy, which appears to be a marker of the acute state. These findings shed light on important aspects of the organization of past knowledge that are likely to be linked to maladaptive processing biases in those with a depression history.

Theories proposing that how one thinks and feels is influenced by feedback from the body remain controversial. A central but untested prediction of many of these proposals is that how well individuals can perceive subtle bodily changes (interoception) determines the strength of the relationship between bodily reactions and cognitive-affective processing. In Study 1, we demonstrated that the more accurately participants could track their heartbeat, the stronger the observed link between their heart rate reactions and their subjective arousal (but not valence) ratings of emotional images. In Study 2, we found that increasing interoception ability either helped or hindered adaptive intuitive decision making, depending on whether the anticipatory bodily signals generated favored advantageous or disadvantageous choices. These findings identify both the generation and the perception of bodily responses as pivotal sources of variability in emotion experience and intuition, and offer strong supporting evidence for bodily feedback theories, suggesting that cognitive-affective processing does in significant part relate to “following the heart.”

Background: There is increasing theoretical, clinical and research evidence for the role of trauma memory in the aetiology of acute pathological stress responses in adults. However, research into the phenomenology of trauma memories in young people is currently scarce. Methods: This study compared the nature of trauma narratives to narratives of unpleasant non‐traumatic events in young people (aged 8-17) who sought emergency medical attention following an assault or road traffic accident. Data were collected within 2-4 weeks of the index event. Symptom severity was assessed by child self‐report and face‐to‐face diagnostic interviews. Comparisons of narrative indices were made between those children with acute stress disorder (ASD) and those without ASD. Results: Among participants (n = 50), those with ASD (38%) had significantly elevated levels of disorganisation in their trauma narrative, compared both to trauma‐exposed controls and to their unpleasant comparative narrative. This effect was not accounted for by age. Regardless of ASD diagnostic status, trauma narratives had significantly higher sensory content and significantly lower positive emotion content compared to the unpleasant comparative narrative. These effects were not significant when age was included as a covariate. Acute symptom severity was significantly predicted by the level of disorganisation in the trauma narrative and the child's cognitive appraisals of the event. Conclusions: These data provide the first empirical evidence that disorganisation is not only directly linked to symptom severity, but also specific to the trauma memory. In addition, it provides support for the adaptation of adult cognitive models to acute pathological stress reactions in children and adolescents.

Phylogenetic threats such as spiders evoke our deepest primitive fears. When close or looming, such threats engage evolutionarily conserved monitoring systems and defense reactions that promote self-preservation. With the use of a modified behavioral approach task within functional MRI, we show that, as a tarantula was placed closer to a subject's foot, increased experiences of fear coincided with augmented activity in a cascade of fear-related brain networks including the periaqueductal gray, amygdala, and bed nucleus of the stria terminalis. Activity in the amygdala was also associated with underprediction of the tarantula's threat value and, in addition to the bed nucleus of the stria terminalis, with monitoring the tarantula's threat value as indexed by its direction of movement. Conversely, the orbitofrontal cortex was engaged as the tarantula grew more distant, suggesting that this region emits safety signals or expels fear. Our findings fractionate the neurobiological mechanisms associated with basic fear and potentially illuminate the perturbed reactions that characterize clinical phobias.

Delineating the differential effects of anxiety versus depression on patterns of information processing has proved challenging. The tripartite model of mood disorders (Clark & Watson, 1991) suggests that one way forward is to adopt a dimensional rather than categorical approach, making it possible to explore the main and interaction effects of depression- and anxiety-specific symptoms on a given cognitive-affective process. Here we examined how the interplay of anxiety-specific arousal and depression-specific anhedonia symptoms in the same individuals relate to interoceptive (bodily) awareness. 113 participants with varying levels of mood disorder symptoms completed a heartbeat perception task to assess interoceptive accuracy. Superior interoception was associated with anxiety-specific arousal symptoms, and this relationship held when controlling for depression-specific anhedonia symptoms and shared general distress symptoms. This main effect was qualified by an interaction between anhedonia and arousal. As anhedonia symptoms increased in severity, the relationship between arousal and interoceptive accuracy became less strong. These results further validate the tripartite framework, help clarify the mixed existing literature on interoception in mood disorders, and suggest that considering the unique and interactive effects of different symptom dimensions is a useful strategy to help identify the cognitive-affective profiles associated with anxiety and depression.

Emotions of fear and disgust are related to core symptoms of depression. The neurobiological mechanisms of these associations are poorly understood. This functional magnetic resonance imaging study aimed at examining the Blood oxygenation level dependent (BOLD) response to facial expressions of fear and disgust in patients with major depressive disorder. Nine patients in an episode of major depression and nine healthy controls underwent two functional magnetic resonance imaging experiments where they judged the gender of facial identities displaying different degrees (mild, strong) of fear or disgust, intermixed with non-emotional faces. Compared with healthy controls, patients with depression demonstrated greater activation in left insula, left orbito-frontal gyrus, left middle/inferior temporal gyrus, and right middle/inferior temporal gyrus to expressions of strong disgust. Depressed patients also demonstrated reduced activation in left inferior parietal lobe to mildly fearful faces. Enhanced activation to facial expressions of disgust may reflect an emotion processing bias that suggests high relevance of emotion of disgust to depression.

Prolonged grief disorder (PGD) (previously called complicated grief (CG)) is proposed as a distinct post loss syndrome, with its own core symptoms. A key issue concerning the diagnostic validity of PGD is whether it can reliably be distinguished from related psychiatric outcomes following bereavement. This study therefore sought to determine whether the core symptoms of PGD could be distinguished from those of bereavement-related anxiety, depression and posttraumatic stress disorder (PTSD). Data were derived from a community sample of 223 bereaved adults in Croatia. PGD symptomatology was measured using the Revised Inventory of Complicated Grief. Depression and anxiety symptoms were measured using the Beck Depression and Anxiety Inventories, respectively. The intrusion and avoidance symptoms of PTSD were assessed using the Revised Impact of Event Scale. The distinctiveness of the five symptom clusters was examined using principal component analysis (PCA). Symptoms of prolonged grief, depression, anxiety, PTSD-intrusion, and PTSD-avoidance clustered together into five distinct factors. These results support the phenomenological distinctiveness of prolonged grief symptoms, from those of bereavement-related anxiety, depression and, for the first time, PTSD.

It has been well established that depressed mood is related to overgeneral memory recall (OGM), which refers to a relative difficulty in retrieving specific information from one's autobiographical memory (AM). The present study examined whether OGM is also related to depressed mood in children and whether lack of inhibitory control mediates this relationship. One hundred thirty-five children (ages 9-13) completed measures assessing depressive symptoms, AM specificity, and inhibitory control. The results showed that depressed mood is positively associated with OGM and that inhibitory control mediated this relationship.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2-4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed.

Identifying patterns of biased cognitive processing specific to depression has proved difficult. The tripartite model of mood disorders [Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336] suggests that a clearer processing ‘blueprint’ may emerge if depression is viewed dimensionally rather than categorically and by focusing on variations in the degree of positive, rather than negative, processing bias. To investigate this possibility, the present study examined the extent to which a reduced positive self-judgment bias previously found in depressed individuals relates to depression-specific anhedonic symptoms. Sixty participants with varying levels of anxiety and depression symptoms evaluated their own performance on a working memory task in the absence of external feedback. Overall, participants showed a positive self-judgment bias, overestimating the number of trials they had performed correctly relative to objective criteria. Consistent with the tripartite framework, the extent of this positive self-judgment bias was significantly and uniquely related to depression-specific symptoms, with the positive bias reducing as anhedonia severity increased across three different symptom measures.

Appraising negative experiences in ways that reduce associated distress is a key component of successful emotion regulation. In 4 studies, the authors examined the effects of systematically practicing appraisal skills using a computer-mediated cognitive bias modification (CBM) methodology. In Studies 1-3, healthy participants practiced applying appraisal themes linked to the idea of seeing the bigger picture to a series of distressing training films, either during each film (Study 1) or immediately after each film (Studies 2 and 3). Control participants watched the same films with no appraisal instructions. Participants who practiced appraisal, compared with controls, exhibited reduced levels of self-reported negative emotional (Studies 1-3) and electrodermal (Study 1) responses to a final test film that all participants were instructed to appraise. In Study 4, a comparable effect of appraisal practice was found using distressing autobiographical memories for participants with higher levels of negative affect. Appraisal practice also led to reduced intrusion and avoidance of the target memories in the week poststudy, compared with prestudy levels, and relative to the no-practice controls. The findings are discussed in terms of the broader literature on CBM.

Objective: Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and elementary school-age children who were exposed to a traumatic event. Method: Participants were 114 children (age range: 2-10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7-10 years) completed structured interviews 2-4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. Results: At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. Conclusions: These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder.

Individuals exposed to childhood adversities (CA) present with emotion regulation (ER) difficulties in later life, which have been identified as risk and maintenance factors for psychopathologies. However, it is unclear if CA negatively impacts on ER capacity per se or whether observed regulation difficulties are a function of the challenging circumstances in which ER is being deployed. In this longitudinal study, we aimed to clarify this association by investigating the behavioral and neural effects of exposure to common moderate CA (mCA) on a laboratory measure of ER capacity in late adolescence/young adulthood. Our population-derived samples of adolescents/young adults (N = 53) were administered a film-based ER-task during functional magnetic resonance imaging that allowed evaluation of ER across mCA-exposure. mCA-exposure was associated with enhanced ER capacity over both positive and negative affect. At the neural level, the better ER of negative material in those exposed to mCA was associated with reduced recruitment of ER-related brain regions, including the prefrontal cortex and temporal gyrus. In addition mCA-exposure was associated with a greater down-regulation of the amygdala during ER of negative material. The implications of these findings for our understanding of the effects of mCA on the emergence of resilience in adolescence are discussed.

OBJECTIVE: Following child trauma, parents are at risk of developing posttraumatic stress disorder (PTSD), either owing to their direct involvement or from hearing of their child's involvement. Despite the potential impact of a parent's development of PTSD on both the parent and child, little is known about what may place a parent at increased risk. METHOD: PTSD symptoms were assessed ≤4 weeks, 6 months, and 3 years post-trauma, along with a range of potential risk factors, in a sample of parents of 2-10-year-old children who were involved in a motor vehicle collision. RESULTS AND CONCLUSIONS: Two symptom trajectories were identified: Those parents whose symptoms remained low across all time points and those whose symptoms remained elevated at 6 months post-trauma and declined by 3 years. Subjective threat, thought suppression, and maladaptive cognitions about damage to the child were identified as key predictors of poorer outcomes. Language: en

Traumatized individuals experiencing posttraumatic stress have difficulty retrieving specific autobiographical memories to cue words on the Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). This may represent a generalized, functional avoidance of the personal past. However, such individuals also often report specific intrusive memories of their trauma in the day-to-day. This raises the possibility that memories tied to the source of the person's distress are immune to this putative avoidance process. This was investigated in bereaved individuals with complicated grief (CG) who reported intrusive, specific memories from the life of their deceased loved one, and matched bereaved controls without CG. Participants performed the AMT and two Biographical Memory Tests (BMTs), cueing memories from the life of the deceased (BMT-Deceased) and from a living significant other (BMT-Living). To negative word cues, the CG group showed reduced specificity for the AMT and BMT-Living, relative to controls, but this effect was reversed on the BMT-Deceased. These data support the proposal that memories tied to the source of an individual's distress are immune to the processes that underlie the standard reduced specificity effect.

Alterations in bodily awareness have been implicated in depression but there has been little detailed empirical characterisation of the degree and accuracy of body perception in the disorder. The present study examined the objective accuracy of heartbeat perception (using the Schandry mental tracking task) and the subjective degree of bodily focus (using the Bodily Consciousness Questionnaire; BCQ) in healthy control volunteers, a moderately depressed community sample, and a more severely depressed clinic sample (n=18 in each group). The community sample showed less accurate heartbeat perception than the control group as expected. Counter to prediction, however, the more severely depressed clinic sample performed better than the community depressed sample and equivalently to control volunteers on the Schandry task. There were no group differences on subjective bodily awareness. Implications for theories of depression are discussed.

It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT; J. M. G. Williams and K. Broadbent, 1986). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1-4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6-8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.

The accuracy with which dysphoric (Study 1) and clinically depressed (Study 2) individuals make self-regulatory judgments about their own performance in the absence of external feedback and the extent to which this relates to trait self-focused attention (SFA) were examined. Relative to objective criteria, both dysphoric and depressed participants showed a positive judgment bias, overestimating the number of trials they had performed correctly. Relative to control participants, the dysphoric and depressed groups showed a reduction in the extent of this positive bias in that they judged error trials more accurately and correct trials less accurately. Although the dysphoric and depressed groups both reported elevated trait SFA, this did not correlate significantly with accuracy of self-judgment on the performance-monitoring task. Implications for self-regulation models of depression are discussed.

To date, no studies have investigated factors associated with acute stress disorder (ASD) in children and adolescents. Relationships between ASD and a number of demographic, trauma, cognitive, and trauma memory variables were therefore investigated in a sample (N=93) of children and adolescents involved in assaults and motor vehicle accidents. Several cognitive variables and the quality of trauma memories, but not demographic or trauma variables, were correlated with ASD and also mediated the relationship between peritraumatic threat and ASD. Finally, nosological analyses comparing ASD with indexes of posttraumatic stress disorder in the month posttrauma revealed little support for the dissociation mandate that uniquely characterizes ASD. The results are discussed with respect to assessment and treatment for the acute traumatic stress responses of children and young people.

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.

The Children's Post-Traumatic Cognitions Inventory (CPTCI) is a self-report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test-retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7-17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test-retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate-to-high test-retest reliability (r = .78) over a 2-month period. The Children's Post-Traumatic Cognitions Inventory-Short Form (CPTCI-S) had excellent internal consistency (α = .92), and moderate-to-high test-retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker-Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI-S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI-S has excellent psychometric properties.

BackgroundIndividuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.ObjectivesTo establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT’s acceptability and mechanism of action.DesignSingle-blind, parallel, individual randomised controlled trial.SettingUK general practices.ParticipantsAdult patients with a diagnosis of recurrent depression and who were taking m-ADM.InterventionsParticipants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT’s acceptability and mechanism of action.Main outcomes measuresThe primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.ResultsIn total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.ConclusionsThere is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.Trial registrationCurrent Controlled Trials ISRCTN26666654.FundingThis project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full inHealth Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.

1. Introduction Part One - Philosophy And Theory 2. The Cognitive Philosophy of Emotion 3. Cognitive Theories of Emotion 4. Cognitive Theories of Emotional Disorder 5. Towards an Integrated Cognitive Theory of Emotion: The Spaars Approach Part Two - Basic Emotions and Their Disorders 6. Fear 7. Sadness 8. Anger 9. Disgust 10. Happiness 11. Overview and Conclusions

We propose a Survival Optimization System (SOS) to account for the strategies that humans and other animals use to defend against recurring and novel threats. The SOS attempts to merge ecological models that define a repertoire of contextually relevant threat induced survival behaviors with contemporary approaches to human affective science. We first propose that the goal of the nervous system is to reduce surprise and optimize actions by (i) predicting the sensory landscape by simulating possible encounters with threat and selecting the appropriate pre-encounter action and (ii) prevention strategies in which the organism manufactures safe environments. When a potential threat is encountered the (iii) threat orienting system is engaged to determine whether the organism ignores the stimulus or switches into a process of (iv) threat assessment, where the organism monitors the stimulus, weighs the threat value, predicts the actions of the threat, searches for safety, and guides behavioral actions crucial to directed escape. When under imminent attack, (v) defensive systems evoke fast reflexive indirect escape behaviors (i.e., fight or flight). This cascade of responses to threat of increasing magnitude are underwritten by an interconnected neural architecture that extends from cortical and hippocampal circuits, to attention, action and threat systems including the amygdala, striatum, and hard-wired defensive systems in the midbrain. The SOS also includes a modulatory feature consisting of cognitive appraisal systems that flexibly guide perception, risk and action. Moreover, personal and vicarious threat encounters fine-tune avoidance behaviors via model-based learning, with higher organisms bridging data to reduce face-to-face encounters with predators. Our model attempts to unify the divergent field of human affective science, proposing a highly integrated nervous system that has evolved to increase the organism's chances of survival.

Depressed individuals endeavor to suppress intrusive thoughts and memories as a form of mood control. Two predictions from this literature were examined. The 1st was that attempts to suppress a preselected negative memory during a stream-of-consciousness (SOC) task in dysphoric individuals, relative to a no-suppress condition, would lead to relatively speeded access to other negative but not positive memories on a subsequent cue-word recall task. No such effects were predicted for nondysphoric controls. The 2nd prediction was that, across all participants who were asked to suppress memories, higher levels of depressed mood would be associated with more intrusions of the to-be-suppressed memory during the SOC and that this association would be stronger than the comparable relation in participants who were not asked to suppress memories. Results support both predictions.

Research examining dysfunctional attitudes in Seasonal Affective Disorder (SAD) has produced contrasting results. The present study sought to resolve this contradiction by addressing some methodological problems of the previous studies. The study examined dysfunctional attitudes using the Dysfunctional Attitudes Scale (DAS) in individuals with SAD and never-depressed controls. The SAD group were tested both when depressed in the winter (Time 1) and during their remission period (Time 2). At Time 1 the SAD group displayed a relatively elevated DAS compared to controls and to their Time 2 scores. These data therefore provide potential support for a view that SAD is characterized by underlying dysfunctional attitudes.

Overgeneral autobiographical memory (OGM) is strongly associated with depression in adults and appears to reflect a stable cognitive bias. However, it is not known whether this bias exists in children or what factors contribute to its development. We examined the roles of age, dysphoria, and a new variable, emotion-focusing (EF), on the production of specific autobiographical memory (AM) in children, using the standard Autobiographical Memory Test (AMT; Williams & Broadbent, 1986 ). Results show that older children are more specific than younger children, irrespective of cue valence. Dysphoria was linked to less specific retrieval of positive memories in children. A three-way interaction between age, valence, and dysphoria was also found, such that older dysphoric children demonstrated a difficulty in retrieving specific negative memories. In addition, emotion-focusing was associated with specific AM recall, especially to negative cues. Results are discussed with reference to the development of depressogenic biases.