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Boundary extension is a memory phenomenon in which an individual reports seeing more of a scene than they actually did. We provide the first examination of boundary extension in individuals diagnosed with depression, hypothesising that an overemphasis on pre-existing schema may enhance boundary extension effects on emotional photographs. The relationship between boundary extension and overgeneralisation in autobiographical memory was also explored. Individuals with (n = 42) and without (n = 41) Major Depressive Disorder completed a camera paradigm task utilising positive, negative, and neutral stimuli. Across all participants, positive (d = 0.37) and negative (d = 0.66) stimuli were extended more than neutral stimuli. This effect did not differ between depressed and never-depressed participants. Across all participants, images containing objects were extended more than images containing faces. An association was also evident between extension effects in memory for perceptual space and extensions of autobiographical memory across time.

Aberrations to metacognition— the ability to reflect on and evaluate self-performance— are a feature of poor mental health. Theoretical models suggest that following a stressful event, maladaptive metacognitive evaluations and appraisals of the event drive development of post-traumatic stress symptoms. Yet it is unclear whether disruptions to metacognition causes or contributes to symptom development, or are simply a consequence of ongoing psychopathology. In two studies, using hierarchical Bayesian modelling of metacognition combined with a memory encoding task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Study 1 indicated that heightened perceived stress was associated with impairments in metacognitive efficiency on a memory test after a stress induction (N = 27). Study 2 demonstrated that a transdiagnostic sample of individuals experiencing intrusive memories following a traumatic stressor (N = 39) showed no significant differences in metacognitive efficiency compared to matched controls on the same memory test (N = 45). Our results show that alterations to metacognition do not occur in patients experiencing intrusive memories following traumatic stress, but instead are associated with temporary, heighted levels of acute stress. This suggests that differential sensitivity to acute stress, rather than ongoing psychopathology, induces metacognitive impairments, which could predispose individuals to future mental health problems via downstream changes to other cognitive processes.

This trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds) designed to address the gap in effective interventions for people with complex and comorbid presentations including anxiety, disturbed mood, and trauma sequelae. Shaping Healthy Minds is a modular intervention which synthesises several evidence-based treatment techniques, allowing for standardised, yet flexible, treatment delivery. We conducted a patient-level two-arm randomised controlled trial (HARMONIC) that compared Shaping Healthy Minds to psychological treatment-as-usual (PTAU) for individuals aged >18 years (n = 42). Participants met criteria for at least two comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorder diagnoses and were recruited from outpatient psychological services within the UK National Health Service (NHS). This early phase trial aimed to estimate the efficacy, feasibility, and acceptability of the transdiagnostic intervention. We obtained estimates of likely effect size and acquired basic demographic, cognitive and behavioural data to assess potential mediators and moderators of outcome in preparation for a later phase fully-powered efficacy trial. Co-primary outcomes were self-reported depression and anxiety symptoms, disability and functional impairment; and the trial provided point estimates of efficacy for Shaping Healthy Minds versus Psychological TAU with moderate effect sizes in favour of Shaping Healthy Minds at post-treatment (Cohen’s d estimates ranging from 0.60-0.92) and at 3-month follow-up (Cohen’s d 0.41-0.48). Secondary outcomes included number of diagnoses and changes in transdiagnostic processes. The project has demonstrated that a full trial is feasible, and that the Shaping Healthy Minds treatment approach appears likely to be efficacious compared to PTAU. The trial procedures were approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). The results of this feasibility trial will inform future large-scale trials of psychological interventions for co-occurring mood, anxiety, and stressor-related disorders.Trial registration NCT03143634.

Individuals who experience repeated interpersonal trauma exposure often present with posttraumatic stress disorder (PTSD) with more complex features. There is currently no consensus regarding whether current evidence-based interventions for PTSD need to be tailored to better account for these complex features. However, one recommended adaptation is to adopt a phase-based or sequenced approach involving three phases, each with a distinct function. This paper describes the development of a 12-session Emotion- and Memory-Processing Group Programme, adapted from Cloitre's Skills Training in Affective and Interpersonal Regulation (STAIR) phase-based treatment protocol. A single case series provided a preliminary examination of the group-based intervention's efficacy for three groups of women with a history of repeated interpersonal trauma and PTSD with complex features (Las personas que experimentan una exposición al trauma interpersonal de manera repetida a menudo presentan un Trastorno de Estrés Postraumático (TEPT) con características más complejas. Actualmente, no hay consenso respecto a la necesidad de adaptar las intervenciones para el TEPT basadas en la evidencia disponible, con el fin de considerar mejor estas características complejas. Sin embargo, una adaptación recomendada es adoptar un abordaje basado en fases, o secuenciado, que involucra tres fases, cada una con una función distinta. Este artículo describe el desarrollo de un Programa Grupal de Procesamiento de Emociones y Memoria de 12 sesiones, adaptado del protocolo de tratamiento basado en fases del Entrenamiento de Habilidades en Regulación Afectiva e Interpersonal (STAIR) de Cloitre. Una serie de casos únicos proporcionó un examen preliminar de la eficacia de la intervención basada en grupos para tres grupos de mujeres con una historia de trauma interpersonal repetido y TEPT con características complejas (反复经历人际创伤暴露的个体经常出现具有复杂特征的创伤后应激障碍（PTSD）。目前还没有一致的结论确认是否需要针对这些复杂特征修订PTSD的循证干预措施。尽管如此，受到建议采用的调整方法是使用阶段式或循序干预的方法，其中包括三个功能各异的阶段。本文描述了一个12期的情绪和记忆加工团体干预项目的开发，该干预项目是根据Cloitre的情感和人际调节技能阶培训（STAIR）的阶段性治疗大纲改编。在伦敦的 Haven 性侵转诊中心（Haven Sexual Assault Referral Centre）招募了三组有反复人际创伤和复杂 PTSD 的女性（

Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated that an episodic specificity induction increased detail and specificity of autobiographical memory in people with major depression, relative to control conditions (N=88). We therefore examined whether the induction enhanced the efficacy of CBT tasks that depend on episodic memory – cognitive reappraisal (Study 2, N=30), evidence gathering (Study 2, N=30), and planning behavioural experiments (Study 3, N=30). Across all three tasks, there were no significant differences in emotion- or belief-change between the specificity and control conditions. Although the induction temporarily enhanced specificity in depressed individuals, it did not significantly boost the efficacy of CBT tasks theorised to benefit from the use of specific mnemonic information.

Positive autobiographical memories (AMs) have the potential to repair low mood, but previously depressed individuals have difficulty leveraging their positive AMs for emotion- regulation purposes. We examined whether previously depressed individuals benefit from guided, deliberate recollection of preselected AMs to counteract low mood in their daily life. Participants (N=60) were randomly allocated to retrieval of positive or neutral AMs and completed ecological momentary assessment of emotional experience for three weeks. Feelings of happiness increased only in the positive condition from pre to post AM recollection, whereas feelings of sadness decreased in both conditions. The positive AM condition was more likely to spontaneously use memory recall to counteract low mood. This effect was moderated by the strength of emotional benefit previously experienced upon recall. Strengthening positive, self-affirming AMs in daily life may provide a tool to support regulation of everyday, transient low mood in those remitted from depression.

Mindfulness-based programmes (MBPs) are suggested to improve work performance despite scarcity of evidence. We synthesised randomised controlled trials (RCTs) assessing the impact of MBPs on adults’ work performance. The primary outcome was task performance. Secondary outcomes were contextual performance, adaptive performance, and counter-productive behaviour. In March 2021 we searched ASSIA, EMBASE, ERIC, MEDLINE, PsycINFO, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). Cochrane Risk of Bias tool 2 was used. We conducted pairwise random-effects meta-analyses to calculate Hedges’ gs. A total of 47 studies (N = 5041) were included, all of them with high risk of bias. MBPs were not found to improve task performance (k = 7, n = 454, Hedges’ g = 0.52, 95% CI -0.03 to 1.07, p = 0.059) up to 4 weeks post-intervention compared to passive control groups. However, MBPs improved adaptive performance and contextual performance. The number of studies was insufficient for comparisons with active control groups. Confidence in the review results, per Grading of Recommendations Assessment, Development and Evaluation (GRADE), is low to very low. Future trials need to improve their quality to confirm effects on work performance and use active as well as passive control groups.

Depression and anxiety are associated with the interrupted operation of a number of different memory systems. Two memory systems in particular appear to be integral to the maintenance and continuation of symptoms; working memory and autobiographical memory. Within working memory, those experiencing poor mental health appear to have a reduced ability to store and manipulate both visual and spatial information, relative to their healthy counterparts. Working memory appears to be particularly impaired for emotional material. As such, novel interventions have emerged to improve working memory deficits in the mentally unwell, with the most promising results found for emotional working memory programs. Autobiographical memory has long been understood to play a key role in the onset and perpetuation of depression and anxiety, and techniques to edit autobiographical memory feature in our gold-standard psychological treatments for depression and anxiety. Voluntary retrieval of autobiographical memories of specific, single incident events is impaired, as is retrieval of memories that are positive in emotional valence. Individuals experiencing both depression and anxiety also report increased involuntary retrieval of autobiographical memories. This chapter discusses how current treatments target autobiographical memories to decrease symptoms, and introduces the new, science-driven memory interventions which seek to improve our treatment options for depression and anxiety.

Depressed individuals show a wide range of difficulties in executive functioning (incl. working memory), which can be a significant burden on everyday mental processes. Theoretical models of depression have proposed these difficulties to be especially pronounced in affective contexts. However, evidence investigating affective working memory (WM) capacity in depressed individuals has shown mixed results. The pre-registered study used a complex span task, which has been shown to be sensitive to difficulties with WM capacity in affective relative to neutral contexts in other clinical groups, to explore affective WM capacity in clinical depression. Affective WM capacity was compared between individuals with current depression (n = 24), individuals in remission from depression (n = 25), and healthy controls (n = 30). The results showed that overall, WM capacity was more impaired in the context of negative distractor images, relative to neutral images. Furthermore, those with a lifetime history of depression (individuals with current depression and individuals remitted from depression), performed worse on the task, compared to healthy controls. However, there was no support for the greater disruption of WM capacity in affective compared to neutral contexts in those with a lifetime history of depression. These findings’ implications for current models of depression are discussed.

Reduced ability to retrieve specific autobiographical memories is a well-defined feature of posttraumatic stress disorder (PTSD), and science-driven interventions have emerged to improve memory specificity and thereby symptoms. However, research in depressed samples indicates that the ability to flexibly move between retrieval of specific and general memory types (i.e., memory flexibility) may more accurately conceptualize autobiographical memory deficits in emotional disturbance. In this study, we evaluated memory specificity and memory flexibility in Iranian trauma survivors ( N = 63) with and without PTSD relative to community control participants. Trauma-exposed participants had experienced a serious road-traffic accident. Results indicated that individuals with PTSD experienced reduced memory specificity and memory flexibility relative to trauma-exposed participants and community control participants. A small sample size limits the strength of conclusions, although good statistical power was obtained. Findings suggest that reduced memory flexibility may be a transdiagnostic marker of emotional disturbance and support further development of memory flexibility interventions for PTSD.

Highlights • Perception of low social status is a risk factor for depression. • Investigated social status in a community sample and a case control design. • BDI score associated with perceptions of low social status in a community sample. • Perceptions of low social status endured in clinical remission from depression., Background : The risk of depressive relapse and recurrence is associated with social risk factors that may be amplified by a submissive socio-cognitive profile. Methods : In Study 1 we aimed to identify perceptions of low social status in a community sample (N = 613) with a self-reported history of mental health difficulties (n = 232) and, more specifically in Study 2 (N = 122), in individuals in clinical remission from depression (n = 18), relative to a never-depressed control group (n = 64), and relative to a group experiencing a current depressive episode (n = 40). Results : In Study 1, a total of 225 of the 232 participants in the self-reported mental health difficulties group opted to provide further information regarding their mental health history, of whom 153 (68%) reported a history of anxiety, 168 (74.7%) reported a history of depression, and 13 (5.8%) reported an unspecified mental health history. Elevated depressive symptoms were associated with perceptions of low social status which significantly differed between individuals with and without a self-reported history of mental health difficulties. In Study 2 we found enduring perceptions of low social status in remitted depressed individuals. Limitations : We were unable to discern between historical or current clinical diagnosis in the community sample of Study 1, as we were reliant on self-report. We were unable to explore the effects of medication or causal relationships between depressive symptoms and social status as the studies were cross-sectional in nature. Conclusions : These findings suggest that evolutionarily rooted socio-cognitive profiles could impact affiliative processes and may confer increased vulnerability to future depressive episodes.

IntroductionMental ill health is a major cause of disability. Workplaces are attractive for preventative interventions since most adults work; meanwhile, employers are interested in improving employees’ well-being and productivity. Mindfulness-based programmes are increasingly popular in occupational settings. However, there is inconsistent evidence whether mindfulness interventions improve work performance and how effective mindfulness-based programmes are, compared with other interventions, in preventing mental ill health.Methods and analysisIn this online randomised controlled feasibility trial, an anticipated 240 employees will be randomised to either a 4-week light physical exercise course or a mindfulness course of the same duration (1:1 allocation). The primary outcome is work performance, measured using the Work Role Functioning Questionnaire. We aim to evaluate the acceptability, feasibility and procedural uncertainties of a randomised controlled trial in a workplace, calculate an effect size estimate to inform power calculations for a larger trial, and explore whether improved executive function and/or enhanced mental health could be potential mechanisms underlying the effect of mindfulness on work performance. Outcomes will be collected at baseline, postintervention and 12-week follow-up.Ethics and disseminationApproval has been obtained from Cambridge Psychology Research Ethics Committee. (PRE.2020072). Results will be published in peer-reviewed journals. A lay summary will be disseminated to a wider audience including participating employers.Trial registration numberNCT04631302.

Cognitive distancing is a therapeutic technique commonly used in psychological treatment of various mental health disorders, but its computational mechanisms remain unknown. To determine the effects of cognitive distancing on computational learning mechanisms, we use an online reward decision-making task, combined with reinforcement learning modelling in 935 participants, 49.1% of whom were trained to regulate their emotional response to task performance feedback. Those participants practicing cognitive distancing showed heightened learning from negative events as well as an increased integration of previous choice values. These differences seemed to represent an evolving shift in strategy by the distancing participants during the task, from exploiting optimal choices earlier in the task (as indicated by greater inverse temperature parameters), to a late-stage increase in learning from negative outcomes (represented as higher loss learning rates). Our findings suggest adaptive changes in computational learning mechanisms underpin the clinical utility of cognitive distancing in psychological therapy.

We examined the organization of past and future affective autobiographical knowledge in sexual-trauma survivors compared with control participants. Participants ( N = 113) divided their past (and future) life into chapters (e.g., “college,” “marriage”), then characterized each chapter using positive or negative attributes. Sexual-trauma survivors ( n = 27) endorsed a greater proportion of negative attributes, demonstrated greater affective compartmentalization (separation of positive and negative attributes into different chapters), and showed reduced redundancy (consistent endorsement across chapters) of positive attributes relative to control participants ( n = 23). Groups did not differ on negative redundancy for past life structure or any metrics for future life structure. In a secondary analysis, we compared life structures for the sexual-trauma group and for individuals with chronic depression but no sexual-trauma history ( n = 30) and matched control participants ( n = 56), which revealed significantly greater negative redundancy in the depressed group. The distinct life structure presented by sexual-trauma survivors may reflect efforts to constrain the impact of trauma on an individual’s self-identity.

In mentally healthy individuals, autobiographical memory is typically biased toward positive events, which may help to maintain psychological well-being. Our aim was to assess a range of important positive memory biases in the mentally healthy and explore the possibility that these biases are mitigated in those with mental health problems. We administered a novel recall paradigm that required recollection of multiple good and bad past events (the Good Day–Bad Day task) to healthy and depressed individuals. This allowed us to explore differences in memory category fluency (i.e., the ability to generate integrated sets of associated events) for positive and negative memories, along with memory specificity, and fading affect bias—a greater reduction in the intensity of memory-related affect over time for negative versus positive events. We found that healthy participants demonstrated superior category fluency for positive relative to negative events but that this effect was absent in depressed participants. Healthy participants exhibited a strong fading affect bias that was significantly mitigated, although still present, in depression. Finally, memory specificity was reduced in depression for both positive and negative memories. Findings demonstrate that the positive bias associated with mental health is maintained by multiple autobiographical memory processes and that depression is as much a function of the absence of these positive biases as it is the presence of negative biases. Results provide important guidance for developing new treatments for improving mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Background The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

Emotion can affect the way in which experiences are stored in our memory. The dual representation account proposes that traumatic events may be encoded as fragmented sensory-perceptual details without a broader conceptual organisation. This can result in involuntary retrieval of perceptual information triggered by environmental cues without the associated context – a phenomenon referred to as intrusive memories.Currently, it is unknown whether individuals who experience intrusive memories have an underlying vulnerability to aberrant memory encoding, which may lead to the onset or maintenance of symptoms.In Experiment 1, we examined memory recall for neutral and negative images in a transdiagnostic sample of patients with intrusive memories (N= 36), compared to healthy controls (N= 44). Clinical diagnoses in the patient sample included Post-Traumatic Stress Disorder, Major Depressive Disorder, Social Anxiety Disorder, Generalised Anxiety Disorder, Panic Disorder and Other Specified Feeding or Eating Disorders. We excluded participants currently taking psychotropic medication. At encoding, participants viewed neutral, negative and mixed valence image pairs. In the test phase, participants were presented with cues and, if recognised, were asked to recall the associated image. We found a significant group effect, with patients demonstrating impaired item memory for negative images [F(1,280) = 4.435, p = 0.036], relative to healthy controls. This group difference might suggest that individuals with intrusive memories experienced greater sensitivity to negative stimuli, leading to disruptions in memory encoding. Recent work highlights attention maintenance on threat and high levels of threat-related emotional arousal in anxiety- and fear-related disorders which may be one factor driving the disruption to item memory observed in our clinical population.For Experiment 2, in a separate sample of healthy participants (N= 18) we measured eye-tracking behaviour during the encoding phase of the same task. Healthy participants showed greater item memory [F(3, 136 = 2.893, p = 0.0377] and avoidance of fixation [F(1, 110) = 4.898, p = 0.029] on highly arousing, negative stimuli relative to neutral. This might suggest that a shift in attention away from negative stimuli prevents item memory impairments for emotional information.Our future work will identify biological factors driving attentional biases and higher emotional arousal in clinical populations.

Objective Posttraumatic stress disorder (PTSD) is a debilitating condition that when left untreated can have severe lifelong consequences for psychological, social, and occupational functioning. Initial conceptualizations of PTSD were centered on adult presentations. However, the instantiation of developmentally appropriate PTSD in young children (PTSD-YC) criteria, tailored to preschool (6 years old and younger) children, represents an important step toward identifying more young children experiencing distress. This study explored population-level prevalence of PTSD-YC indexed via an alternative algorithm for DSM-IV PTSD (AA-PTSD). Method Representative population data were used to test whether application of AA-PTSD criteria, relative to the DSM-IV PTSD algorithm, increased identification of 5- to 6-year-old children with clinical needs in both the general population (n = 3,202) and among looked after children (ie, in Britain, foster children are called looked after children [more commonly referred to as children in care].) (n = 137), in whom the risk of mental health issues is greater. Results Notably, no 5- to 6-year-old children in the general population sample were diagnosed with PTSD using adult-based DSM-IV criteria. In contrast, AA-PTSD prevalence was 0.4% overall, rising to 5.4% in trauma-exposed children. In looked after children, overall PTSD prevalence rose from 1.2% when applying adult-based DSM-IV criteria to 14% when using AA-PTSD criteria. Of trauma-exposed looked after children, 2.7% met criteria for DSM-IV PTSD compared with 57.0% when applying AA-PTSD criteria. In both samples, use of the alternative algorithm to index PTSD-YC criteria markedly increased identification of children experiencing functional impairment owing to symptoms. Conclusion Results demonstrate the utility of the PTSD-YC diagnosis beyond at-risk and treatment-seeking samples. Use of PTSD-YC criteria substantially improves identification of 5- to 6-year-old children burdened by PTSD at the population level.

This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire-Child version (PTQ-C) – in young people diagnosed with anxiety and depressive disorders. Participants (N = 114) were 11- to 17-year-olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three-factor model for the PTQ-C; however, hypotheses of both perfect and close fit were rejected, and a subsequent bifactor model suggested minimal unique variance for each subscale. Results demonstrated good internal consistency, convergent validity and divergent validity for the total score and three PTQ-S subscales: core characteristics, perceived unproductiveness, and consumed mental capacity of negative repetitive thinking. PTQ-C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content-specific measure may be warranted in clinical samples. Findings emphasize the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders. Practitioner points: Validates Perseverative Thinking Questionnaire in anxious and depressed youth. Support for convergent and divergent validity, and internal consistency. Results suggest measure is appropriate for complex and comorbid presentations.

Depression is the leading cause of disability worldwide, with prevalence rates rising. Despite the scale of the problem, available pharmacological and psychological interventions only have limited efficacy. The National Institute of Health's Science of Behaviour Change framework proposes to address this issue by capitalising on insights from basic science to identify mechanisms that can be targeted by novel interventions. The current study evaluated the potential of a computerized programme aimed at improving affective control, a mechanistic target involved in both risk and maintenance of depression. In a first phase the cognitive profiles of 48 depressed individuals (mean age: 39 years, 75 % female) were compared to cognitive functioning in 16 never-depressed individuals (mean age: 31 years, 56 % female). The sole index of functioning that differed between diagnostic groups was reaction time across negative and positively valanced trials on an affective Stroop task (d = 0.58). This index was then used to evaluate an affective control training (AffeCT) against a placebo training. Results showed no significant changes on tasks that showed no differences with never-depressed individuals in Phase I. However, compared to placebo training, AffeCT led to significantly greater improvement in the target index, affective Stroop performance (d = 1.17). Importantly, AffeCT led to greater reductions in negative affect as measured by the Positive Affect and Negative Affect Schedule compared to the placebo training (d = 0.98). This proof-of-concept study shows promising benefits of AffeCT on depressed individuals' affect, but not depressive symptoms. It further supports the utility of the Science of Behaviour Change framework, highlighting the need for determining meaningful assays of target mechanisms when evaluating novel interventions.

Background The 11th edition of the International Classification of Diseases (ICD-11) made a number of significant changes to the diagnostic criteria for post-traumatic stress disorder (PTSD). We sought to determine the prevalence and 3-month predictive values of the new ICD-11 PTSD criteria relative to ICD-10 PTSD, in children and adolescents following a single traumatic event. ICD-11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD-11 CPTSD features following exposure to a single-incident trauma. Method Data were analysed from a prospective cohort study of youth aged 8-17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post-trauma, allowing us to calculate and compare the prevalence and predictive value of ICD-10 and ICD-11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions. Results At Week 9, 15 participants (7%) were identified as experiencing ICD-11 PTSD, compared to 23 (11%) experiencing ICD-10 PTSD. There was no significant difference in comorbidity rates between ICD-10 and ICD-11 PTSD diagnoses. Ninety per cent of participants with ICD-11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria. Conclusions Reduced prevalence of PTSD associated with the use of ICD-11 criteria is likely to reduce identification of PTSD relative to using ICD-10 criteria but not relative to DSM-4 and DSM-5 criteria. Diagnosis of CPTSD is likely to be infrequent following single-incident trauma.

This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire-Child version (PTQ-C) – in young people diagnosed with anxiety and depressive disorders. Participants (N = 114) were 11- to 17-year-olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three-factor model for the PTQ-C; however, hypotheses of both perfect and close fit were rejected, and a subsequent bifactor model suggested minimal unique variance for each subscale. Results demonstrated good internal consistency, convergent validity and divergent validity for the total score and three PTQ-S subscales: core characteristics, perceived unproductiveness, and consumed mental capacity of negative repetitive thinking. PTQ-C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content-specific measure may be warranted in clinical samples. Findings emphasize the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders.

The ability to retrieve specific, single-incident autobiographical memories has been consistently posited as a predictor of recurrent depression. Elucidating the role of autobiographical memory specificity in patient-response to depressive treatments may improve treatment efficacy and facilitate use of science-driven interventions. We used recent methodological advances in individual patient data meta-analysis to determine a) whether memory specificity is improved following mindfulness-based cognitive therapy (MBCT), relative to control interventions, and b) whether pre-treatment memory specificity moderates treatment response. All bar one study evaluated MBCT for relapse prevention for depression. Our initial analysis therefore focussed on MBCT datasets only(n = 708), then were repeated including the additional dataset(n = 880). Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions. There was no evidence that baseline memory specificity predicted treatment response in terms of symptom-levels, or risk of relapse. Findings raise important questions regarding the role of memory specificity in depressive treatments.

Anhedonia – a pervasive loss of interest or enjoyment in relation to previously valued stimuli - is a central feature of clinical depression. A series of studies investigated alterations in perceptual sensitivity and attention, and their relation to anhedonia, in participants with persistent depressive illness in comparison to healthy controls. Study 1 measured perceptual sensitivity in the somatic and auditory modalities while minimising attentional influences. Study 2 maximised attentional influences to assess their impact on perceptual sensitivity in the same modalities. Perceptual sensitivity did not differ between groups in either study. Both studies found evidence of lateralised attentional deficits suggestive of subtle left-sided neglect in the depressed samples. In both studies, lateralised attentional deficits were associated with anhedonia above and beyond depression severity. Study 3 demonstrated through simulation that a single lateralised attentional lapse model could predict the key outcomes in both empirical studies, and additionally demonstrated the plausibility of a resource conservation strategy as a data-generating process among depressed participants. In conclusion, the studies support the novel insight that anhedonia may be related to disruptions in brain networks subserving stimulus-driven attention, with a potential contribution of resource conservation strategies that reduce access to precise sensory information.

Disrupted bodily awareness may reflect mechanisms which drive both symptomatology and disorder maintenance in clinical depression. We investigated attentional capture by somatic signals in clinically depressed individuals and healthy controls as one aspect of bodily awareness. Attentional performance in a cross-modal covert orienting task was globally disrupted when depressed participants attempted to ignore uninformative somatic cues, in a largely modality-specific manner. In a subsequent study employing a similar paradigm, attention was disproportionately captured in depressed participants by informative somatic cues, in a similarly modality-specific way. Taken together, the results suggest that the salience of somatic signals is amplified in clinical depression, and that attempts to ignore them may have a disruptive effect on attentional processing more generally in this population.

Chronic and recurrent forms of clinical depression can persist for a lifetime and often respond poorly to intervention. Psychological formulations implicate rigid, negative expectations of self and world which are resistant to updating with new information, a phenomenology consistent with a Bayesian account of brain function. Bayesian predictive processing models suggest that sensory data which is represented with low precision (high uncertainty) in the brain cannot exert much influence on existing beliefs, giving rise to the hypothesis that persistent forms of depression may be characterised by disturbances in sensory precision optimization. We optimized a computational model with data from a cross-modal (visual, auditory, somatic) covert attention task to estimate sensory precision in persistently depressed participants relative to healthy controls. Results suggested that both sensory precision and the salience of attentional targets were attenuated in depressed participants across sensory modalities, contributing to a suppression of contextual prediction error in this group. These outcomes provide support for a novel theoretical account of depression chronicity and suggest avenues for enhancing the effectiveness of psychological interventions for this population.

BackgroundThis study examined the structure of the self-concept in a sample of sexual trauma survivors with posttraumatic stress disorder (PTSD) compared to healthy controls using a self-descriptive card-sorting task. We explored whether individuals with PTSD possess a highly affectively-compartmentalized self-structure, whereby positive and negative self-attributes are sectioned off into separate components of self-concept (e.g. self as an employee, lover, mother). We also examined redundancy (i.e. overlap) of positive and negative self-attributes across the different components of self-concept.MethodParticipants generated a set of self-aspects that reflected their own life (e.g. ‘self at work’). They were then asked to describe their self-aspects using list of positive or negative attributes.ResultsResults revealed that, relative to the control group, the PTSD group used a greater proportion of negative attributes and had a more compartmentalized self-structure. However, there were no significant differences between the PTSD and control groups in positive or negative redundancy. Sensitivity analyses demonstrated that the key findings were not accounted for by comorbid diagnosis of depression.ConclusionFindings indicated that the self-structure is organized differently in those with PTSD, relative to those with depression or good mental health.

Autobiographical memory distortions are a key feature of posttraumatic stress disorder (PTSD). In this proof-of-concept randomized controlled trial ( N = 43), we evaluated an autobiographical memory flexibility intervention, MemFlex. We aimed to determine whether the mechanism-focused intervention, which aims to improve autobiographical memory processes, may also affect other cognitive predictors of PTSD and potentially reduce PTSD symptoms in Iranian trauma survivors diagnosed with PTSD. Results indicated significant, moderate to large between-groups effect sizes in favor of MemFlex, relative to wait-list control, for the targeted cognitive mechanism of autobiographical memory flexibility and PTSD symptoms. A large, significant effect was also observed on maladaptive posttraumatic cognitions—a strong predictor of PTSD prognosis, which is a key target of high-intensity cognitive therapies for PTSD. Findings support future completion of a scaled-up trial to evaluate treatment efficacy of MemFlex for PTSD to determine whether MemFlex may offer a culturally adaptive, low-cost, low-intensity intervention able to improve cognitive mechanisms of PTSD.

Introduction Trauma-focused cognitive behavioural therapies are the first-line treatment for posttraumatic stress disorder (PTSD) in children and adolescents. Nevertheless, open questions remain with respect to efficacy: why does this first-line treatment not work for everyone? For whom does it work best? Individual clinical trials often do not provide sufficient statistical power to examine and substantiate moderating factors. To overcome the issue of limited power, an individual participant data meta-analysis of randomised trials evaluating forms of trauma-focused cognitive behavioural therapy in children and adolescents aged 6–18 years will be conducted. Methods and analysis We will update the National Institute for Health and Care Excellence guideline literature search from 2018 with an electronic search in the databases PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials and CINAHL with the terms (trauma* OR stress*) AND (cognitive therap* OR psychotherap*) AND (trial* OR review*). Electronic searches will be supplemented by a comprehensive grey literature search in archives and trial registries. Only randomised trials that used any manualised psychological treatment—that is a trauma-focused cognitive behavioural therapy for children and adolescents—will be included. The primary outcome variable will be child-reported posttraumatic stress symptoms (PTSS) post-treatment. Proxy-reports (teacher, parent and caregiver) will be analysed separately. Secondary outcomes will include follow-up assessments of PTSS, PTSD diagnosis and symptoms of comorbid disorders such as depression, anxiety-related and externalising problems. Random-effects models applying restricted maximum likelihood estimation will be used for all analyses. We will use the Revised Cochrane Risk of Bias tool to measure risk of bias. Ethics and dissemination Contributing study authors need to have permission to share anonymised data. Contributing studies will be required to remove patient identifiers before providing their data. Results will be published in a peer-reviewed journal and presented at international conferences. PROSPERO registration number CRD42019151954.

Low-intensity psychological interventions that target cognitive risk factors for depressive relapse may improve access to relapse prevention programs and thereby reduce subsequent risk. This study provides the first evaluation of an autobiographical memory-based intervention for relapse prevention, to establish whether memory-training programs that are efficacious for acute depression may also aid those currently in remission. We also provide the longest follow-up to-date of the effects of autobiographical memory training on autobiographical memory processes themselves. This pre-registered randomized-controlled proof-of-concept trial (N = 74) compared an autobiographical Memory Flexibility (MemFlex) intervention to Psychoeducation about cognitive-behavioral mechanisms which maintain depression. Both interventions were primarily self-guided, and delivered via paper workbooks completed over four weeks. The key cognitive outcome was ability to retrieve and alternate between specific and general autobiographical memories. Co-primary clinical outcomes were time until depressive relapse and depression-free days in the twelve-months following intervention. Results indicated a small-moderate effect size (d = 0.35) in favor of MemFlex for the cognitive outcome. A small Hazard Ratio (1.08) was observed for time until depressive relapse, along with a negligible effect size for depression-free days (d = 0.11). Although MemFlex produced long-term improvement in memory retrieval skills, there was little support for MemFlex as a relapse prevention program for depression., Editor highlights • Study evaluates autobiographical memory-based intervention for relapse prevention. • Intervention-driven gains in autobiographical memory were maintained one year later. • MemFlex did not reduce risk of depressive relapse any more than Psychoeducation. • Autobiographical memory interventions may be best utilised as treatment programs.

Memory Specificity Training (MeST) is an intervention developed from basic science that has found clinical utility. MeST uses cued recall exercises to target the difficulty that some people with emotional disorders have in recalling personally experienced events. MeST is simple enough to be delivered alongside traditional interventions or online by artificial intelligence. Currently, research indicates MeST’s effects are immediate, but short lived, and there is limited research indicating its superiority over established interventions. Future investigations must establish the dosage and specific components of MeST that are necessary for clinically significant effects. Further, it must establish the secondary processes (e.g., problem-solving) that mediate between MeST-driven improvements in memory and symptoms. Similar interventions that build upon the idea of training autobiographical memory specificity are also emerging, and warrant further investigation. ispartof: Current Opinion in Psychology vol:41 pages:28-33 ispartof: location:Netherlands status: published

If left untreated, posttraumatic stress disorder (PTSD) can become chronic and significantly impact child and family functioning and general well-being. The first step to treating PTSD is to provide an assessment. This chapter provides an update on the evidence base for key measures for child and adolescent PTSD, including brief screening tools, symptom checklists, and diagnostic interviews. There is also a section specific to the more recently proposed preschool PTSD. Many of these tools are freely available, providing practitioners and services with relatively easily accessible evidence-based tools to best understand whether a young person may be experiencing elevated PTSD symptoms, ultimately informing the treatment approach to these young people.

This study examined the diversity of experienced positive and negative emotions – emodiversity – within two existing datasets involving female survivors of sexual abuse and assault, who all met criteria for chronic Posttraumatic Stress Disorder (PTSD) as well as a diversity of comorbid diagnoses. Study 1 investigated the structure of the self-concept and Study 2 explored the organization of past autobiographical knowledge. In each study, we measured emodiversity for positive and negative emotion constructs in the trauma sample, relative to healthy control participants with no history of sexual trauma or PTSD. Results confirmed our hypotheses that individuals with a severe sexual trauma history and resultant PTSD would show elevated negative emodiversity and reduced positive diversity across both the structure of the self-concept and the structure of the life narrative, relative to control participants. The current results differ from community studies where greater negative emodiversity is associated with better mental health but mirror those from a prior study with individuals with Major Depressive Disorder. This suggests that valence-based differences in emodiversity may result from chronic emotional disturbance., Highlights • Examined diversity of experienced positive and negative emotion in trauma survivors. • Emotional diversity was measured for self-concept and the autobiographical past. • Trauma was related to increased diversity for negative emotion, relative to controls. • Trauma survivors also showed reduced diversity for positive emotion.

Models of memory propose that separate systems underpin the storage and recollection of specific events from our past (e.g., the first day at school), and of the generic structure of our experiences (e.g., how lonely I am), and that interplay between these systems serves to optimize everyday cognition. Specifically, it is proposed that memories of discrete events help define the circumstances (boundary conditions) in which our generalized knowledge applies, thereby enhancing accuracy of memory-dependent cognitive processes. However, in the domain of self-judgment, cognition is systematically biased, with a robust self-enhancement bias characterizing healthy individuals and a negativity bias characterizing the clinically depressed. We hypothesized that self-enhancement effects in the mentally healthy may partly rest on an impaired ability for specific memories to set appropriate boundary conditions on positive self-generalizations, while the opposite may be true for self-referred negative traits in the depressed. To assess this, we asked healthy and depressed individuals to think about the applicability of a trait to themselves, then to recall a specific memory that was inconsistent with that trait which would therefore index a boundary condition for its applicability. Healthy individuals showed faster recall only for specific positive memories following negative trait evaluations, while depressed individuals demonstrated faster recall only of specific negative memories following positive trait evaluations-the pattern expected given the respective self-enhancement and negativity biases. Results suggest that specific memories may serve to delimit self-generalizations in biased ways, and thus support systemic biases in trait judgments characteristic of healthy and depressed individuals. (PsycINFO Database Record

Cognitive training designed to recalibrate maladaptive aspects of cognitive-affective processing associated with the presence of emotional disorder can deliver clinical benefits. This study examined the ability of an integrated training in self-distancing and perspective broadening (SD-PB) with respect to distressing experiences to deliver such benefits in individuals with a history of recurrent depression (≥3 prior episodes), currently in remission. Relative to an overcoming avoidance (OA) control condition, SD-PB: a) reduced distress to upsetting memories and to newly encountered events, both during training when explicitly instructed to apply SD-PB techniques, and after-training in the absence of explicit instructions; b) enhanced capacity to self-distance from and broaden perspectives on participants' experiences; c) reduced residual symptoms of depression. These data provide initial support for SD-PB as a low-intensity cognitive training providing a spectrum of cognitive and affective benefits for those with recurrent depression who are at elevated risk of future episodes.

Background Greater diversity in the experience of negative and positive emotions – emodiversity - is associated with better mental health outcomes in the general population (Quoidbach et al. 2014). However, conceptual accounts of depression suggest this might differ in clinical depression. In this study, the diversity of negative and positive emotion experiences as remembered by a recurrently depressed sample and a never-depressed control group were compared. Methods Emodiversity was assessed using a life structure card sort task which allowed for the assessment of memory for emotional experience over the life course. Depressed (n=34) and non-depressed (n=34) participants completed the card sort task, from which emodiversity metrics were calculated for negative and positive emotion experience. Results Depressed individuals showed recollections of enhanced emodiversity across negative emotion but reduced emodiversity across positive emotion, relative to never-depressed individuals. Limitations This study involved a relatively small sample size. Discussion This study indicates that greater diversity of negative emotion experience, which has been interpreted as a protective factor against depressed mood in community samples (Quoidbach et al., 2014), instead characterises the remembered experience of recurrent clinical depression. The finding that positive emodiversity is adaptive in depression suggests that therapeutic outcomes may be improved by facilitating exposure to a diverse range of positive emotions. These findings indicate that the relationship between emotion diversity and mental health is more complex than hitherto assumed.

IntroductionCognitive behavioural therapies (CBTs) are one of the most effective treatments for major depression. However, ~50% of individuals do not adequately respond to intervention and of those who do remit from a depressive episode, over 50% will experience later relapse. Identification of patient-level factors which moderate treatment response may ultimately help to identify cognitive barriers that could be targeted to improve treatment efficacy. This individual patient data meta-analysis explores one such potential moderator—the ability to retrieve specific, detailed memories of the autobiographical past—as cognitive-based therapeutic techniques draw heavily on the ability to use specific autobiographical information to challenge the dysfunctional beliefs which drive depression.Methods and analysisWe have formed a collaborative network which will contribute known datasets. This will be supplemented by datasets identified through literature searches in Medline, PsycInfo, Web of Science, the Cochrane Central Register of Controlled Trials and WHO trials database between December 2018 and February 2019. Inclusion criteria are delivery of a cognitive or cognitive behavioural therapy for major depression, and measurement of autobiographical memory retrieval at preintervention. Primary outcomes are depressive symptoms and clinician-rated diagnostic status at postintervention, along with autobiographical memory specificity at postintervention. Secondary outcomes will consider each of these variables at follow-up. All analyses will be completed using random-effects models employing restricted maximum likelihood estimation. Risk of bias in included studies will be measured using the Revised Cochrane Risk of Bias Tool.Ethics and disseminationThe findings will be published in a peer-reviewed journal. Study results will contribute to better understanding of the role of autobiographical memory in patient response to CBTs, and may help to inform personalised medicine approaches to treatment of depression.PROSPERO registration numberCRD42018109673.

Auditory Verbal Hallucinations (AVHs) are commonly associated with psychosis but are also reported in post-traumatic stress disorder (PTSD). Hearing voices after the experience of stress has been conceptualised as a dissociative experience. Brewin and Patels’s (2010) seminal study reported that hearing voices is relatively common in PTSD, as hearing voices was associated with PTSD in half and two thirds of military veterans and survivors of civilian trauma, respectively. The authors conceptualised these voices as “auditory pseudohallucinations.” To build upon this work, we extended Brewin and Patel’s’ methodology with adult survivors (n=40) of repeated physical and sexual trauma involving a dominant perpetrator with PTSD, and healthy controls (n=39). In contrast to previous findings, only 5% (n=2) of our PTSD sample reported recently hearing a voice that was consistent with a pseudohallucination, with no reports in our control group. Thus, no support was provided for pseudo-hallucinations as a significant symptom in this population.

This study primarily examined the organization of past and future autobiographical knowledge in a sample of sexual trauma survivors with posttraumatic stress disorder (PTSD) compared to a sample of healthy controls, using a self-descriptive card-sorting task. Participants were asked to imagine that they had to write their autobiography and in preparation that they should divide their past (and future) life into chapters (e.g. ‘school years’ and ‘marriage’). They then characterized each chapter using a list of positive or negative attributes. We explored whether individuals with PTSD possessed a more affectively-compartmentalized life-structure, whereby positive and negative self-attributes showed greater disaggregation into separate chapters. We also examined redundancy (i.e., consistent endorsement) of positive and negative self-attributes across the different life-chapters. Results revealed that the PTSD group overall utilized a greater proportion of negative descriptors, along with greater affective compartmentalization and reduced positive redundancy, across their past life-structure relative to the control participants. Groups did not differ on negative redundancy for the past life structure nor on any metrics for future life structure. Follow-up secondary analyses compared the past life-structure profile for those with PTSD to that of individuals with chronic depression, revealing significantly greater negative redundancy in the depressed group. Our findings are consistent with the prior theoretical and empirical literatures on mechanisms, such as avoidance and dissociation, that are implicated in PTSD as a means of inhibiting the negative impact of past traumatic experiences specifically, and negative information more generally.

Successful navigation within the autobiographical memory store is integral to daily cognition. Impairment in the flexibility of memory retrieval can thereby have a detrimental impact on mental health. This randomised controlled phase II exploratory trial (N = 60) evaluated the potential of a novel intervention drawn from basic science – an autobiographical Memory Flexibility (MemFlex) training programme – which sought to ameliorate memory difficulties and improve symptoms of Major Depressive Disorder. MemFlex was compared to Psychoeducation (an evidence-based low-intensity intervention) to determine the likely range of effects on a primary cognitive target of memory flexibility at post-intervention, and co-primary clinical targets of self-reported depressive symptoms and diagnostic status at three-month follow-up. These effect sizes could subsequently be used to estimate sample size for a fully-powered trial. Results demonstrated small-moderate, though as expected statistically non-significant, effect sizes in favour of MemFlex for memory flexibility (d = 0.34, p = .20), and loss of diagnosis (OR = 0.65, p = .48), along with the secondary outcome of depression-free days (d = 0.36, p = .18). A smaller effect size was observed for between-group difference in self-reported depressive symptoms (d = 0.24, p = .35). Effect sizes in favour of MemFlex in this early-stage trial suggest that fully-powered evaluation of MemFlex may be warranted as an avenue to improving low-intensity treatment of depression. Trial registration ClinicalTrials.gov, Identifier NCT02371291., Highlights • Trial evaluates a mechanism-driven autobiographical memory-based intervention. • Key aim was to prepare for a larger trial of MemFlex. • Superior treatment effect sizes for MemFlex compared to Psychoeducation. • A larger trial is now indicated to determine the treatment efficacy of MemFlex.

Background We explored whether school-based Cogmed Working Memory Training (CWMT) may optimise both academic and psychological outcomes at school. Training of executive control skills may form a novel approach to enhancing processes that predict academic achievement, such as task-related attention, and thereby academic performance, but also has the potential to improve the regulation of emotion, social problems and behavioural difficulties. Methods Primary school children (Mean age = 12 years, N = 148) were cluster-randomised to complete active CWMT, a nonadaptive/placebo version of CWMT, or no training. Results No evidence was found for training effects on task-related attention when performing academic tasks, or performance on reading comprehension and mathematics tasks, or teacher-reported social, emotional and behavioural difficulties. Conclusions CWMT did not improve control of attention in the classroom, or regulation of social, emotional and behavioural difficulties.