The pill and the will : pharmacological and psychological modulation of cognitive and affective processes

Background: Impairments in cognition are components of practically all psychiatric disorders and in that sense transdiagnostic factors. In both clinical and non-clinical populations, ‘hot’ and ‘cold’ cognitive control, i.e., in emotional context and non-emotional context, is strongly associated with daily functioning and physical and mental well-being. The paradigm shift that the National Institute of Mental Health (NIMH) Research Domain Criteria initiative (RDoC) has introduced, signifies that targeting the underlying biological and behavioural endophenotypes that determine mental health and illness might be more fruitful than simply focusing on symptom based diagnostic categories. Yet, little is known on how pharmacological interventions such as selective serotonin reuptake inhibitors (SSRI) and psychostimulants (CS), that are routinely used in everyday clinical praxis, affect cognitive and emotional processes beyond the symptoms they are supposed to treat. Aim: The aim of this thesis was to compare induction and regulation of fear and disgust in healthy subjects, and to investigate how SSRI affect these processes. This basic design was expanded to also include the effect of stimulant medication on the induction and regulation of negative emotions in healthy controls and patients with ADHD. A parallel aim was to compare pharmacological emotion regulation (SSRI and CS) with psychological emotion regulation (reappraisal) and emotion regulation with skills training/ exposure (task repetition). Methods: A multimodal approach was used to explore (i) subjective rating of emotion intensity and objective measures of performance at the behavioural level, (ii) neural underpinnings in the CNS with functional near-infrared spectroscopy (fNIRS), functional magnetic resonance imaging (fMRI) and voxel-based morphometry (VBM) and (iii) physiological components of the sympathetic nervous system (electrodermal activity), which were all evaluated in the absence and presence of pharmacological and psychological interventions, during emotion induction, emotion regulation, cognitive Stroop and emotional Stroop paradigms. Results: Study I and IV demonstrated that emotion regulation with reappraisal is an effective strategy with robust effects on subjective emotional experience and electrodermal activity. Study II and III showed that task repetition improved performance during both cognitive and emotional Stroop tasks, and reduced electrodermal activity during cognitive Stroop, without significantly modifying emotion induction or emotion regulation. Study II and III showed significant effects of single dose escitalopram in reducing subjective emotional experience, improving task performance during affective interference of an ongoing cognitive process, altering prefrontal activity in a task-specific manner, and blurring the differences in the electrodermal activity between fear and disgust seen at baseline. Study IV showed that single dose CS reduced emotion induction, and that emotion regulation with reappraisal was significantly more effective in reducing subjective emotional experience compared to pharmacological emotion regulation with CS. Lastly, Study IV revealed aberrant emotion processing in patients with ADHD both at the behavioural and CNS levels, with patients reporting lower emotion induction and regulation scores, accompanied by less activation of dorsolateral prefrontal cortex, less deactivation of the default mode network and instead greater deactivation of the dorsal attention network, during emotion regulation compared to healthy controls. Structurally (VBM), less gray matter volume was found in limbic and paralimbic areas in patients with ADHD compared to healthy controls. Conclusions and implications: Dimensional approach using behavioural endophenotypes is a fruitful framework for studying normal physiology and diagnostic and treatment aspects of psychiatric disorders. In this thesis, it is demonstrated that emotional and non-emotional cognitive processes, although part of a continuum, likely respond differentially to psychological and pharmacological interventions and skills training with task repetition. Ultimately, improved knowledge in this field will help formulate hypothesisdriven and science-informed frameworks that will guide diagnosis and treatment plans, and usher a shift in psychiatric praxis

Embodied Decisions and the Predictive Brain

Decision-making has traditionally been modelled as a serial process, consisting of a number of distinct stages. The traditional account assumes that an agent first acquires the necessary perceptual evidence, by constructing a detailed inner repre- sentation of the environment, in order to deliberate over a set of possible options. Next, the agent considers her goals and beliefs, and subsequently commits to the best possible course of action. This process then repeats once the agent has learned from the consequences of her actions and subsequently updated her beliefs. Under this interpretation, the agent’s body is considered merely as a means to report the decision, or to acquire the relevant goods. However, embodied cognition argues that an agent’s body should be understood as a proper part of the decision-making pro- cess. Accepting this principle challenges a number of commonly held beliefs in the cognitive sciences, but may lead to a more unified account of decision-making. This thesis explores an embodied account of decision-making using a recent frame- work known as predictive processing. This framework has been proposed by some as a functional description of neural activity. However, if it is approached from an embodied perspective, it can also offer a novel account of decision-making that ex- tends the scope of our explanatory considerations out beyond the brain and the body. We explore work in the cognitive sciences that supports this view, and argue that decision theory can benefit from adopting an embodied and predictive perspective

Situational Awareness in Operational Police Encounters : How is it formed, what factors influence it and how it can be trained

Taitoa ja kykyä muodostaa tilannetietoisuus voidaan pitää kaikkein tärkeimpänä ja kriittisempiä taitona poliisin ammatissa, sillä kaikki poliisitoiminta kuten päätösten tekeminen, taktiikan valinta ja voimakeinojen käyttämisen arviointi ja keinot perustuvat tai niiden tulisi perustua tilannetietoisuuteen. Tässä väitöskirjassa määritellään poliisin operatiivisessa toiminnassa vaadittava tilannetietoisuus; miten tilannetietoisuus muodostuu, mitä se sisältää ja mitkä tekijät vaikuttavat siihen sekä miten poliisitoimintaan liittyvää tilannetietoisuuden opetusta voidaan kehittää. Tämä väitöskirja sisältää neljä osatutkimusta, joissa jokaisessa poliisityöhön liittyvää tilannetietoisuutta pyritään selvittämään erilaisilla tutkimuskysymyksillä ja menetelmillä. Ensimmäisessä teoreettisessa tutkimuksessa keskitytään selvittämään sitä, mitä poliisin operatiiviseen toimintaan liittyvästä tilannetietoisuudesta on aikaisemmin tiedetty ja sitä mitä pitäisi edelleen tutkia, sekä selvitetään motoristen taitojen oppimisen ja tilannetietoisuuden oppimisen välistä yhteyttä. Toisessa osatutkimuksessa tutkitaan tilannetietoisuuteen liittyvää toimintaa ja käyttäytymistä empiirisen tutkimusasetelman avulla sekä selvitetään tutkimuksessa määriteltyjen käyttäytymisen ulottuvuuksien ja yksilöllisen persoonallisuuden piirteiden välistä yhteyttä. Väitöskirjan toisessa empiirisessä tutkimusasetelmassa selvitetään katseen käyttäytymistä sekä käsitteellistetään nimenomaan poliisitoimintaan liittyvä tilannetietoisuus käyttämällä kvalitatiivisia menetelmiä. Väitöskirjan tulokset käsittelevät poliisin tilannetietoisuuden kouluttamiseen ja käytäntöihin liittyviä poliisin koulutuksen maailmanlaajuisia haasteita; poliisityöhön liittyvää tilannetietoisuutta ei ole koskaan aikaisemmin määritelty tai operationalisoitu, ja se on ollut merkittävä rajoitus tilannetietoisuuden ja operatiivisen poliisitoiminnan opetukselle ja koulutukselle sekä niiden kehittämiselle. Tämä väitöstutkimus osoittaa, että poliisin tilannetietoisuuteen liittyvät elementit voidaan tunnistaa, määritellä ja niitä on mahdollista opettaa. Väitöskirja paljastaa ja määrittelee kuusi käyttäytymisen ulottuvuutta, jotka vaikuttavat tilannetietoisuuteen ja/tai poliisin toimintaan joko positiivisesti tai negatiivisesti sekä näiden ulottuvuuksien ja persoonallisuuden piirteiden välisiä yhteyksiä. Väitöskirjassa selvitetään millä tavoin kokeneet poliisit pyrkivät keräämään tietoa erilaisissa kohtaamisissa. Lopuksi väitöskirjassa tunnistetaan ja määritellään kokeneiden poliisien, eksperttien käyttämät seitsemän erityistä teemaa/elementtiä, joiden avulla voidaan muodostaa operatiivisen poliisitoiminnan edellyttämä tilannetietoisuus.The formation of situational awareness can be seen as the most critical and important skill in the police profession, as all other activities of the police, such as decision-making, tactics, and the use of force, are or should be based on situational awareness. This dissertation defines the situational awareness required in the operational work situations of police, what it consists of and is formed by, what factors affect it, and how its teaching can be developed. The dissertation consists of four sub-studies, each of which examined the situational awareness of the police through a variety of research questions and settings. Some of the sub-studies examined what was previously known about situational awareness specific to the police, what should be investigated, and the link between the learning of police situational awareness and other motor skills. The dissertation also studied behaviour and activity related to situational awareness in simulated training tasks and examined the relationship between newly defined behavioural dimensions and individual personality traits. The second empirical study design in this dissertation examined gaze behaviour and used qualitative methods to conceptualize police-specific situational awareness. The results of the dissertation address global challenges of police education relating to the training and practices of police situational awareness, which has so far not been defined or operationalized and is a major limitation for teaching and training. This research shows that elements related to police situational awareness can be identified, defined, and taught. The dissertation revealed and defined six behavioural dimensions that affect situational awareness and/or police activity either positively or negatively, as well as the relationship between these dimensions and personality traits. The dissertation identified the ways in which officers try to collect information in various encounters. Finally, the dissertation identified and defined seven specific themes that when taken into account can form the specific situational awareness of the police