The relationship between dissociation and panic symptoms in adolescence and the exploration of potential mediators

Background: Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear. Methods: In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13–18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart. Results: Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators. Conclusions: Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship

Understanding jumping to conclusions in patients with persecutory delusions: working memory and intolerance of uncertainty

Background. Persecutory delusions are a key psychotic experience. A reasoning style known as ‘jumping to conclusions’ (JTC) – limited information gathering before reaching certainty in decision making – has been identified as a contributory factor in the occurrence of delusions. The cognitive processes that underpin JTC need to be determined in order to develop effective interventions for delusions. In the current study two alternative perspectives were tested: that JTC partially results from impairment in information-processing capabilities and that JTC is a motivated strategy to avoid uncertainty.Method. A group of 123 patients with persistent persecutory delusions completed assessments of JTC (the 60:40 beads task), IQ, working memory, intolerance of uncertainty, and psychiatric symptoms. Patients showing JTC were compared with patients not showing JTC.Results. A total of 30 (24%) patients with delusions showed JTC. There were no differences between patients who did and did not jump to conclusions in overall psychopathology. Patients who jumped to conclusions had poorer working memory performance, lower IQ, lower intolerance of uncertainty and lower levels of worry.Working memory and worry independently predicted the presence of JTC.Conclusions. Hasty decision making in patients with delusions may partly arise from difficulties in keeping information in mind. Interventions for JTC are likely to benefit from addressing working memory performance, while in vivo techniques for patients with delusions will benefit from limiting the demands on working memory. The study provides little evidence for a contribution to JTC from top down motivational beliefs about uncertainty

The Gas Temperature of Starless Cores in Perseus

In this paper we study the determinants of starless core temperatures in the Perseus molecular cloud. We use NH3 (1,1) and (2,2) observations to derive core temperatures (T_kin) and data from the COMPLETE Survey of Star Forming Regions and the c2d Spitzer Legacy Survey for observations of the other core and molecular cloud properties. The kinetic temperature distribution probed by NH3 is in the fairly narrow range of 9 - 15 K. We find that cores within the clusters IC348 and NGC1333 are significantly warmer than "field" starless cores, and T_kin is higher within regions of larger extinction-derived column density. Starless cores in the field are warmer when they are closer to class O/I protostars, but this effect is not seen for those cores in clusters. For field starless cores, T_kin is higher in regions in which the 13CO linewidth and the 1.1mm flux from the core are larger, and T_kin is lower when the the peak column density within the core and average volume density of the core are larger. There is no correlation between T_kin and 13CO linewidth, 1.1mm flux, density or peak column density for those cores in clusters. The temperature of the cloud material along the line of sight to the core, as measured by CO or far-infrared emission from dust, is positively correlated with core temperature when considering the collection of cores in the field and in clusters, but this effect is not apparent when the two subsamples of cores are considered separately.Comment: Accepted to ApJ; 13 pages, including 3 tables and three figure

Measuring dissociation across adolescence and adulthood:developing the short-form Černis Felt Sense of Anomaly scale (ČEFSA-14)

Background Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale. Aims We aimed to develop a short-form version of the ČEFSA that is valid for adolescent and adult respondents. Method Data were collected from 1031 adult NHS patients with psychosis and 932 adult and 1233 adolescent non-clinical online survey respondents. Local structural equation modelling (LSEM) was used to establish measurement invariance of items across the age range. Ant colony optimisation (ACO) was used to produce a 14-item short-form measure. Finally, the expected test score function derived from item response theory modelling guided the establishment of interpretive scoring ranges. Results LSEM indicated 25 items of the original 35-item ČEFSA were age invariant. They were also invariant across gender and clinical status. ACO of these items produced a 14-item short-form (ČEFSA-14) with excellent psychometric properties (CFI=0.992; TLI=0.987; RMSEA=0.034; SRMR=0.017; Cronbach’s alpha=0.92). Score ranges were established based on the expected test scores at approximately 0.7, 1.25, and 2.0 theta (equivalent to standard deviations above the mean). Scores of 29 and above may indicate elevated levels of FSA-dissociation. Conclusions The ČEFSA-14 is a psychometrically valid measure of FSA-dissociation for adolescents and adults. It can be used with clinical and non-clinical respondents. It could be used by clinicians as an initial tool to explore dissociation with their clients

The Dynamics of Dense Cores in the Perseus Molecular Cloud II: The Relationship Between Dense Cores and the Cloud

We utilize the extensive datasets available for the Perseus molecular cloud to analyze the relationship between the kinematics of small-scale dense cores and the larger structures in which they are embedded. The kinematic measures presented here can be used in conjunction with those discussed in our previous work as strong observational constraints that numerical simulations (or analytic models) of star formation should match. We find that dense cores have small motions with respect to the 13CO gas, about one third of the 13CO velocity dispersion along the same line of sight. Within each extinction region, the core-to-core velocity dispersion is about half of the total (13CO) velocity dispersion seen in the region. Large-scale velocity gradients account for roughly half of the total velocity dispersion in each region, similar to what is predicted from large-scale turbulent modes following a power spectrum of P(k) ~ k^{-4}.Comment: Accepted for publication in ApJ. 47 pages (preprint format), 20 figures, 5 table

Dense Gas Tracers in Perseus: Relating the N2H+, NH3, and Dust Continuum Properties of Pre- and Proto-Stellar Cores

We investigate 35 pre-stellar cores and 36 proto-stellar cores in the Perseus molecular cloud. We find a very tight correlation between the physical parameters describing the N2H+ and NH3 gas. Both the velocity centroids and the line widths of N2H+ and NH3 correlate much better than either species correlates with CO, as expected if the nitrogen-bearing species are probing primarily the dense core gas where the CO has been depleted. We also find a tight correlation in the inferred abundance ratio between N2H+ and para-NH3 across all cores, with N(p-NH3)/N(N2H+)= 22 +/- 10. We find a mild correlation between NH3 (and N2H+) column density and the (sub)millimeter dust continuum derived H2 column density for pre-stellar cores, N(p-NH3)/N(H2) ~ 10e-8, but do not find a fixed ratio for proto-stellar cores. The observations suggest that in the Perseus molecular cloud the formation and destruction mechanisms for the two nitrogen-bearing species are similar, regardless of the physical conditions in the dense core gas. While the equivalence of N2H+ and NH3 as powerful tracers of dense gas is validated, the lack of correspondence between these species and the (sub)millimeter dust continuum observations for proto-stellar cores is disconcerting and presently unexplained.Comment: ApJ accepted. 45 pages, 8 figure

Outflow - Core Interaction in Barnard 1

In order to study how outflows from protostars influence the physical and chemical conditions of the parent molecular cloud, we have observed Barnard 1 (B1) main core, which harbors four Class 0 and three Class I sources, in the CO (J=1-0), CH3OH (J_K=2_K-1_K), and the SiO (J=1-0) lines using the Nobeyama 45 m telescope. We have identified three CO outflows in this region; one is an elongated (~ 0.3 pc) bipolar outflow from a Class 0 protostar B1-c in the submillimeter clump SMM 2, another is a rather compact (~ 0.1 pc) outflow from a Class I protostar B1 IRS in the clump SMM 6, and the other is an extended outflow from a Class I protostar in SMM 11. In the western lobe of the SMM 2 outflow, both the SiO and CH3OH lines show broad redshifted wings with the terminal velocities of 25 km/s and 13 km/s, respectively. It is likely that the shocks caused by the interaction between the outflow and ambient gas enhance the abundance of SiO and CH3OH in the gas phase. The total energy input rate by the outflows (1.1x10^{-3} Lsun) is smaller than the energy loss rate (8.5x10^{-3} Lsun$) through the turbulence decay in B1 main core, which suggests that the outflows can not sustain the turbulence in this region. Since the outflows are energetic enough to compensate the dissipating turbulence energy in the neighboring, more evolved star forming region NGC 1333, we suggest that the turbulence energy balance depends on the evolutionary state of the star formation in molecular clouds.Comment: 34 pages, 8 figures, accepted for the publication in Ap

Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis

BACKGROUND: Worry might be a contributory causal factor in the occurrence of persecutory delusions in patients with psychotic disorders. Therefore we postulated that reducing worry with cognitive behaviour therapy (CBT) would reduce persecutory delusions.METHODS: For our two-arm, assessor-blinded, randomised controlled trial (Worry Intervention Trial [WIT]), we recruited patients aged 18-65 years with persistent persecutory delusions but non-affective psychosis from two centres: the Oxford Health National Health Service (NHS) Foundation Trust (Oxford, UK) and the Southern Health NHS Foundation Trust (Southampton, UK). The key inclusion criteria for participants were a score of at least 3 on the Psychotic Symptoms Rating Scale (PSYRATS) denoting a current persecutory delusion; that the delusion had persisted for at least 3 months; a clinical diagnosis of schizophrenia, schizoaffective disorder, or delusional disorder; and a clinically significant level of worry. We randomly assigned (1:1) eligible patients, using a randomly permuted block procedure with variable block sizes and division by four strata, to either six sessions of worry-reduction CBT intervention done over 8 weeks added to standard care (the CBT-intervention group), or to standard care alone (the control group). The assessors were masked to patient allocations and did their assessments at week 0 (baseline), 8 weeks (end of treatment), and 24 weeks, follow-up. The primary outcomes were worry measured by the Penn State Worry Questionnaire (PSWQ) and delusions measured by the PSYRATS-delusion scale; we did the analyses in the intention-to-treat population, and also did a planned mediation analysis. This trial is registered with the ISRCTN Registry (number ISRCTN23197625) and is closed to new participants.FINDINGS: From Nov 1, 2011, to Sept 9, 2013, we recruited 150 eligible participants and randomly assigned 73 to the CBT intervention group, and 77 to the control group. 143 patients (95%) provided primary outcome follow-up data. Compared with standard care alone, at 8 weeks the CBT intervention significantly reduced worry (mean difference 6·35 [SE 1·56] PSWQ units, 95% CI 3·30-9·40; p&lt;0·001) and persecutory delusions (2·08 [SE 0·73] PSYRATS units, 95% CI 0·64-3·51; p=0·005). The reductions were maintained to 24 weeks follow-up. The mediation analysis suggested that the change in worry accounted for 66% of the change in delusion. No patients died or were admitted to secure units during our study. Six suicide attempts (two in the CBT intervention group, and four in the control group) and two serious violent incidents (one in each group) were noted, but no adverse events were deemed related to the treatments or the assessments.INTERPRETATION: To our knowledge, this is the first large trial focused on persecutory delusions. We have shown that long-standing delusions were significantly reduced by a brief intervention targeted on worry, although the limitations for our study include no determination of the key elements within the intervention. Our results suggest that worry might cause paranoia, and that worry intervention techniques might be a beneficial addition to the standard treatment of psychosis.FUNDING: Efficacy and Mechanism Evaluation programme, which is a UK Medical Research Council and National Institute of Health Research partnership.</p

A targeted psychological treatment for sleep problems in young people at ultra-high risk of psychosis in England (SleepWell): a parallel group, single-blind, randomised controlled feasibility trial

Background Sleep disturbance is common and problematic for young people at ultra-high risk of psychosis. Sleep disruption is a contributory causal factor in the occurrence of mental health problems, including psychotic experiences, anxiety, and depression. The implication is that treating sleep problems might have additional benefits on mental health outcomes in individuals at high risk. The present study had two aims: first, to establish the feasibility and acceptability of a randomised controlled trial to treat sleep problems with the aim of reducing psychotic experiences in young people at ultra-high risk of psychosis; and second, to provide proof of concept of the clinical efficacy of the treatment. Methods We did a parallel group, single-blind, randomised controlled feasibility trial in two National Health Service trusts in England. Eligible participants were aged 14–25 years, a patient of mental health services, assessed as being at ultra-high risk of psychosis on the Comprehensive Assessment of At-Risk Mental States, and having current sleep problems (score of ≥15 on the self-report Insomnia Severity Index [ISI]). Participants were randomly assigned (1:1) to either a targeted psychological therapy for sleep problems (SleepWell) plus usual care or usual care alone via an automated online system, with non-deterministic minimisation that balanced participants for ISI score and referring service. The SleepWell therapy was delivered on an individual basis in approximately eight 1-h sessions over 12 weeks. Assessments were done at 0, 3, and 9 months, with trial assessors masked to treatment allocation. The key feasibility outcomes were the numbers of patients identified, recruited, and retained, treatment uptake, and data completion. Treatment acceptability was measured with the Abbreviated Acceptability Rating Profile (AARP). In preliminary clinical assessments, the primary clinical outcome was insomnia at 3 and 9 months assessed with the ISI, reported by randomised group (intention-to-treat analysis). Safety was assessed in all randomly assigned participants. The trial was prospectively registered on ISRCTN, 85601537, and is completed. Findings From Nov 18, 2020, to Jan 26, 2022, 67 young people were screened, of whom 40 (60%) at ultra-high risk of psychosis were recruited. Mean age was 16·9 years (SD 2·5; range 14–23), and most participants identified as female (n=19 [48%]) or male (n=19 [48%]) and as White (n=32 [80%]). 21 participants were randomly assigned to SleepWell therapy plus usual care and 19 to usual care alone. All participants provided data on at least one follow-up visit. 39 (98%) of 40 participants completed the primary outcome assessment at 3 and 9 months. 20 (95%) of 21 participants assigned to SleepWell therapy received the prespecified minimum treatment dose of at least four sessions. The median treatment acceptability score on the AARP was 48 (IQR 46 to 48; n=17; maximum possible score 48). At the post-intervention follow-up (3 months), compared with the usual care alone group, the SleepWell therapy group had a reduction in insomnia severity (ISI adjusted mean difference –8·12 [95% CI –11·60 to –4·63]; Cohen's d=–2·67 [95% CI –3·81 to –1·52]), which was sustained at 9 months (ISI adjusted mean difference –5·83 [–9·31 to –2·35]; Cohen's d=–1·91 [–3·06 to –0·77]). Among the 40 participants, eight adverse events were reported in six participants (two [11%] participants in the usual care group and four [19%] participants in the SleepWell therapy group). One serious adverse event involving hospital admission for a physical health problem was reported in the SleepWell therapy group, and one patient in the usual care alone group transitioned to psychosis. None of these events were classed as being related to trial treatment or procedures. Interpretation A randomised controlled trial of a targeted psychological sleep therapy for young people at ultra-high risk of psychosis is feasible. Patients can be retained in the trial and assessments done by masked assessors. Uptake of the sleep therapy was high, and we found preliminary evidence of sustained reductions in sleep problems. A definitive multicentre trial is now needed. Funding NIHR Research for Patient Benefit and NIHR Oxford Health Biomedical Research Centre