Attention and the specificity of emotion processing impairments in adolescents with a diagnosis of Attention-Deficit/Hyperactivity Disorder with or without comorbid Conduct Disorder

Impairments in emotion processing have been separately associated with Attention-Deficit/Hyperactivity Disorder (ADHD) and Conduct Disorder (CD). However, due to their common co-occurrence it is unclear if these impairments are general to ADHD or are specific to ADHD with comorbid CD. In addition, the extent to which they are associated with ADHD or CD symptom severity or callous-unemotional (CU) traits is uncertain and the role atypical attentional allocation to facial features plays in these impairments also remains poorly understood. Participants with a diagnosis of ADHD either with or without comorbid CD performed four emotion processing tasks. Participants with ADHD and comorbid CD showed impairments in all emotion processing tasks compared to ADHD alone. They showed specific impairments in both the conscious recognition and automatic processing of fear faces, general impairments across emotion categories in affective (but not cognitive) empathy, and both reduced differential fear conditioning and a faster rate of extinction learning than ADHD alone. Groups did not differ in processing of the eye region of faces during emotion recognition or empathy tasks, suggesting other mechanisms may account for differences in emotion processing. As opposed to CD severity or CU traits, ADHD severity was the only predictor of reduced attention to the eye region. Further, while CD severity was most strongly negatively associated with both the conscious recognition and automatic processing of fear faces, and to affective empathy for happiness, CU traits were strongly associated with the ability to affectively empathise with negative emotions. The findings of the current thesis highlight the importance of assessing emotion processing and clinical heterogeneity in those with ADHD in order to offer appropriate and tailored interventions

Treating trauma-driven OCD with narrative exposure therapy alongside cognitive behavioural therapy

When post-Traumatic stress disorder (PTSD) co-occurs with obsessive compulsive disorder (OCD), symptoms of the former can interfere with evidence-based treatment of the latter. As a result, exposure-based treatments are recommended for both OCD and PTSD, potentially facilitating a concurrent treatment approach. This case study describes the application of concurrent cognitive behaviour therapy (CBT including exposure and response prevention; ERP) for OCD and narrative exposure therapy to treat a patient whose PTSD symptoms of intrusive images of memories and hyperarousal were interfering with standard CBT (including ERP) treatment for OCD. Following this concurrent approach, the patient's symptoms of OCD reduced to non-clinical levels and showed reliable improvement in PTSD symptoms. Whilst further methodologically robust research is required, this case study highlights that this approach may be beneficial to the treatment of OCD where PTSD symptoms are impacting on treatment. Key learning aims (1) To explore the literature considering explanations of the co-occurrence of OCD and PTSD symptomology. (2) To consider how symptoms of two mental health conditions can maintain one another and attenuate the effectiveness of evidence-based treatment for the other mental health condition. (3) Consider the use of concurrent therapeutic approaches to treat co-occurring mental health conditions.</p

QOL-34. The relationship between psychological flexibility, quality-of-life and psychological health in young people who have experienced a brain tumour [Abstract]

Despite increasing survival rates in young people who have experienced a brain tumour, this patient group have the poorest reported quality-of-life (QoL) of all cancer survivors. QoL is defined as an individual’s perception of their position in life in relation to their goals, expectations and standards. QoL can be influenced by physical functioning but one of its strongest predictors is psychological health. A concept that has a large impact on psychological health is Psychological Flexibility (PF). PF refers to the ability to recognise and adapt to situations, shift cognitive and behavioural repertoires which are impacting negatively on personal and social functioning and commit to behaviours that are in line with strongly held values. Studies have demonstrated a relationship between PF and QoL in other patient populations such as chronic pain and breast cancer survivors. In this study we explored the relationship between PF and QoL at baseline in a sample of young people enrolled in a randomised controlled trial of Acceptance and Commitment Therapy (ACT) for young people who have experienced a brain tumour. We found that higher PF was associated with higher QoL in both 11-15 year olds (R2 = .69, p < .05) and 16 – 24 year olds (R2 = .29, p < .01). We also found higher PF was associated with lower levels of mental health difficulties (R2s ≥ .24, ps < .01) which was also associated with higher levels of QoL (R2 = .49 , p < .01). The results suggest assessing and providing support to increase PF is important for young people who have experienced a brain tumour. It highlights that interventions found to increase PF, such as ACT, could be helpful in improving psychological health in this population

Treating trauma-driven OCD with narrative exposure therapy alongside cognitive behavioural therapy

When post-traumatic stress disorder (PTSD) co-occurs with obsessive compulsive disorder (OCD), symptoms of the former can interfere with evidence-based treatment of the latter. As a result, exposure-based treatments are recommended for both OCD and PTSD, potentially facilitating a concurrent treatment approach. This case study describes the application of concurrent cognitive behaviour therapy (CBT including exposure and response prevention; ERP) for OCD and narrative exposure therapy to treat a patient whose PTSD symptoms of intrusive images of memories and hyperarousal were interfering with standard CBT (including ERP) treatment for OCD. Following this concurrent approach, the patient’s symptoms of OCD reduced to non-clinical levels and showed reliable improvement in PTSD symptoms. Whilst further methodologically robust research is required, this case study highlights that this approach may be beneficial to the treatment of OCD where PTSD symptoms are impacting on treatment

Facial emotion recognition and eye gaze in attention-deficit/hyperactivity disorder with and without comorbid conduct disorder

Objective: Conduct disorder (CD) is associated with impairments in facial emotion recognition. However, CD commonly co-occurs with attention deficit hyperactivity disorder (ADHD); thus, it is unclear whether these impairments are explained by ADHD or by one of its core features - inattention. We explored whether emotion recognition impairments are specific to those with ADHD and comorbid CD while also examining the mechanisms that might explain such deficits. Method: Sixty-three male and female adolescents with ADHD (mean age = 14.2 years, age range = 11–18 years) and with (ADHD+CD) or without comorbid CD (ADHD), and 41 typically developing controls (HC; mean age = 15.5, age range = 11–18 years) performed an emotion recognition task with concurrent eye-tracking. Results: Participants with ADHD+CD were less accurate at recognising fear and neutral faces, and more likely to confuse fear with anger than ADHD alone and HC. Both ADHD subgroups fixated the eye region less than HC. Although there was a negative correlation between ADHD symptom severity and eye fixation duration, only CD severity was inversely related to emotion recognition accuracy. Conclusions: Only ADHD participants with comorbid CD showed impairments in emotion recognition, suggesting that these deficits are specific to individuals with conduct problems. However, lack of attention to the eye region of faces appears to be a characteristic of ADHD. These findings suggest that emotion recognition impairments in those with ADHD+CD are related to misinterpretation rather than poor attention, offering interesting opportunities for intervention

QOL-26. Exploring the experience of young people receiving remotely delivered Acceptance and Commitment Therapy following treatment for a brain tumour

Despite high survival rates of children and young people diagnosed with a brain tumour, survival is often associated with poor psychological, physical, and social outcomes. Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention shown to improve psychological and physical outcomes in adults and children with chronic disease, including cancer. The ACT Now study investigates the feasibility of ACT delivered remotely with young people who have experienced a brain tumour. This study aims to describe participant experience whilst better understanding the impact of therapy and capturing the barriers and facilitators to engagement. Participants of the ACT Now study were invited to take part in a semi-structured interview with questions covering experience of study initiation, receipt of ACT, remote delivery and overall impact of ACT. Ten participants who had previously undergone treatment for a brain tumour have been interviewed to date. Interviews were transcribed verbatim and coded into broad themes. We found that pre-therapy mood and altruism served as motivation for interviewees’ involvement in the study. Interviewees reported hoping to learn coping techniques to navigate fluctuating moods and the pressures of young adult life. Despite the technology used for remote delivery occasionally malfunctioning, interviewees reported increased ability to access therapy via this method. However, an overall preference for face-to-face therapy delivery was reported with interviewees describing that they felt communication might have been easier in person. The therapeutic relationship and the therapists’ flexible schedules were seen as facilitators to session attendance. Barriers to attendance were scarcely reported but included scheduling conflicts due to work or school. ACT was highly regarded amongst interviewees and provided an opportunity for them to learn about themselves and how they can live in accordance with their personal values. Interviewees benefitted from ACT psychologically, physically, and socially and reported an overall positive experience of study involvement

Investigating the Experience of Individuals with Comorbid Posttraumatic Stress Disorder and Substance Misuse Attending a Seeking Safety Group

Purpose: There is no specific recommended treatment for the co-morbid presentation of Post-traumatic Stress Disorder and Substance Use Disorder in the United Kingdom (UK). Seeking Safety, a group-based treatment that targets symptoms of both disorder, has emerging evidence in the United States (US) however to date no UK based studies have explored service users’ experience of attending Seeking Safety or evaluated its impact of the group on mental health symptomology or substance misuse. Design/Methodology/Approach: A mixed method approach was used to evaluate the acceptability of Seeking Safety for a small sample (n=7) of adult users of a substance misuse service in the UK. Thematic Analysis was used to explore their experiences, derived from individual semi-structured interviews.. We also calculated the number of participants who achieved reliable and/or clinically significant change in mental health symptomology and substance misuse from data routinely collected by the service.Findings: Seven overarching themes emerged: (1) Strengthening the Foundations of the Self, (2) The Evocation and Management of Emotions, (3) Safety and Validation Provided Relationally, (4) Readiness and Commitment, (5) Content and Delivery, (6) Seeking Safety is Not an Island, and (7) Ending. Most participants with data available both before and after the group made reliable (3 out of 4) and clinically significant (2 out of 3) change for depression and anxiety symptomology, however this was less evident for PTSD symptomology with 2 out of 3 making reliable change and 1 out of 3 making clinically significant change. <br/