Face Experience and the Attentional Bias for Fearful Expressions in 6- and 9-Month-Old Infants

Infants demonstrate an attentional bias toward fearful facial expressions that emerges in the first year of life. The current study investigated whether this attentional bias is influenced by experience with particular face types. Six-month-old (n = 33) and 9-month-old (n = 31) Caucasian infants' spontaneous preference for fearful facial expressions when expressed by own-race (Caucasian) or other-race (East Asian) faces was examined. Six-month-old infants showed a preference for fearful expressions when expressed by own-race faces, but not when expressed by other-race faces. Nine-month-old infants showed a preference for fearful expressions when expressed by both own-race faces and other-race faces. These results suggest that how infants deploy their attention to different emotional expressions is shaped by experience: Attentional biases might initially be restricted to faces with which infants have the most experience, and later be extended to faces with which they have less experience

Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): a randomised controlled pilot feasibility trial for low mood in acquired brain injury

Abstract: Background: Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here, we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the activity planning group (traditional BA), the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The activity engagement group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls. Method: This study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs waitlist controls. Adults (≥ 18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation and sense of control over one’s life. Ethics and dissemination: The trial has been approved by the Health Research Authority of the NHS in the UK (East of England—Cambridge Central, REF 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations and social media. Trial registration: ClinicalTrials.gov, NCT03874650 pre-results. Protocol version 2.1, March 5, 201

Long-term psychological outcomes following stroke: the OX-CHRONIC study

Background: Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. Methods: N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen’s d effect size estimates and percent Minimal Clinically Important Difference changes between time points. Results: On the Montreal Cognitive Assessment 65.3% scored  Conclusion: Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development

Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): Results From a Randomised Controlled Pilot Feasibility Trial for Low Mood in Acquired Brain Injury

Background: Acquired brain injury (ABI) is linked to increased depression risk. Existing therapies for depression in ABI (e.g., Cognitive Behavioural Therapy) have mixed efficacy. Behavioural Activation (BA), an intervention that encourages engaging in positively reinforcing activities, shows promise. The primary aims were to assess feasibility, acceptability, and potential efficacy of two 8-week BA groups. Methods: Adults (≥ 18 years) recruited from local ABI services, charities, and self-referral via social media were randomised to condition. The Activity Planning group (AP; “traditional” BA) trained participants to plan reinforcing activities over 8 weeks, the Activity Engagement group (AE; “experiential” BA) encouraged engagement in positive activities within session only. Both BA groups were compared to an 8-week Waitlist group (WL). The primary outcomes, feasibility and acceptability, were assessed via recruitment, retention, attendance, and qualitative feedback on groups. The secondary outcome, potential efficacy, was assessed via blinded assessments of self-reported activity levels, depression, and anxiety (at pre- and post-intervention and 1 month follow up) and were compared across trial arms. Data were collected in-person and remotely due to COVID-19. Results: N = 60 participants were randomised to AP (randomised n = 22; total n = 29), AE (randomised n = 22; total n = 28), or re-randomised following WL (total n = 16). Whether in-person or remote, AP and AE were rated as similarly enjoyable and. In exploring efficacy, 58.33% of AP members had clinically meaningful activity level improvements, relative to 50% AE and 38.5% WL. Both AP and AE groups had depression reductions relative to WL, but only AP participants demonstrated anxiety reductions relative to AE and WL. AP participants noted benefits of learning strategies to increase activities and learning from other group members. AE participants valued social discussion and choice in selecting in-session activities. Conclusions: Both in-person and remote group BA were feasible and acceptable in ABI. Though both traditional and experiential BA may be effective, these may have different mechanisms. Trial Registration: Clinicaltrials.gov, NCT03874650. Protocol version 2.3, May 26th 2020

A Mixed-Methods Investigation of Behavioural Activation Theory in Acquired Brain Injury

In the UK alone, roughly 700 in every 100,000 individuals will sustain an acquired brain injury (ABI) annually, including non-progressive damage to the brain such as traumatic brain injury, stroke, anoxia, or pressure from a brain tumour. Roughly half of those with ABI will experience depression. Therapies for depression have variable efficacy in ABI, possibly due to high demands on cognitive capacities that may be impaired post-injury. Behavioural approaches to treating depression that place lesser demands on cognition, such as Behavioural Activation (BA) therapy, offer promise. BA theory posits that depression reduces energy levels and expectations of positive outcomes from activities, and increases avoidance, which exacerbates depression. This dissertation provides a test of BA theory by investigating novel predictors of mood and activity levels, and outlines two interventions aimed at increasing activity levels and improving mood, in adults with an ABI from a wide variety of recruitment sources. I utilise both quantitative (e.g., structural equation modelling and mixed-effects models) and qualitative (e.g., interpretive description, thematic analysis) methodology to harmonise the individual perspective of ABI and to identify common patterns in ABI samples. The first empirical chapter concerns how mood disorders, activation and avoidance relate to intolerance of uncertainty (IU), a set of negative beliefs about uncertainty and its implications, in ABI. I demonstrate that IU can be reliably assessed in ABI, and that despite changes in uncertainty due to COVID-19, IU remains a robust predictor of poor mental health, lower activity levels, and greater avoidance in ABI. When controlling for ABI symptoms, the inhibiting effects of uncertainty provided unique variance in anxiety disorders but not depression. Although not as strongly associated with decreases in activity level, higher IU was associated with increased avoidance and rumination. The second empirical chapter focuses on discrepancies in estimation of functional capabilities (“impaired self-awareness”), specifically whether an individual with ABI overestimates or underestimates their ability relative to a family member. Using assessment data from over 200 adults assessed in NHS ABI neurorehabilitation services, those who overestimate themselves tended to be less depressed and anxious compared to those who underestimate and accurately estimate themselves, and had more severe injuries. However, those who overestimate themselves did not fare worse in long-term participation outcomes. The third empirical chapter uses qualitative methodology to explore perspectives of individuals with an ABI on changes in activity levels, and their views on various BA components used to increase activity levels. Level of perceived effort, its potential emotional impact and relation to participant values, and whether the component was used at the “right time” post-ABI were central themes when attempting to increase activity level. An investigation of two 8-week group interventions, designed to increase activity levels and mood in ABI, is presented in the final empirical chapter. Changes linked with each group are compared to waitlist controls in a pilot feasibility randomised controlled trial. The first intervention, “traditional” BA, uses therapeutic strategies and directly encourages individuals to plan and engage in reinforcing activities beyond group sessions. The second intervention, “experiential” BA, encourages participants to engage in reinforcing activities during group sessions only. Both interventions were feasible and acceptable, with approximately 50% - 60% of participants demonstrating clinically meaningful improvements in activity levels. In exploratory analyses of efficacy, both interventions improved mood, but only “traditional” BA resulted in lower anxiety, reductions in the impact of the inhibiting effects of uncertainty, and improvements in motivation. Analysis of qualitative data indicated that “traditional” BA seems to challenge negative self-beliefs and enhance confidence through planning activities, while “experiential” BA provides a low-pressure environment to engage in reinforcing activities. This dissertation demonstrates that increasing activity levels to improve mood in adults with ABI is an easily scalable and potentially effective therapeutic target, in alignment with BA theory. These data point towards potential expansions of BA theory in ABI, in particular the role of uncertainty and impaired self-awareness to activity level and their contributions to mood. This thesis concludes by stating that in clinical research, a mixed-methods approach to the application of relevant theory and intervention design is essential.Gates Cambridge Trus

Up and At Them: Problem Solving Strategies to Activity Engagement and Uncertainty in Acquired Brain Injury

The purpose of this study is to: 1) assess common barriers to activity engagement; 2) identify commonly-used problem solving strategies to overcoming barriers to activity engagement; 3) collect participant feedback on the perceived utility of established problem-solving techniques, and 4) evaluate the psychometric properties of the Intolerance of Uncertainty Scale-Short Form in an acquired brain injury populatio

Estimation of Abilities and their relation to Cognitive and Emotional Factors in Acquired Brain Injury

The purpose of this study is to determine whether levels of anxiety, mood, cognitive function, societal participation, and brain injury symptoms differ between individuals who accurately estimate, over estimate, or underestimate their abilities