Testing a model of consultation-based reassurance and back pain outcomes with psychological risk as a moderator: A prospective cohort study.

Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk. Methods: We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up. Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups. Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles

Beyond autism and technology: lessons from neurodiverse populations

Purpose – This short paper reports on the sixth seminar in a 7-seminar series entitled, “Innovative Technologies for Autism: Critical Reflections on Digital Bubbles”, funded by the UK Economic and Social Research Council (ESRC). The aim of this particular seminar was to reflect upon the implications from neurodiverse communities for the development of technology for autism. Design/methodology/approach – Presentations from key researchers and parental perspectives are reviewed, highlighting contemporary issues in neurodiverse populations that have important implications for autism. Findings – Whilst there are many conditions associated with autism, most commonly intellectual disability (learning difficulties), this is not reflected in research. In addition, for child-based research, researchers are at least a generation older than participants and have had different digital-childhoods. Involving neurodiverse populations within participatory design sessions can address both of these issues. Understanding the context of the issues that the participatory design sessions address is crucial for developing participatory design principles that extend from one condition to another. This includes understanding when findings based upon verbal populations can be extended to nonverbal populations. Originality/value – This paper offers up-to-date insights into how design principles from one condition extend to different conditions. Universal interaction and neurodiversity HCI are considered. This is important within neurodiverse populations, especially given the high rates of additional conditions that are associated with autism. Whilst the majority of autism research has involved verbal populations, the benefits of technology can extend to non-verbal populations

Creativity, altered states of consciousness and anomalous cognition: the role of epistemological flexibility in the creative process

In this PhD research a question is posed that concerns ‘varieties of creativity’ that have infrequently been explored empirically, although often described anecdotally. This question being: is, and if so, how, is creativity related to altered states of consciousness (ASCs) and parapsychological experiences? This thesis systematically explores the relationship between multiple dimensions of creativity and: personality traits characterised by an openness to intrapersonal experience and a fluid cognitive-style; specific altered states of consciousness and anomalous experiences (such as mystical experiences and subjective paranormal experiences); and anomalous cognition. The common thread is conceived as an examination of the extent to which creativity might involve ‘epistemological flexibility’ — that is, involves shifts into, and between, different ‘ways of knowing’. As such, a major part of this thesis was the psychometric development of a new self-report instrument, the Creative Cognition Inventory, which measures the reported use of different epistemological resources (such as intuition, dreams and rational logic) in the creative process. Creativity is defined in terms of a process, participated in at the person-level, which leads to a novel and adaptive product or performance. Drawing upon models of the creative process and person, it is suggested that a biphasic process is common to most theories of creativity, and that individuals with particular traits have been hypothesised to engage in this with more facility. Models that have explored cognitive, affective and perceptual ‘looseness’ as facilitating novelty are examined. As altered states of consciousness involve subjective shifts in these same dimensions, it is proposed that creativity and ASCs may be experientially related, either directly, or in terms of an overarching trait, such as ‘boundary-thinness’ or ‘transliminality’, which propitiates both. A multi-dimensional approach was taken to creativity measurement, accepting its complexity as a componential construct that might consist of multiple creativities. In Study One, the benefits of a multidimensional approach to creativity measurement were evident, refuting earlier work that had used only cognitive estimates of creativity and found no relationship with either boundary-thinness or transliminality. These constructs are experiential-traits that assess ones degree of intrapersonal openness, cognitive fluidity and sensitivity, and are associated with a proclivity to have unusual experiences. In Study One, they were found to be significantly correlated with both domain general measures of creativity (creative personality) and domain specific measures (emotional creativity and involvement in the arts). The sample for Study One consisted of 65 psychology undergraduates (49 females; 16 males). A second study assessed the degree to which different dimensions of creativity were related to different experiences of consciousness. 211 participants were recruited from the general population through opportunity sampling (108 females; 101 males). The sample included professional artists (n = 36) and scientists (n = 27). Competing models of a relationship between creativity and ASC-proclivity were assessed: cognitive expansion; affective openness; and motivational impetus. This study provided numerous insights into the experiences of consciousness that might be related to varieties of creativity. The key findings were that emotional creativity was most robustly associated with ASCs; artistic creative-personality was associated with ‘positive’ ASCs, including those along an oneiric continuum (e.g. hypnagogia and hallucinations), and those along an affective expansion continuum (e.g. dissociation and positive mystical experiences). Further, original and flexible cognition appeared to be associated with states along an oneiric continuum. Thus, Study Two found support for the affective and cognitive models, yet within different ranges of experience. This ‘model’ helps to clarify, by using heterogeneous, rather than homogenous constructs of ‘unusual experiences’, specific processes by which ASCs and creativity may be related and as such deserves further exploration. The final piece of research developed a novel protocol for recording impressions thought by participants to involve extrasensory perception (ESP) and associated states of consciousness in daily life, using experience- sampling methodology. As success in ESP experiments has consistently been reported amongst visual artists, the above models were used to explore what aspects of the creativity complex might be associated with ESP-performance. As only emotional creativity related to the reporting of parapsychological experiences in Study Two, the affective openness model was expected to predict ESP-performance. Further, a carefully matched control group (n = 15) was used against which to compare success of artists (n = 15). Artists did not demonstrate a superior ESP effect in this study, although they did perform at a level commensurate with previous research. The affective openness hypothesis for ESP performance was rejected. Rather, it was questioned whether previous studies had not adequately matched controls or that the ‘take-home’ methodology, perhaps increasing relaxation and control for the participants, increased performance levels for the non-artist

Surviving to thriving: Impact of art interventions on the wellbeing of women who have experienced sexual violence

This evaluation report describes a series of art workshops designed to support the wellbeing of people who have experienced sexual violence, run through Somerset and Avon Rape and Sexual Abuse Support (SARSAS; www.sarsas.org.uk), led by socially engaged artist Pippa Grace (OneStory; www.one-story.co.uk) and evaluated by Drs Nicola Holt and Emma Halliwell from the University of the West of England.41 females participated in a programme of art workshops (‘Surviving to Thriving’), eight of whom took part in a subsequent programme to develop their art practice further (INSPIRE). The impact on their wellbeing was evaluated using mixed methods: 1) a pre-post evaluation using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) at the start and end of programmes; 2) a process evaluation, examining the impact of each workshop on mood, attention and social connection; and 3) qualitative questionnaires and focus groups to examine the meaning of the programme for participants.The evaluation outcomes suggested that the art-based interventions were effective at improving the wellbeing of participants. During art workshops participants’ anxiety and loneliness decreased, while happiness and alertness increased. Participants with the greatestimprovements in mood during art workshops were also those who reported the greatest wellbeing benefits over time. A thematic analysis resulted in three themes, indicating that participants felt a special bond with others in the group with whom they felt a sense of understanding and of being understood (‘Social Connection’); this safe space allowed opportunities to relax, explore art and become absorbed in the process of making (‘Time for Self-care’). Through this process participants described a new sense of identity, feeling empowered, confident and creative (‘New Identities’).Future work is required to build on and replicate these findings, and to examine the sustainability and longitudinal impact of art workshops. However, these findings support the use of art interventions to help improve the wellbeing of women who have experienced sexual violence

Does latent inhibition underpin creativity, positive schizotypy and anomalous cognition?

This paper presents two experiments in which an experimental paradigm developed to examine the efficacy of filtering mechanisms of attention, Latent Inhibition (LI), was adapted to include a psi component. LI assesses the processing of irrelevant stimuli, thus we tested whether a psi-stimulus might be processed akin to the irrelevant stimulus. Because the processing of the irrelevant stimulus has been shown to be moderated by creativity and positive schizotypy, we hypothesized that these same variables would also moderate the processing of any psi effect. In Experiment 1, a significant LI effect was observed but no psi effect. However, non-linear cognition in the creative process (NLCC) (e.g., intuition and hypnagogia) was significantly associated with a psi-LI-like effect. In Experiment 2 there was a significant psi effect that seemed to operate under the same conditions as LI (being attenuated with a high attentional load). However, creativity and positive schizotypy did not moderate the strength of this psi-LI-like effect. The LI effect was significantly enhanced by NLCC and attenuated by originality

Cognitive and affective reassurance and patient outcomes in primary care:a systematic review

In the context of uncertainty about aetiology and prognosis, good clinical practice commonly recommends both affective (creating rapport, showing empathy) and cognitive reassurance (providing explanations and education) to increase self-management in groups with nonspecific pain conditions. The specific impact of each of these components in reference to patients' outcomes has not been studied. This review aimed to systematically evaluate the evidence from prospective cohorts in primary care that measured patient-practitioner interactions with reference to patient outcomes. We carried out a systematic literature search and appraisal of study methodology. We extracted measures of affective and cognitive reassurance in consultations and their associations with consultation exit and follow-up measures of patients' outcomes. We identified 16 studies from 16,059 abstracts. Eight studies were judged to be high in methodological quality. Pooling could not be achieved as a result of heterogeneity of samples and measures. Affective reassurance showed inconsistent findings with consultation exit outcomes. In 3 high-methodology studies, an association was found between affective reassurance and higher symptom burden and less improvement at follow-up. Cognitive reassurance was associated with higher satisfaction and enablement and reduced concerns directly after the consultations in 8 studies; with improvement in symptoms at follow-up in 7 studies; and with reduced health care utilization in 3 studies. Despite limitations, there is support for the notion that cognitive reassurance is more beneficial than affective reassurance. We present a tentative model based on these findings and propose priorities for future research. © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved

Genetics of anophthalmia and microphthalmia. Part 1, Non-syndromic anophthalmia/microphthalmia

Eye formation is the result of coordinated induction and differentiation processes during embryogenesis. Disruption of any one of these events has the potential to cause ocular growth and structural defects, such as anophthalmia and microphthalmia (A/M). A/M can be isolated or occur with systemic anomalies, when they may form part of a recognizable syndrome. Their etiology includes genetic and environmental factors; several hundred genes involved in ocular development have been identified in humans or animal models. In humans, around 30 genes have been repeatedly implicated in A/M families, although many other genes have been described in single cases or families, and some genetic syndromes include eye anomalies occasionally as part of a wider phenotype. As a result of this broad genetic heterogeneity, with one or two notable exceptions, each gene explains only a small percentage of cases. Given the overlapping phenotypes, these genes can be most efficiently tested on panels or by whole exome/genome sequencing for the purposes of molecular diagnosis. However, despite whole exome/genome testing more than half of patients currently remain without a molecular diagnosis. The proportion of undiagnosed cases is even higher in those individuals with unilateral or milder phenotypes. Furthermore, even when a strong gene candidate is available for a patient, issues of incomplete penetrance and germinal mosaicism make diagnosis and genetic counselling challenging. In this review, we present the main genes implicated in nonsyndromic human A/M phenotypes and, for practical purposes, classify them according to the most frequent or predominant phenotype each is associated with. Our intention is that this will allow clinicians to rank and prioritize their molecular analyses and interpretations according to the phenotypes of their patients

WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives