Guided Internet-based Cognitive Behavioural Therapy for Perfectionism, and its Impact on Self-esteem and Intolerance of Uncertainty: A Randomised Controlled Trial

Perfectionism, low self-esteem, and intolerance of uncertainty are transdiagnostic processes, elevated across, and implicated in the aetiology and maintenance of, a number of mental health disorders. The present research explores the relationship between these transdiagnostic processes, and whether a change in one (perfectionism), can effect a change in the others (self-esteem and intolerance of uncertainty). Part one is a meta-analytic review of 21 studies investigating the relationship between perfectionism and self-esteem. A negative association was found between self-esteem and perfectionism, particularly the unhelpful or maladaptive aspects of perfectionism known as perfectionistic concerns. Part two presents the findings of a randomised controlled trial (RCT) of a guided internet-based cognitive behaviour therapy (ICBT) for perfectionism, which was conducted jointly with Professor Roz Shafran and her research team. A total of 120 participants took part (experimental = 62, control = 58). Negative associations were observed between perfectionism and self-esteem, and self-esteem and intolerance of uncertainty. A positive association was observed between perfectionism and intolerance of uncertainty. ICBT for perfectionism significantly reduced levels of perfectionism and intolerance of uncertainty, and increased self-esteem, post-intervention (12 weeks). Changes in perfectionism and intolerance of uncertainty, but not self-esteem, were maintained at follow-up (24 weeks). Part three considers the broader challenges of internet-based interventions, treating perfectionism, conducting RCTs, and the advantages and disadvantages of being a clinician-researcher

Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years:A UK general population cohort study

BACKGROUND: Some people with eating disorders have difficulties with social communication. However, no longitudinal evidence regarding the direction of this association exists. We investigated trajectories of autistic social traits across childhood and adolescence in adolescents with and without disordered eating behaviours in early adolescence. METHODS: We used data from the Avon Longitudinal Study of Parents and Children. Our disordered eating measure indicated presence of any, monthly and weekly disordered eating (fasting, purging, dieting, binge eating) at age 14 years. Autistic social traits were reported by mothers using the Social and Communication Disorders Checklist (SCDC) at age seven, 11, 14 and 16 years. We modelled SCDC score trajectories using multilevel negative binomial models adjusting for a number of child‐ and maternal‐level confounders. RESULTS: Of the 5,381 adolescents included in our sample, 421 (7.8%) experienced one or more disordered eating behaviours, and 148 (2.8%) weekly episodes. Adolescents with disordered eating had a 20% increase in SCDC scores (relative risk (RR) 1.23, 95% confidence interval (CI):1.14, 1.32) compared to those without disordered eating. This association was particularly apparent for those reporting weekly (RR 1.43, 95%CI: 1.27, 1.61) as opposed to monthly disordered eating (RR 1.12, 95%CI: 1.01, 1.22). CONCLUSIONS: Greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence. Although mechanisms of this association need to be elucidated, clinicians should be aware that autistic social traits could have predated the eating disorder when managing people with these conditions

Mental contamination: Relationship with Psychopathology and Transdiagnostic Processes

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (August 2017) in accordance with the publisher’s archiving policyBackground Mental contamination, the experience of feeling dirty in the absence of physical uncleanliness, is closely associated with obsessive compulsive disorder (OCD). Given that many features of OCD are found in other diagnoses, the primary aim of this study was to determine whether mental contamination is specific to OCD or whether it is also associated with psychopathology found in other disorders. We hypothesised that, in addition to OCD symptoms, mental contamination would be associated with other psychopathology, in particular symptoms of depression, anxiety and eating disorders, and with transdiagnostic processes such as perfectionism. Methods 120 participants (82%) completed measures of psychological disorders and transdiagnostic processes. Results were analysed using Pearson's r correlations and a multiple regression analysis. Results Mental contamination was most strongly associated with symptoms of OCD but was also associated with eating disorder symptoms, depression and anxiety. It was also correlated with perfectionism, intolerance of uncertainty and fear of compassion. OCD, eating disorder symptoms, fear of compassion and low self-esteem were significant independent predictors of mental contamination. Conclusions Mental contamination is associated with a range of psychopathology but is most strongly associated with symptoms of OCD. Further research is warranted to advance treatment for mental contamination

A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes

© 2019 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyBackground and objectives Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion). Methods Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported. Results The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5). Conclusions Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

Intimate Partner Violence amongst women with eating disorders during the perinatal period

Prevalence of intimate partner violence (IPV) during pregnancy is estimated to be 4%-8%. Women with mental health difficulties are at increased risk for IPV during the perinatal period. Prevalence of IPV is high among women with eating disorders (ED); however, prevalence of IPV during the perinatal period among women with ED is unknown

2D:4D ratio in children at familial high-risk for eating disorders: The role of prenatal testosterone exposure

Markers of prenatal hormone exposure have been associated with the development of eating disorder (ED) behaviors. Our aim was to determine whether 2D:4D ratio, a marker for in utero testosterone exposure, is associated with risk for ED in a large population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC)

Social communication and emotion difficulties and second to fourth digit ratio in a large community-based sample

Recent research investigating the extreme male brain theory of autism spectrum disorders (ASD) has drawn attention to the possibility that autistic type social difficulties may be associated with high prenatal testosterone exposure. This study aims to investigate the association between social communication and emotion recognition difficulties and second to fourth digit ratio (2D:4D) and circulating maternal testosterone during pregnancy in a large community-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). A secondary aim is to investigate possible gender differences in the associations

Gender differences in the relationship between social communication and emotion recognition

To investigate the association between autistic traits and emotion recognition in a large community sample of children using facial and social motion cues, additionally stratifying by gender