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

A randomized control trial of the effects of home-based online attention training and working memory training on cognition and everyday function in a community stroke sample.

Cognitive difficulties are common following stroke and can have widespread impacts on everyday functioning. Technological advances offer the possibility of individualized cognitive training for patients at home, potentially providing a low-cost, low-intensity adjunct to rehabilitation services. Using this approach, we have previously demonstrated post-training improvements in attention and everyday functioning in fronto-parietal stroke patients. Here we examine whether these benefits are observed more broadly in a community stroke sample. Eighty patients were randomized to either 4 weeks of online adaptive attention training (SAT), working memory training (WMT) or waitlist (WL). Cognitive and everyday function measures were collected before and after the intervention, and after 3 months. During training, weekly measures of patients' subjective functioning were collected. The training was well received and compliance good. No differences in our primary end-point, spatial bias, or other cognitive functions were observed. However, on patient-reported outcomes, SAT participants showed greater levels of improvement in everyday functioning than WMT or WL participants. In line with our previous work, everyday functioning improvements were greatest for patients with spatial impairments and those who received SAT training. Whether attention training can be recommended for stroke survivors depends on whether cognitive test performance or everyday functioning is considered more relevant

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

Social cognitive deficits and their neural correlates in progressive supranuclear palsy

Although progressive supranuclear palsy is defined by its akinetic rigidity, vertical supranuclear gaze palsy and falls, cognitive impairments are an important determinant of patients’ and carers’ quality of life. Here, we investigate whether there is a broad deficit of modality-independent social cognition in progressive supranuclear palsy and explore the neural correlates for these. We recruited 23 patients with progressive supranuclear palsy (using clinical diagnostic criteria, nine with subsequent pathological confirmation) and 22 age- and education-matched controls. Participants performed an auditory (voice) emotion recognition test, and a visual and auditory theory of mind test. Twenty-two patients and 20 controls underwent structural magnetic resonance imaging to analyse neural correlates of social cognition deficits using voxel-based morphometry. Patients were impaired on the voice emotion recognition and theory of mind tests but not auditory and visual control conditions. Grey matter atrophy in patients correlated with both voice emotion recognition and theory of mind deficits in the right inferior frontal gyrus, a region associated with prosodic auditory emotion recognition. Theory of mind deficits also correlated with atrophy of the anterior rostral medial frontal cortex, a region associated with theory of mind in health. We conclude that patients with progressive supranuclear palsy have a multimodal deficit in social cognition. This deficit is due, in part, to progressive atrophy in a network of frontal cortical regions linked to the integration of socially relevant stimuli and interpretation of their social meaning. This impairment of social cognition is important to consider for those managing and caring for patients with progressive supranuclear palsy

Measuring Intolerance of Uncertainty after Acquired Brain Injury. Part 2: Reliability and Validity of the Intolerance of Uncertainty Scale-12

Intolerance of uncertainty (IU) increases risk for poor mental health. Acquired brain injury (ABI), such as stroke and traumatic brain injury, is often accompanied by considerable uncertainty and increased risk of mood disorder. The Intolerance of Uncertainty Scale-12 (IUS-12) is a widely used measure of IU comprising two subscales, Prospective Anxiety and Inhibitory Anxiety. Here, in the second of a two-part investigation of IUS-12 psychometric properties in ABI, we report its test-retest reliability, concurrent validity, and predictive validity (N = 118). Both subscales had excellent test-retest reliability (intraclass correlations of 0.75 and 0.86 respectively) and correlated with generalised anxiety, depression, social anxiety, and activity levels/avoidance completed concurrently or 20-weeks later. Relationships between mood measures and Inhibitory Anxiety were particularly robust. Inhibitory Anxiety was predictive of generalised and social anxiety even when accounting for ABI symptoms. Results indicate that the IUS-12 is a reliable and valid measure in ABI

Measuring Intolerance of Uncertainty after Acquired Brain Injury: Factor Structure, Reliability, and Validity of the Intolerance of Uncertainty Scale-12

Intolerance of uncertainty (IU) is a risk factor for poor mental health. Acquired brain injury (ABI; e.g., stroke, traumatic brain injury), often brings considerable uncertainty and increased mood disorder vulnerability. The Intolerance of Uncertainty Scale-12 (IUS-12) is a brief, well-validated measure of IU argued to comprise two subscales, Prospective Anxiety and Inhibitory Anxiety. Here, for the first time, we investigated its reliability and validity (N = 118), and factor structure (N = 176), in ABI. Both subscales had high test-retest reliability (ICCs of 0.75 and 0.86) and were significantly associated with mood disorder symptoms. The two-factor model was superior to a one-factor IU model fit. IUS-12 scores were stable despite great uncertainties of COVID-19, consistent with its conceptualisation as a trait. Consistent with recent debates about the factor structure of IUS-12 and, in exploratory analyses, we found indications of improved fits that warrant further investigation in independent ABI samples

Measuring Intolerance of Uncertainty After Acquired Brain Injury: Factor Structure, Reliability, and Validity of the Intolerance of Uncertainty Scale-12.

Peer reviewed: TrueIntolerance of uncertainty (IU) is a risk factor for poor mental health. Acquired brain injury (ABI; for example, stroke, traumatic brain injury) often brings considerable uncertainty and increased mood disorder vulnerability. The Intolerance of Uncertainty Scale-Short Form (IUS-12) is a brief, well-validated IU measure in non-ABI samples, comprising two subscales, namely, Prospective Anxiety and Inhibitory Anxiety. Here, for the first time, we investigated its reliability and validity (N = 118), and factor structure (N = 176), in ABI. Both subscales had high test-retest reliability (intraclass correlation coefficients [ICCs] of .75 and .86) and were significantly associated with mood disorder symptoms. The two-factor model was superior to a one-factor IU model fit. Some fit statistics were less than optimal (standardized root mean square residual [SRMR] = 0.06, root mean square error of approximation [RMSEA] = 0.09); hence, exploration of other factor structures in other ABI samples may be warranted. Nonetheless, the IUS-12 appears suitable in ABI

Measuring Intolerance of Uncertainty after Acquired Brain Injury. Part 1: The Factor Structure of the Intolerance of Uncertainty Scale-12

Intolerance of uncertainty (IU) is a risk factor for poor mental health. Acquired brain injury (ABI), such as stroke or traumatic brain injury, often brings considerable uncertainty. This is the first of a two-part investigation of the psychometric properties of the Intolerance of Uncertainty Scale-12 (IUS-12) in ABI. Here, we evaluate its internal consistency and factor structure in 176 adults with ABI. A two-factor structure (Prospective Anxiety and Inhibitory Anxiety) was superior to a one-factor model. However, some fit statistics were unacceptable. In an exploratory factor analysis, a new two-factor model emerged with a superior fit. A bifactor model provided even better fit, though the sample size precluded exhaustive evaluation. For now, retaining the original Prospective Anxiety and Inhibitory Anxiety subscales is recommended for ABI. IUS-12 scores did not differ pre- or during COVID-19 assessment, suggesting the IUS-12 is measuring individual differences regardless of uncertainty levels

Prefrontal control of attention to threat

Attentional control refers to the regulatory processes that ensure that our actions are in accordance with our goals. Dual-system accounts view temperament as consisting of both individual variation in emotionality (e.g. trait anxiety) and variation in regulatory attentional mechanisms that act to modulate emotionality. Increasing evidence links trait variation in attentional control to clinical mood and anxiety disorder symptoms, independent of trait emotionality. Attentional biases to threat have been robustly linked to mood and anxiety disorders. However, the role of variation in attentional control in influencing such biases, and the neural underpinnings of trait variation in attentional control, are unknown. Here, we show, that individual differences in trait attentional control, even when accounting for trait and state anxiety, are related to the magnitude of an attentional blink following threat-related targets. Moreover, we demonstrate that activity in dorsolateral prefrontal cortex, is observed specifically in relation to control of attention over threatening stimuli, in line with neural theories of attentional control, such as guided activation theory. These results have key implications for neurocognitive theories of attentional bias and emotional resilience