Grandiose narcissism shapes counterfactual thinking (and regret):Direct and indirect evidence

Little is known about how individuals high in grandiose narcissism think about what could have been. Across four studies (three online surveys and one online experiment; N = 801), we addressed this gap by examining the relationship between grandiose narcissism, its admiration and rivalry dimensions, and counterfactual thinking and regret. Unlike anticipated, high rivalry was associated with more rather than fewer upward counterfactuals in Study 1. Yet, high rivalry predicted an increased likelihood of generating a downward (vs. upward) counterfactual in a feedback situation (Study 3). Moreover, grandiose narcissism (preliminary study) and admiration (Study 2) negatively correlated with regret. Collectively, our findings stress the importance of considering grandiose narcissism’s dimensions separately and highlight a novel dispositional moderator of counterfactual thinking

Do episodic counterfactual thoughts focus on personally controllable action?:The role of self-initiation

Counterfactual thoughts refer to alternatives to the past. Episodic counterfactual thoughts have in past research been shown to be primarily goal-directed and to engender performance improvement. Some past research supports this perspective with the observation that episodic counterfactuals center mostly on controllable action, whereas other research does not show this. We offer a theoretical resolution for these discrepant findings centering on the role of self-initiation, such that counterfactuals more often focus on internally controllable action to the extent that the circumstance is one that was self-initiated rather than initiated by others. In doing so, we disambiguate two dimensions of causal explanation: locus (self vs. other) and controllability (high vs. low) that previous studies conflated, demonstrating that variation as a function of self-initiation in the content of episodic counterfactuals occurs primarily along the former but not the latter dimension. These results support the functional theory of counterfactual thinking

Dispositional optimism weakly predicts upward, rather than downward, counterfactual thinking:A prospective correlational study using episodic recall

Counterfactual thoughts center on how the past could have been different. Such thoughts may be differentiated in terms of direction of comparison, such that upward counterfactuals focus on how the past could have been better, whereas downward counterfactuals focus on how the past could have been worse. A key question is how such past-oriented thoughts connect to future-oriented individual differences such as optimism. Ambiguities surround a series of past studies in which optimism predicted relatively greater downward counterfactual thinking. Our main study (N= 1150) and six supplementary studies (N= 1901) re-examined this link to reveal a different result, a weak relation between optimism and upward (rather than downward) counterfactual thinking. These results offer an important correction to the counterfactual literature and are informative for theory on individual differences in optimism

Repetitive regret, depression, and anxiety: findings from a nationally representative survey

Past research has established a connection between regret (negative emotions connected to cognitions about how past actions might have achieved better outcomes) and both depression and anxiety. in the present research, the relations between regret, repetitive thought, depression, and anxiety were examined in a nationally representative telephone survey. although both regret and repetitive thought were associated with general distress, only regret was associated with anhedonic depression and anxious arousal. Further, the interaction between regret and repetitive thought (i.e., repetitive regret) was highly predictive of general distress but not of anhedonic depression nor anxious arousal. these relations were strikingly consistent across demographic variables such as sex, race/ethnicity, age, education, and income

The acceptability of a guided internet-based trauma-focused self-help programme (Spring) for post-traumatic stress disorder (PTSD)

Background Guided internet-based, cognitive behavioural therapy with a trauma-focus (i-CBT-TF) is recommended in guidelines for post-traumatic stress disorder (PTSD). There is limited evidence regarding its acceptability, with significant dropout from individual face-to-face CBT-TF, suggesting non-acceptability at least in some cases. Objective To determine the acceptability of a guided internet-based CBT-TF intervention, ‘Spring’, in comparison with face-to-face CBT-TF for mild to moderate PTSD. Method Treatment adherence, satisfaction, and therapeutic alliance were measured quantitatively for participants receiving ‘Spring’ or face-to-face CBT-TF as part of a Randomised Controlled Trial. Qualitative interviews were conducted with a purposive sample of therapists and participants. Results ‘Spring’ guided internet-based CBT-TF was found to be acceptable, with over 89% participants fully or partially completing the programme. Therapy adherence and alliance for ‘Spring’ and face-to-face CBT-TF did not differ significantly, apart from post-treatment participant-reported alliance, which was in favour of face-to-face CBT-TF. Treatment satisfaction was high for both treatments, in favour of face-to-face CBT-TF. Interviews with participants receiving, and therapists delivering ‘Spring’ corroborated its acceptability. Conclusions Guided internet-based CBT-TF is acceptable for many people with mild to moderate PTSD. Findings provide insights into future implementation, highlighting the importance of personalising guided self-help, depending on an individual’s presentation, and preferences. Keywords: post-traumatic stress disorder, internet-based cbt, guided self-help, acceptability, dropout

Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0–8) across UK early years and children’s services

Background: Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective. Methods: A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years. Discussion: This study will address feasibility questions associated with progression to a future randomised trial of WMP. Trial registration: ISRCTN13644899. Registered on 14th April 2023

Minocycline for negative symptoms of schizophrenia and possible mechanistic actions:the BeneMin RCT

Objectives: To determine the efficacy of minocycline on the negative symptoms of schizophrenia and the mechanistic role of neuroprotective, anti-inflammatory and cognitive enhancing actions. Methods: Two hundred and seven patients with a current research diagnosis of schizophrenia within 5 years of onset were randomised by a permuted blocks algorithm to minocycline (300 mg/day) or matching placebo as an adjunct to their continuing treatment. The primary efficacy outcome variable was the negative symptom subscale score from the Positive and Negative Syndrome Scales at 2, 6, 9 and 12 months. The primary mechanistic (biomarker) variables were (1) medial prefrontal grey matter volume (GMV), (2) circulating cytokine interleukin (IL) 6 concentration and (3) dorsolateral prefrontal cortex functional magnetic resonance imaging (fMRI) activations during performance of the N-back task. Movement disorder, side effects and treatment adherence were monitored throughout the study. Results: Compared with placebo, the addition of minocycline had no effect on the severity of negative symptoms [treatment effect difference –0.186, 95% confidence interval (CI) –1.225 to 0.854] across the 2-, 6-, 9- and 12-month follow-up visits. None of the mechanistic biomarkers was influenced by minocycline: left GMV –91.2 (95% CI –303.8 to 121.4), IL-6 0.072 (95% CI –0.118 to 0.262) and N-back fMRI 0.66 (95% CI –1.53 to 0.20). There were no statistically significant treatment effects on any of the secondary outcomes and no group differences at baseline. Most measures were stable over the 12 months. Twenty-five out of the 29 serious adverse events were hospital admission for worsening psychiatric state, which affected 10 minocycline-treated participants and six placebo-treated participants. Main outcome measures: The addition of minocycline to standard treatment had no benefit on the symptoms of schizophrenia in this early phase sample. There was no evidence of a progressive neuropathic or inflammatory process affecting GMV. Limitations: Although recruitment to target was achieved on time, only 43% (n = 89) of the 207 randomised patients completed 12 months of the study. However, 83% of those who started treatment remained on it and were assessed over 6 months. By contrast, no follow-up data were available for the cognitive and imaging markers in those who dropped out before the final 12-month assessments, and this reduced the power to detect treatment effects on these mechanistic variables. Patients were not selected for the presence of negative symptoms, and their initial overall psychopathology was, at most, moderate and, therefore, less likely to show treatment effects. Conclusions: The results of the study do not support the use of adjunctive minocycline for the treatment of negative or other symptoms of schizophrenia within 2–5 years of onset. More secure evidence of central inflammation is needed before further trials are conducted at other stages of psychosis. Trial registration: Current Controlled Trials ISRCTN49141214. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research partnership. The study was sponsored by Greater Manchester Mental Health NHS Foundation Trust and supported by the UK Clinical Research Network

Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID)

Objective To determine if guided internet based cognitive behavioural therapy with a trauma focus (CBT-TF) is non-inferior to individual face-to-face CBT-TF for mild to moderate post-traumatic stress disorder (PTSD) to one traumatic event. Design Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). Setting Primary and secondary mental health settings across the UK’s NHS. Participants 196 adults with a primary diagnosis of mild to moderate PTSD were randomised in a 1:1 ratio to one of two interventions, with 82% retention at 16 weeks and 71% retention at 52 weeks. 19 participants and 10 therapists were purposively sampled and interviewed for evaluation of the process. Interventions Up to 12 face-to-face, manual based, individual CBT-TF sessions, each lasting 60-90 minutes; or guided internet based CBT-TF with an eight step online programme, with up to three hours of contact with a therapist and four brief telephone calls or email contacts between sessions. Main outcome measures Primary outcome was the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at 16 weeks after randomisation (diagnosis of PTSD based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5). Secondary outcomes included severity of PTSD symptoms at 52 weeks, and functioning, symptoms of depression and anxiety, use of alcohol, and perceived social support at 16 and 52 weeks after randomisation. Results Non-inferiority was found at the primary endpoint of 16 weeks on the CAPS-5 (mean difference 1.01, one sided 95% confidence interval −∞ to 3.90, non-inferiority P=0.012). Improvements in CAPS-5 score of more than 60% in the two groups were maintained at 52 weeks, but the non-inferiority results were inconclusive in favour of face-to-face CBT-TF at this time point (3.20, −∞ to 6.00, P=0.15). Guided internet based CBT-TF was significantly (P<0.001) cheaper than face-to-face CBT-TF and seemed to be acceptable and well tolerated by participants. The main themes of the qualitative analysis were facilitators and barriers to engagement with guided internet based CBT-TF, treatment outcomes, and considerations for its future implementation. Conclusions Guided internet based CBT-TF for mild to moderate PTSD to one traumatic event was non-inferior to individual face-to-face CBT-TF and should be considered a first line treatment for people with this condition