The importance of positive cognitive processes in psychological well-being

Introduction: Clinical psychologists have traditionally focused on understanding and treating psychological distress, and psychological theories have rarely been applied to understand positive psychological well-being. This project is interested in applying the principles of Cognitive Theory, a well-established model for the mechanisms underpinning psychological disorders, to understanding positive psychological states. Method: Semi-structured interviews were conducted with undergraduate students to investigate how they think when they feel well. Items derived from these interviews were used in the design of two measures of positive cognition (one of positive core-beliefs and one of positive assumptions). These measures were administered to a larger sample of students, in a battery of questionnaires, examining other psychological variables and well-being. The results were analysed, to investigate the relationship between positive cognition and psychological well-being. Results: The findings provide evidence in support of the psychometric properties of the two measures, suggesting that positive cognitions can be reliably and validly measured. Correlation analyses indicated a positive relationship between positive cognition and psychological well-being. Regression analyses indicated that positive core-beliefs predict psychological well-being, although self-esteem was the best predictor. Core-beliefs had some unique predictive power, when other variables were accounted for. Discussion: The findings provide some support for the hypothesis that positive cognitions exist and are related to psychological well-being in a way predicted by cognitive theory. The study also produces two measures of positive cognition, which have the potential to be developed and used in future research. Methodological issues are discussed along with the implications of the findings for theory, clinical practice and future research

Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND) : a multicentre, parallel, randomised controlled trial in the UK

Background Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Acceptance and Commitment Therapy (ACT) is a psychological therapy incorporating acceptance, mindfulness, and behaviour change techniques. We aimed to evaluate the effectiveness of ACT plus usual care, compared with usual care alone, for improving quality of life in people with motor neuron disease. Methods We conducted a parallel, multicentre, two-arm randomised controlled trial in 16 UK motor neuron disease care centres or clinics. Eligible participants were aged 18 years or older with a diagnosis of definite or laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis; progressive muscular atrophy; or primary lateral sclerosis; which met the World Federation of Neurology's El Escorial diagnostic criteria. Participants were randomly assigned (1:1) to receive up to eight sessions of ACT adapted for people with motor neuron disease plus usual care or usual care alone by a web-based system, stratified by site. Participants were followed up at 6 months and 9 months post-randomisation. Outcome assessors and trial statisticians were masked to treatment allocation. The primary outcome was quality of life using the McGill Quality of Life Questionnaire-Revised (MQOL-R) at 6 months post-randomisation. Primary analyses were multi-level modelling and modified intention to treat among participants with available data. This trial was pre-registered with the ISRCTN Registry (ISRCTN12655391). Findings Between Sept 18, 2019, and Aug 31, 2022, 435 people with motor neuron disease were approached for the study, of whom 206 (47%) were assessed for eligibility, and 191 were recruited. 97 (51%) participants were randomly assigned to ACT plus usual care and 94 (49%) were assigned to usual care alone. 80 (42%) of 191 participants were female and 111 (58%) were male, and the mean age was 63·1 years (SD 11·0). 155 (81%) participants had primary outcome data at 6 months post-randomisation. After controlling for baseline scores, age, sex, and therapist clustering, ACT plus usual care was superior to usual care alone for quality of life at 6 months (adjusted mean difference on the MQOL-R of 0·66 [95% CI 0·22–1·10]; d=0·46 [0·16–0·77]; p=0·0031). Moderate effect sizes were clinically meaningful. 75 adverse events were reported, 38 of which were serious, but no adverse events were deemed to be associated with the intervention. Interpretation ACT plus usual care is clinically effective for maintaining or improving quality of life in people with motor neuron disease. As further evidence emerges confirming these findings, health-care providers should consider how access to ACT, adapted for the specific needs of people with motor neuron disease, could be provided within motor neuron disease clinical services

Behavioural management of migraine

It is important to recognise that migraine is a ′biological′ and not a ′psychological′ entity. However, psychological factors can be involved in migraine in 4 different ways:- 1) Migraines can be triggered by psychological stressors; 2) Severe migraine can itself be a cause of significant psychological stress which can, in turn, exacerbate the problem; 3) Even if psychological stress is not significantly involved in the genesis of the headache, pain management techniques can help people cope with their pain more effectively; 4) Longitudinal data demonstrate a complex bidirectional association between mood disorders and migraine. Treatment of a co-existing mood disorder, for example with cognitive behavioural techniques, may therefore reduce the impact of migraine. It would thus appear logical to view medical and psychological approaches as potentially synergistic rather than mutually exclusive. Functional imaging indicates that cognition, emotions, and pain experiences change the way the brain processes pain inputs. This may provide a physiological rationale for psychological interventions in pain management. As most studies of psychological management of migraine have been relatively small and the approach often varies between clinicians, the magnitude of benefit, optimum method of delivery, and the length of intervention are uncertain

An Evaluation of the Validity of Spatial Navigation Tasks for the diagnosis of Alzheimer’s Disease: A Pilot Study

Objective: The present study aimed to design and evaluate series of novel computerised measures of spatial navigation for use as cognitive screening measures of Alzheimer’s Disease (AD). Tasks were designed so as to limit additional test taker burden and to be accessible to a wide cross-section of assessing clinicians with the hope of future integration into the digital version of the Addenbrooke’s Cognitive Examination (ACEMobile). Method: The study adopted a retrospective diagnostic accuracy design, comparing the performance of 12 participants with AD to 10 healthy older adults on the novel measures of spatial navigation. Results: Promising results were obtained, suggesting that measures of object-location binding effectively discriminate between participants with AD and healthy older adults. Further, the results suggest notable effect sizes for tests of route learning and route planning. Further research is required to further evaluate the use of these measures. Conclusions: The results of the present study add further evidence to the utility of measures of spatial navigation in the diagnosis of AD. The present study also demonstrates that brief, accessible measures of spatial navigation are able to discriminate between individuals with AD and healthy older adults. Further research will be needed to develop these preliminary findings, with the hope of validating measures of spatial navigation to be integrated into routine clinical practice

Memory, metamemory and their dissociation in temporal lobe epilepsy

Patients with temporal-lobe epilepsy (TLE) present with memory difficulties. The aim of the current study was to determine to what extent these difficulties could be related to a metamemory impairment. Fifteen patients with TLE and 15 matched healthy controls carried out a paired-associates learning task. Memory recall was measured at intervals of 30 min and 4 weeks. We employed a combined Judgement-of-Learning (JOL) and Feeling-of-Knowing (FOK) task to investigate whether participants could monitor their memory successfully at both the item-by-item level and the global level. The results revealed a clear deficit of episodic memory in patients with epilepsy compared with controls, but metamemory in TLE patients was intact. Patients were able to monitor their memory successfully at the item-by-item level, and tended to be even more accurate than controls when making global judgements. © 2009 Elsevier Ltd. All rights reserved

Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology.

Peer reviewed: TrueAcknowledgements: We would like to thank Love of the Game for their support with this work. Peter Hutchinson would also like to thank the NIHR Senior Investigator Award, Cambridge Biomedical Research Centre, Medtech Brain Injury Co-operative, Global Health Research Group on Acquired Brain and Spine Injury and Royal College of Surgeons of England. AH is supported by the Cambridge Biomedical Research Campus, the Royal College of Surgeons of England, and is a Theme Lead in the NIHR Brain Injury MedTech Collaborative.OBJECTIVE: To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome. DESIGN: This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%. SETTING: Specialist outpatient services. PARTICIPANTS: Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England. PRIMARY OUTCOME MEASURE: A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England. RESULTS: 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics. CONCLUSIONS: This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway

Acceptance and commitment therapy for people living with motor neuron disease : an uncontrolled feasibility study

Background: Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND. Methods: PlwMND aged ≥18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (≥80% of the target sample [N=28] recruited) and initial engagement with the intervention (≥70% completing ≥2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months. Results: Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended ≥2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status. Conclusions: There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway