Frances Meeten

Does a ‘Singing Together Group’ improve the quality of life of people with a dementia and their carers? A pilot evaluation study:

Ten people with dementia (PWD) and their family carers participated in a Singing Together Group for 10 weeks and measures of mood, quality of life, PWDs behavioural and psychological problems, activities of daily living and cognitive status were measured at pre, post and 10-week follow-up. Engagement levels were monitored during the sessions and care partners asked to rate each session. Additional qualitative information was obtained through interview pre-post and at follow-up and subjected to thematic analysis. The results showed that PWD were deteriorating slowly over the course of the study on all measures but that they and their carers’ quality of life remained relatively stable. Engagement levels during the group were very high and attendance excellent. Qualitative data gave strong support to the group having promoted wellbeing of all participants and Nolans ‘Senses Framework’ was used to explore this further. Future research directions are suggested.

Resolving Ambiguity in Emotional Disorders: The Nature and Role of Interpretation Biases.

People with emotional disorders, such as social anxiety disorder (SAD), generalized anxiety disorder (GAD), and depression, demonstrate a consistent tendency, or bias, to generate negative interpretations of ambiguous material. This is different from people without emotional disorders who tend, in general, to make positive interpretations of ambiguity. If central components of an emotional disorder have high levels of inherent ambiguity (e.g., concern about the negative perceptions of others in SAD, or worry in GAD), then interpretive bias may have a causal maintaining role, and this has been demonstrated in studies using cognitive bias modification techniques. This research has also shown that interpretation biases combine with other cognitive processes, such as imagery and memory, which could exacerbate distress. Psychological interventions will benefit from effectively targeting negative interpretations, and future experimental research can inform ways to improve facilitation of more benign inferential processing to maximize amelioration of key components of emotional disorders.

Alterations in Amygdala-Prefrontal Functional Connectivity Account for Excessive Worry and Autonomic Dysregulation in Generalized Anxiety Disorder

BACKGROUND Generalized anxiety disorder (GAD) is characterized by the core symptom of uncontrollable worry. Functional magnetic resonance imaging studies link this symptom to aberrant functional connectivity between the amygdala and prefrontal cortex. Patients with GAD also display a characteristic pattern of autonomic dysregulation. Although frontolimbic circuitry is implicated in the regulation of autonomic arousal, no previous study to our knowledge combined functional magnetic resonance imaging with peripheral physiologic monitoring in these patients to test the hypothesis that core symptoms of worry and autonomic dysregulation in GAD arise from a shared underlying neural mechanism. METHODS We used resting-state functional magnetic resonance imaging and the measurement of parasympathetic autonomic function (heart rate variability) in 19 patients with GAD and 21 control subjects to define neural correlates of autonomic and cognitive responses before and after induction of perseverative cognition. Seed-based analyses were conducted to quantify brain changes in functional connectivity with the right and left amygdala. RESULTS Before induction, patients showed relatively lower connectivity between the right amygdala and right superior frontal gyrus, right paracingulate/anterior cingulate cortex, and right supramarginal gyrus than control subjects. After induction, such connectivity patterns increased in patients with GAD and decreased in control subjects, and these changes tracked increases in state perseverative cognition. Moreover, decreases in functional connectivity between the left amygdala and subgenual cingulate cortex and between the right amygdala and caudate nucleus predicted the magnitude of reduction in heart rate variability after induction. CONCLUSIONS Our results link functional brain mechanisms underlying worry and rumination to autonomic dyscontrol, highlighting overlapping neural substrates associated with cognitive and autonomic responses to the induction of perseverative cognitions in patients with GAD.

Mood-as-input hypothesis and perseverative psychopathologies

Mood-as-input hypothesis is a theory of task perseveration that has been applied to the understanding of perseveration across psychopathologies such as pathological worrying, compulsive checking, depressive rumination, and chronic pain. We review 10 years of published evidence from laboratory-based analogue studies and describe their relevance for perseveration in clinical populations. In particular, mood-as-input hypothesis predicts that perseveration at a task will be influenced by interactions between the individuals stop rules for the task and their concurrent mood, and that the valency of an individuals concurrent mood is used as information about whether the stop rule-defined goals for the task have been met. The majority of the published research is consistent with this hypothesis, and we provide evidence that clinical populations possess characteristics that would facilitate perseveration through mood-as-input processes. We argue that mood-as-input research on clinical populations is long overdue because (1) it has potential as a transdiagnostic mechanism helping to explain the development of perseveration and its comorbidity across a range of different psychopathologies, (2) it is potentially applicable to any psychopathology where perseveration is a defining feature of the symptoms, and (3) it has treatment implications for dealing with clinical perseveration.

Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety.

Generalized anxiety disorder (GAD) is characterized by excessive worry, autonomic dysregulation and functional amygdala dysconnectivity, yet these illness markers have rarely been considered together, nor their interrelationship tested longitudinally. We hypothesized that an individual’s capacity for emotion regulation predicts longer-term changes in amygdala functional connectivity, supporting the modification of GAD core symptoms. Sixteen patients with GAD (14 women) and individually matched controls were studied at two time points separated by 1 year. Resting-state fMRI data and concurrent measurement of vagally mediated heart rate variability were obtained before and after the induction of perseverative cognition. A greater rise in levels of worry following the induction predicted a stronger reduction in connectivity between right amygdala and ventromedial prefrontal cortex, and enhanced coupling between left amygdala and ventral tegmental area at follow-up. Similarly, amplified physiological responses to the induction predicted increased connectivity between right amygdala and thalamus. Longitudinal shifts in a distinct set of functional connectivity scores were associated with concomitant changes in GAD symptomatology over the course of the year. Results highlight the prognostic value of indices of emotional dysregulation and emphasize the integral role of the amygdala as a critical hub in functional neural circuitry underlying the progression of GAD symptomatology.

Neurostructural abnormalities associated with axes of emotion dysregulation in generalized anxiety

Background Despite the high prevalence of generalized anxiety disorder (GAD) and its negative impact on society, its neurobiology remains obscure. This study characterizes the neurostructural abnormalities associated with key symptoms of GAD, focusing on indicators of impaired emotion regulation (excessive worry, poor concentration, low mindfulness, and physiological arousal). Methods These domains were assessed in 19 (16 women) GAD patients and 19 healthy controls matched for age and gender, using questionnaires and a low demand behavioral task performed before and after an induction of perseverative cognition (i.e. worry and rumination). Continuous pulse oximetry was used to measure autonomic physiology (heart rate variability; HRV). Observed cognitive and physiological changes in response to the induction provided quantifiable data on emotional regulatory capacity. Participants underwent structural magnetic resonance imaging; voxel-based morphometry was used to quantify the relationship between gray matter volume and psychological and physiological measures. Results Overall, GAD patients had lower gray matter volume than controls within supramarginal, precentral, and postcentral gyrus bilaterally. Across the GAD group, increased right amygdala volume was associated with prolonged reaction times on the tracking task (indicating increased attentional impairment following the induction) and lower scores on the ‘Act with awareness’ subscale of the Five Facets Mindfulness Questionnaire. Moreover in GAD, medial frontal cortical gray matter volume correlated positively with the ‘Non-react mindfulness’ facet. Lastly, smaller volumes of bilateral insula, bilateral opercular cortex, right supramarginal and precentral gyri, anterior cingulate and paracingulate cortex predicted the magnitude of autonomic change following the induction (i.e. a greater decrease in HRV). Conclusions Results distinguish neural structures associated with impaired capacity for cognitive, attentional and physiological disengagement from worry, suggesting that aberrant competition between these levels of emotional regulation is intrinsic to symptom expression in GAD.

Systematic information processing style and perseverative worry

This review examines the theoretical rationale for conceiving of systematic information processing as a proximal mechanism for perseverative worry. Systematic processing is characterised by detailed, analytical thought about issue-relevant information, and in this way, is similar to the persistent, detailed processing of information that typifies perseverative worry. We review the key features and determinants of systematic processing, and examine the application of systematic processing to perseverative worry. We argue that systematic processing is a mechanism involved in perseverative worry because (1) systematic processing is more likely to be deployed when individuals feel that they have not reached a satisfactory level of confidence in their judgement and this is similar to the worriers striving to feel adequately prepared, to have considered every possible negative outcome/detect all potential danger, and to be sure that they will successfully cope with perceived future problems; (2) systematic processing and worry are influenced by similar psychological cognitive states and appraisals; and (3) the functional neuroanatomy underlying systematic processing is located in the same brain regions that are activated during worrying. This proposed mechanism is derived from core psychological processes and offers a number of clinical implications, including the identification of psychological states and appraisals that may benefit from therapeutic interventions for worry-based problems.

Goal directed worry rules are associated with distinct patterns of amygdala functional connectivity and vagal modulation during perseverative cognition

Excessive and uncontrollable worry is a defining feature of Generalized Anxiety Disorder (GAD). An important endeavor in the treatment of pathological worry is to understand why some people are unable to stop worrying once they have started. Worry perseveration is associated with a tendency to deploy goal-directed worry rules (known as “as many as can” worry rules; AMA). These require attention to the goal of the worry task and continuation of worry until the aims of the “worry bout” are achieved. This study examined the association between the tendency to use AMA worry rules and neural and autonomic responses to a perseverative cognition induction. To differentiate processes underlying the AMA worry rule use from trait worry, we also examined the relationship between scores on the Penn State Worry Questionnaire (PSWQ) and neural and autonomic responses following the same induction. We used resting-state functional magnetic resonance brain imaging (fMRI) while measuring emotional bodily arousal from heart rate variability (where decreased HRV indicates stress-related parasympathetic withdrawal) in 19 patients with GAD and 21 control participants. Seed-based analyses were conducted to quantify brain changes in functional connectivity (FC) with the amygdala. The tendency to adopt an AMA worry rule was associated with validated measures of worry, anxiety, depression and rumination. AMA worry rule endorsement predicted a stronger decrease in HRV and was positively associated with increased connectivity between right amygdala and locus coeruleus (LC), a brainstem noradrenergic projection nucleus. Higher AMA scores were also associated with increased connectivity between amygdala and rostral superior frontal gyrus. Higher PSWQ scores amplified decreases in FC between right amygdala and subcallosal cortex, bilateral inferior frontal gyrus, middle frontal gyrus, and areas of parietal cortex. Our results identify neural mechanisms underlying the deployment of AMA worry rules. We propose that the relationship between AMA worry rules and increased connectivity between the amygdala and prefrontal cortex (PFC) represents attempts by high worriers to maintain arousal and distress levels in order to feel prepared for future threats. Furthermore, we suggest that neural mechanisms associated with the PSWQ represent effortful inhibitory control during worry. These findings provide unique information about the neurobiological processes that underpin worry perseveration.

The role of facial feedback in the modulation of clinically-relevant ambiguity resolution

Two experiments investigated the effect of facial expressions on clinically-relevant ambiguity resolution in a nonclinical sample. Experiment 1 investigated the effect of negative facial feedback (frowning) on a basic threat-interpretation bias procedure using a homophone spelling task and found that participants in a frowning condition interpreted significantly more threat/neutral homophones as threats than did participants in a neutral control condition. Experiment 2 investigated how frowning affected interpretation of bodily sensations. The findings indicated that participants in the frowning condition generated fewer positive consequences for bodily sensation scenarios and also rated the imagined bodily sensations as more negative and more of a cause for health concern. These effects could not simply be explained by differences in self-reported mood or by demand characteristics. These findings suggest that facial expressions have a moderating effect on the cognitive processes that contribute to clinically-relevant ambiguity resolution, and this has implications for clinical interventions.

The Effect of Facial Expressions on the Evaluation of Ambiguous Statements

The present experiment adapted the “Voluntary Facial Action” (VFA) technique (Dimberg & Söderkvist, 2011) to study the effect of facial expressions on the interpretation of ambiguity. This required participants to react with either the zygomatic major muscles (smile) or the corrugator supercilii muscles (frown) when exposed to different stimuli, some of which were ambiguous statements. While contracting the required facial muscles, participants also rated each stimulus on a negative-positive scale. Results indicated that participants contracting smiling muscles during ambiguous statements rated those statements as significantly more positive than participants contracting frowning-relevant muscles. This effect remained significant in participants who were unaware of the purpose of the experiment, and unaware that the experiment was related to mood. Previous studies have demonstrated that facial expressions can reflect the valency of a bias in responding to ambiguous stimuli (e.g. Neta, Norris, & Whalen, 2009), but the present study goes further by suggesting that facial expressions can actively influence the interpretation of stimuli as complex as verbal statements. Some of the implications for the way in which facial expressions may influence cognitive processes relevant to psychopathology are discussed.