J. Mark G. Williams

Are infants with autism socially engaged? A study of recent retrospective parental reports.

The purpose of this study was to identify the specific aspects of social engagement that distinguish infants with autism from infants of similar age and developmental level who do not have autism. Ten parents of preschoolers with autism and 10 parents of matched children without autism were given a semistructured interview, the Detection of Autism by Infant Sociability Interview (DAISI), which elicits reports on whether 19 aspects of social engagement characteristic of typically developing infants were present at some time during the childs first 24 months. The reports of infants with autism differed from those of the control group on 16 items. Findings suggest that infants with autism have marked limitation in both person-to-person and person-person-object social engagement, in keeping with the theory that autism involves impairments in primary as well as secondary intersubjectivity (Hobson, 1993a).

Cognitive mechanisms in the avoidance of painful and dangerous thoughts: Elaborating the Assimilation model

The emotional processing of problematicexperiences is a central feature of psychotherapy.Stiles et al. (1990) propose an Assimilation model as ageneric account of such processes. This paper focuses on two aspects of this model: the concepts of“warding off” and “unwantedthoughts” showing how a cognitive scienceperspective can enrich our understanding of them. Wefocus on the ways in which cognitive processes (particularly different sorts ofmemory) mediate between experience and psychopathology.Two classes of problematic experiences that can beavoided or barred from full awareness to varying degrees are distinguished. We refer to this distinctionas the “pain paradigm,” in which experiencesare inaccessible to memory retrieval using verbalmnemonics,versus the “panic paradigm,” inwhich experiences fail to be retrieved or reported because theperson anticipates catastrophic consequences. We discusshow understanding the cognitive origins of thesephenomena promises to allow researchers and therapists to generate new approaches to overcome blocksin therapy.

Specificity of autobiographical memory and mood disturbance in adolescents

The difficulty in retrieving specific memories to cue words on the autobiographical memory test has been found to be associated with a number of psychiatric disorders: depression, PTSD, obsessive-compulsive disorder, borderline personality disorder, and acute stress disorder, as well as certain forms of behaviour, notably parasuicide. This preliminary study extends the study of autobiographical memory into an adolescent population. Adolescents from a residential inpatient facility completed the autobiographical memory test alongside measures of depression and hopelessness. Their data were compared with normative data collected from a school sample. The clinical group, who were more depressed and hopeless than the normative comparison group, were less specific in their response to cue words on the autobiographical memory test. This result is comparable to that found in adult clinical groups. Unusually for studies of autobiographical memory, a positive correlation was found between specificity, depression and hopelessness in the clinical group, with the more depressed and hopeless participants being more specific. Recall of specific memories in response to negative cues tended to be associated with hopelessness in both males and females. Post-hoc analyses suggested that this was a consequence of a number of adolescents in the clinical group who had a history of parasuicidal behaviour tending to recall the same traumatic memory to more than one cue word.

Linehan's Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation

Dialectical Behaviour Therapy (DBT) is a structured, time-limited, cognitive behavioural treatment originally developed for Borderline Personality Disorder clients who have chronic parasuicidal problems. The therapy integrates individual psychotherapy with concurrent skills training, access to skills generalisation and team consultation for therapists. Initial outcome studies by Linehan and colleagues conducted in the US suggest that the therapy successfully lowers attrition rate, parasuicidal episodes and psychiatric in-patient days. The effect on parasuicidal behaviour and psychiatric inpatient days appear to outlast the therapy by at least a year. This paper overviews the therapy and examines how it may be used in day-to-day clinical practice in other cultural settings. We suggest that any adaptation or modification to DBT should be done in the context of a theoretical model of which psychological processes underlie the treatment effects and with due attention to the advantages and disadvantages of working within the NHS structure.Dialectical Behaviour Therapy (DBT) is a structured, time-limited, cognitive behavioural treatment originally developed for Borderline Personality Disorder clients who have chronic parasuicidal problems. The therapy integrates individual psychotherapy with concurrent skills training, access to skills generalisation and team consultation for therapists. Initial outcome studies by Linehan and colleagues conducted in the US suggest that the therapy successfully lowers attrition rate, parasuicidal episodes and psychiatric in-patient days. The effect on parasuicidal behaviour and psychiatric inpatient days appear to outlast the therapy by at least a year. This paper overviews the therapy and examines how it may be used in day-to-day clinical practice in other cultural settings. We suggest that any adaptation or modification to DBT should be done in the context of a theoretical model of which psychological processes underlie the treatment effects and with due attention to the advantages and disadvantages of wor...

Impairments in working memory associated with naturalistic dieting in women: No relationship between task performance and urinary 5-HIAA levels.

The present study investigated the question of whether the previously observed impairments of working memory characteristic of dieting to lose weight can be explained in terms of preoccupying cognitions relating to body shape or to alterations in serotonergic function resulting from a low dietary intake of tryptophan. The population comprised female non-dieting, lower restrained eaters (N=23), non-dieting higher restrained eaters (N=11) and current dieters (N=19). Each participant completed three tasks, each of which selectively loaded on to a different sub-component of working memory. The tasks comprised the Tower of London task, a letter string recall task and a mental rotation task. In addition, all participants completed self-report measures of body shape concern and affective state. Serotonin turnover was assessed by means of 24 h urine sample collection for each participant on their day of testing. This was analysed (via HPLC) for levels of the main serotonin metabolite 5-HIAA.The results of the present study broadly replicated previous findings of a Central Executive and Phonological Loop (but not Visuo-Spatial Sketchpad) deficit in those subjects who reported themselves to be currently dieting. Tower of London task performance also significantly correlated with self-reported feelings of fatness and body shape disparagement. There were no group differences in 5-HIAA levels nor did 5-HIAA levels correlate with task performance. However, there was a significant negative correlation between 5-HIAA levels and self-reported depression. These results support the hypothesis that the variables mediating this deficit are preoccupying cognitions concerning body shape. They do not support the hypothesis that the serotonergic function of dieters is compromised, although this conclusion is tentative.

Factors mediating suicidal behaviour: Their utility in primary and secondary prevention

Can we prevent suicidal behaviour? This paper reviews the evidence on what factors mediate both suicide and parasuicide. Sociodemographic factors including recent trends in age and sex ratios, impact of life events and difficulties such as unemployment, and the extent to which such behaviour may be imitative are examined. Psychiatric factors which affect vulnerability in people with different diagnoses are considered, and the depressive component is seen as the “final common pathway” of such conditions. Vulnerability rises when these variables are combined with psychological factors including difficulties in emotion regulation, hopelessness, and cognitive dysfunction (especially memory deficits) leading to poor problem solving. Research evidence suggests that teaching primary care agencies to be vigilant for signs and symptoms of depression may affect the probability of suicide, at least temporarily. The paper considers what some of the barriers to such vigilance might be. Finally, secondary prevention of...