James Gregory

Intrusive Images in Psychological Disorders: Characteristics, Neural Mechanisms, and Treatment Implications

Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy.

Intrusive memories and images in bipolar disorder.

Modifying intrusive memories and images is a powerful intervention in depression and anxiety disorders, but little is known about the presence of these intrusions in bipolar disorder. A semi-structured interview was administered to 29 euthymic patients with bipolar disorder, requiring them to report the intrusive memories and images recalled from their most recent episode of euthymia, depression and hypomania. Euthymia was characterised by intrusive memories of the past, which were less distressing than the memories experienced in depressed states. In addition to intrusive memories, depression was associated with vivid images focussed on death and suicide. Intrusive memories were rare in hypomanic states, which instead were characterised by vivid, enjoyable images of future events. Behaviours and emotions in different bipolar states may be amplified by characteristic intrusive memories and images, suggesting novel opportunities for therapeutic intervention. For example, intrusive images may be particularly important prodromal indicators and hence require greater emphasis in relapse-prevention programmes. Rescripting that incorporates negative elements into overly positive images may also be valuable in minimising the extent of hypomanic episodes.

Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis.

BACKGROUND Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. METHOD A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. RESULTS Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77-1.25), as well as at 6- and 12-month follow-up. CONCLUSIONS This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.

Overgeneral autobiographical memory and depressive symptoms in older adults: a systematic review

ABSTRACT Objectives: Overgeneral autobiographical memory (OGM) is a well-researched phenomenon in working age adults with depression. However, the relevance and importance of OGM in older adult depression is not well established. The aim of this review was to synthesise existing literature on OGM and depressive symptoms in older adults under the framework of the Capture and Rumination, Functional Avoidance and Impaired Executive Control (CaR-FA-X) model. Method: Literature searches were conducted using PsychINFO, PubMed and Web of Knowledge. Eighteen articles were reviewed. Results: OGM is elevated in healthy older adults compared to adults of working age, and further elevated in older adults with depression. Evidence supports the role of impaired executive function as a mechanism for OGM in older adults with depression, but no studies measured other components of the CaR-FA-X model (i.e. functional avoidance and rumination). Conclusion: OGM is prevalent in older adults and more so for those with depression; however, there is no clear understanding of the underpinning mechanisms. It is recommended that future research looks at the role of functional avoidance and rumination, and at the use of memory specificity interventions being developed in the working age adult literature.

Could a unified theory of cognition and emotion further the transdiagnostic perspective? A critical analysis using Interacting Cognitive Subsystems as a case example.

There is evidence that common processes underlie psychological disorders transdiagnostically. A challenge for the transdiagnostic movement is accounting for such processes theoretically. Theories of psychological disorders are traditionally restricted in scope, often explaining specific aspects of a disorder. The alternative to such ‘micro-theories’ is developing frameworks which explain general human cognition, so called ‘macro-theories’, and applying these systematically to clinical phenomena. Interacting Cognitive Subsystems (ICS) [Teasdale, J.D., & Barnard, P.J. (1993). Affect, cognition and change: Re-modelling depressive thought, Lawrence Erlbaum Associates, Hove] is a macro-theory which aims to explain aspects of information processing. The aim of this review is to examine whether ICS provides a useful platform for understanding common processes which maintain psychological disorders. The core principles of ICS are explained and theoretical papers adopting ICS to explain a particular psychological disorder or symptom are considered. Dysfunctional schematic mental models, reciprocal interactions between emotional and intellectual beliefs, as well as attention and memory processes, are identified as being important to the maintenance of psychological disorders. Concrete examples of how such variables can be translated into novel therapeutic strategies are given. The review concludes that unified theories of cognition and emotion have the potential to drive forward developments in transdiagnostic thinking, research and treatment.

Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis - CORRIGENDUM.

Please note that in the abstract we state that we follow the PRISMA guidance for systematic reviews; we would like to clarify some details. Firstly, we note that although our protocol was not published it was formally lodged in advance of the study with the University of Bath. Secondly, we did pre-specify all sub-group analyses in the protocol. We also note that we did not publish the full details of the search strategy for one specific database as per PRISMA guidance.