Natalie Kanakam

Motivating people with chronic pain to do physical activity: opportunities for technology design

Physical activity is important for improving quality of life in people with chronic pain. However, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity, make it difficult to maintain and build towards long-term activity goals. Research guiding the design of interactive technology to motivate and support physical activity in people with chronic pain is lacking. We conducted studies with: (1) people with chronic pain, to understand how they maintained and increased physical activity in daily life and what factors deterred them; and (2) pain-specialist physiotherapists, to understand how they supported people with chronic pain. Building on this understanding, we investigated the use of auditory feedback to address some of the psychological barriers and needs identified and to increase self-efficacy, motivation and confidence in physical activity. We conclude by discussing further design opportunities based on the overall findings.

Investigating Country Differences in Mobile App User Behavior and Challenges for Software Engineering

Mobile applications (apps) are software developed for use on mobile devices and made available through app stores. App stores are highly competitive markets where developers need to cater to a large number of users spanning multiple countries. This work hypothesizes that there exist country differences in mobile app user behavior and conducts one of the largest surveys to date of app users across the world, in order to identify the precise nature of those differences. The survey investigated user adoption of the app store concept, app needs, and rationale for selecting or abandoning an app. We collected data from more than 15 countries, including USA, China, Japan, Germany, France, Brazil, United Kingdom, Italy, Russia, India, Canada, Spain, Australia, Mexico, and South Korea. Analysis of data provided by 4,824 participants showed significant differences in app user behaviors across countries, for example users from USA are more likely to download medical apps, users from the United Kingdom and Canada are more likely to be influenced by price, users from Japan and Australia are less likely to rate apps. Analysis of the results revealed new challenges to market-driven software engineering related to packaging requirements, feature space, quality expectations, app store dependency, price sensitivity, and ecosystem effect.

The Appearance Anxiety Inventory: Validation of a Process Measure in the Treatment of Body Dysmorphic Disorder

BACKGROUND At present there are no measures to identify the cognitive processes and behaviours that might mediate the outcome of treatment in people with Body Dysmorphic Disorder (BDD). AIMS To develop and validate a process measure that can be used to assess the progress of patients throughout therapy and in research for BDD. METHOD The psychometric properties of the Appearance Anxiety Inventory (AAI) were explored in a clinical group of participants diagnosed with BDD (Study 1) and in a non-clinical community group with high appearance concerns (Study 2). Item characteristics, reliability, and factor structure were analysed. Convergent validity with measures of related symptoms was assessed. RESULTS The AAI was found to have good test-retest reliability and convergent validity in the measurement of appearance anxiety. It was also sensitive to change during treatment. The scale was found to have a two-factor structure in the clinical group, with one factor characterized by avoidance, and a second factor comprised of threat monitoring. However, in the community sample it appeared to have a one-factor structure. CONCLUSION The results suggest that the AAI has the psychometric properties to determine whether changes in cognitive processes and behaviours can mediate the outcome following treatment in patients with BDD. This supports its potential usefulness in clinical and research settings.

Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: A preliminary investigation in twins

Abstract Objectives. Weak central coherence and poor set shifting are risk markers for eating disorders that are present post recovery and in first degree relatives. The aim of this study was to examine these traits in twins with eating disorders. Methods. Neuropsychological tests were administered to 114 female twins (n = 53 met lifetime DSM-IV eating disorder criteria, n = 19 non-eating disorder cotwins and n = 42 controls). Within pair correlations for monozygotic (MZ) and dizygotic (DZ) twins were calculated and generalised estimating equations (GEE) compared probands, with non-eating disorder cotwins and controls. Results. The genetic basis was highest for the central coherence tasks (Rey–Osterrieth Complex Figure Task: MZ twins r = 0.44 [CI: 0.07–0.70, P = 0.01] and Group Embedded Figures Test: MZ twins r = 0.58 [CI: 0.26–0.79, P = 0.00]). Poor set shifting was related to obsessive compulsive symptoms in both individuals with eating disorders and their non-eating disorder cotwins (r = 0.2–0.5). Conclusion. Set shifting abilities and central coherence appear to be endophenotypes associated with eating disorders.

Social and Emotional Processing as a Behavioural Endophenotype in Eating Disorders: A Pilot Investigation in Twins

OBJECTIVES Emotional processing difficulties are potential risk markers for eating disorders that are also present after recovery. The aim of this study was to examine these traits in twins with eating disorders. METHODS The Reading the Mind in the Eyes test, Emotional Stroop task and the Difficulties in Emotion Regulation Scale were administered to 112 twins with and without eating disorders (DSM IV-TR eating disorder criteria). Generalised estimating equations compared twins with eating disorders against unaffected co-twins and control twins, and within-pair correlations were calculated for clinical monozygotic (n = 50) and dizygotic twins (n = 20). RESULTS Emotion recognition difficulties, attentional biases to social threat and difficulties in emotion regulation were greater in twins with eating disorders, and some were present in their unaffected twin siblings. Evidence for a possible genetic basis was highest for emotion recognition and attentional biases to social stimuli. CONCLUSION Emotion recognition difficulties and sensitivity to social threat appear to be endophenotypes associated with eating disorders. However, the limited statistical power means that these findings are tentative and require further replication.

Getting RID of pain-related behaviour to improve social and self perception: A technology-based perspective

People with chronic musculoskeletal pain can experience pain-related fear of physical activity and low confidence in their own motor capabilities. These pain-related emotions and thoughts are often communicated through communicative and protective non-verbal behaviours. Studies in clinical psychology have shown that protective behaviours affect well-being not only physically and psychologically, but also socially. These behaviours appear to be used by others to appraise not just a persons physical state but also to make inferences about their personality traits, with protective pain-related behaviour more negatively evaluated than the communicative behaviour. Unfortunately, people with chronic pain may have difficulty in controlling the triggers of protective behaviour and often are not even aware they exhibit such behaviour. New sensing technology capable of detecting such behaviour or its triggers could be used to support rehabilitation in this regard. In this paper we briefly discuss the above issues and present our approach in developing a rehabilitation system.

A review of cognitive neuropsychiatry in the taxonomy of eating disorders: State, trait, or genetic?

A greater understanding of neuropsychological traits in eating disorders may help to construct a more biologically based taxonomy. The aim of this paper is to review the current evidence base of neuropsychological traits in people with eating disorders. Evidence of difficulties in set shifting, weak central coherence, emotional processing difficulties, and altered reward sensitivity is presented for people both in the acute and recovered phase of the illness. These traits are also seen in first degree relatives. At present there is limited research linking these neuropsychological traits with genetic and neuroanatomical measures. In addition to improving the taxonomy of eating disorders, neuropsychological traits may be of value in producing targeted treatments.

Altered Reward Reactivity as a Behavioural Endophenotype in Eating Disorders

Altered reward reactivity is a potential risk endophenotype for eating disorders (EDs). The aim of this study was to examine reward reactivity in female twins with EDs and compare it with a twin control group. A sample of 112 twins [n = 51 met lifetime DSM-IV ED criteria (anorexia nervosa n = 26; bulimic disorders n = 24), n = 19 unaffected cotwins and n = 42 control twins] was administered measures assessing reward reactivity, including the Game of Dice Task, the Behavioural Inhibition/Activation (BIS/BAS) Scales and the Appetitive Motivation Scale (AMS). Within pair, correlations for monozygotic and dizygotic twins were calculated and generalised estimating equations compared probands with non-ED cotwins and controls. The BAS and the AMS were reduced in EDs and negatively associated with restrictive symptoms. In addition, monozygotic twins pairs demonstrated significant within pair similarity for the BAS and AMS. Conversely, there was less evidence to support the BIS or risky decision-making as measured by the Game of Dice Task as an endophenotype in EDs. Copyright

Altered Reward Reactivity as a Behavioural Endophenotype in Eating Disorders: A Pilot Investigation in Twins

Altered reward reactivity is a potential risk endophenotype for eating disorders (EDs). The aim of this study was to examine reward reactivity in female twins with EDs and compare it with a twin control group. A sample of 112 twins [n = 51 met lifetime DSM-IV ED criteria (anorexia nervosa n = 26; bulimic disorders n = 24), n = 19 unaffected cotwins and n = 42 control twins] was administered measures assessing reward reactivity, including the Game of Dice Task, the Behavioural Inhibition/Activation (BIS/BAS) Scales and the Appetitive Motivation Scale (AMS). Within pair, correlations for monozygotic and dizygotic twins were calculated and generalised estimating equations compared probands with non-ED cotwins and controls. The BAS and the AMS were reduced in EDs and negatively associated with restrictive symptoms. In addition, monozygotic twins pairs demonstrated significant within pair similarity for the BAS and AMS. Conversely, there was less evidence to support the BIS or risky decision-making as measured by the Game of Dice Task as an endophenotype in EDs. Copyright

Genotypes and Phenotypes of Anorexia Nervosa

At present Anorexia Nervosa (AN) is diagnosed on the basis of phenotypes which are specified in DSM IV. It is argued that the nosology of the current diagnostic criteria lacks an empirical basis. Furthermore diagnosis based on phenotypes can be problematic since the symptoms needed for a diagnosis of AN may be attenuated or absent. Also, symptoms may change over the course of the illness. Intermediate phenotypes such as biomarkers (a biological marker) and endophenotypes may provide additional means to describe and identify these disorders. A variety of biomarkers or endophenotypes have been identified including: abnormalities in brain serotonin and dopamine networks; neuropsychological deficits, which include difficulties in executive function such as set-shifting and weak central coherence; and changes in the structure of the brain. Genes that make an individual susceptible to AN have also been investigated using linkage and association studies. Several loci have been identified which relate to serotoninergic, dopaminergic, opioidergic, and BDNF systems. At present many of these studies have been hampered by methodological limitations. Nevertheless, treatments tailored towards these traits are already being tested and show promise. It is hoped that continued investigation to identify potential biomarkers of AN may facilitate the early diagnosis and perhaps be of value in terms of prevention.