Tim Dalgleish

Autobiographical Memory Specificity and Emotional Disorder

The authors review research showing that when recalling autobiographical events, many emotionally disturbed patients summarize categories of events rather than retrieving a single episode. The mechanisms underlying such overgeneral memory are examined, with a focus on M. A. Conway and C. W. Pleydell-Pearces (2000) hierarchical search model of personal event retrieval. An elaboration of this model is proposed to account for overgeneral memory, focusing on how memory search can be affected by (a) capture and rumination processes, when mnemonic information used in retrieval activates ruminative thinking; (b) functional avoidance, when episodic material threatens to cause affective disturbance; and (c) impairment in executive capacity and control that limits an individuals ability to remain focused on retrieval in the face of distraction.

The emotional brain

The discipline of affective neuroscience is concerned with the neural bases of emotion and mood. The past 30 years have witnessed an explosion of research in affective neuroscience that has addressed questions such as: which brain systems underlie emotions? How do differences in these systems relate to differences in the emotional experience of individuals? Do different regions underlie different emotions, or are all emotions a function of the same basic brain circuitry? How does emotion processing in the brain relate to bodily changes associated with emotion? And, how does emotion processing in the brain interact with cognition, motor behaviour, language and motivation?

Cognitive approaches to posttraumatic stress disorder: The evolution of multirepresentational theorizing

The evolution of multirepresentational cognitive theorizing in psychopathology is illustrated by detailed discussion and analysis of a number of prototypical models of posttraumatic stress disorder (PTSD). Network and schema theories, which focus on a single, explicit aspect/format of mental representation, are compared with theories that focus on 2 or more explicit representational elements. The author argues that the latter theories provide a more complete account of PTSD data, though are not without their problems. Specifically, it is proposed that at least 3 separate representational elements-associative networks, verbal/propositional representations, and schemas-are required to generate a comprehensive cognitive theory of PTSD. The argument that the development of multirepresentational cognitive theory in PTSD is a paradigm case for the development of similar theories in other forms of psychopathology is elaborated, and a brief agenda is proposed promoting 2 levels of theorizing-deep, formal theory alongside more localized, applied theory.

Biases of attention and memory in disorders of anxiety and depression

Abstract Theoretical frameworks and experimental paradigms derived from cognitive psychology provide a valuable approach to the investigation of cognitive aspects of disorders of anxiety and depression. Review of the literature provides strong evidence of attentional bias towards threat stimuli in anxiety, though evidence of comparable attentional bias in depression is weaker. There is also strong evidence of memory bias towards mood-congruent materials in depression, though comparable evidence regarding anxiety-congruent memory is mixed. A variety of theoretical frameworks for explaining such phenomena have been advanced, using concepts such as networks, schema and mental models. There is a need now for theoretical frameworks that address themselves to the specificity of the empirical phenomena. Clinical and empirical implications of these findings and models are discussed, including developments in diathesis-stress models of psychopathology, the use of experimental-cognitive paradigms in clinical assessment, and the prospect of therapeutic applications.

Reduced Specificity of Autobiographical Memory and Depression: The Role of Executive Control

It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1–4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6–8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.

Patterns of Processing Bias for Emotional Information Across Clinical Disorders: A Comparison of Attention, Memory, and Prospective Cognition in Children and Adolescents With Depression, Generalized Anxiety, and Posttraumatic Stress Disorder

This study investigated theoretical claims that different emotional disorders are associated with different patterns of cognitive bias, both in terms of the cognitive processes involved and the stimulus content that is preferentially processed. These claims were tested by comparing clinically anxious (generalized anxiety disorder [GAD], posttraumatic stress disorder [PTSD]) and clinically depressed children and adolescents on a range of cognitive tasks measuring attention, memory, and prospective cognition, with both threat-related and depressogenic stimulus materials. The results did reveal some relative specificity of processing in that the anxious participants exhibited a greater selective attentional bias for threat relative to depressogenic material with no such difference being apparent in the depressed sample. However, this bias was only clear-cut on a dot-probe measure of attentional processing and not on a modified Stroop measure, and indeed threat-related bias on the 2 tasks was uncorrelated. On the prospective cognition task, anxious participants exhibited an other-referent bias in their risk estimations regarding future negative events that was absent in the depressed sample. No specificity effects were evident on the memory task. The results are discussed in terms of the strengths and weaknesses of carrying out direct comparisons across groups and tasks versus drawing conclusions from overall patterns across multiple studies.

Listening to Your Heart How Interoception Shapes Emotion Experience and Intuitive Decision Making

Theories proposing that how one thinks and feels is influenced by feedback from the body remain controversial. A central but untested prediction of many of these proposals is that how well individuals can perceive subtle bodily changes (interoception) determines the strength of the relationship between bodily reactions and cognitive-affective processing. In Study 1, we demonstrated that the more accurately participants could track their heartbeat, the stronger the observed link between their heart rate reactions and their subjective arousal (but not valence) ratings of emotional images. In Study 2, we found that increasing interoception ability either helped or hindered adaptive intuitive decision making, depending on whether the anticipatory bodily signals generated favored advantageous or disadvantageous choices. These findings identify both the generation and the perception of bodily responses as pivotal sources of variability in emotion experience and intuition, and offer strong supporting evidence for bodily feedback theories, suggesting that cognitive-affective processing does in significant part relate to “following the heart.”

Functional Neuroanatomy of Body Shape Perception in Healthy and Eating-Disordered Women

BACKGROUND Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders. METHODS Brain responses to line drawings of underweight, normal weight, and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa, 13 with anorexia nervosa, and 18 healthy women. Participants rated the stimuli for fear and disgust. RESULTS In the three groups, the lateral fusiform gyrus, inferior parietal cortex, and lateral prefrontal cortex were activated in response to body shapes compared with the control condition (drawings of houses). The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects. Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women. In the group with eating disorders, the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex. CONCLUSIONS Processing of female body shapes engages a distributed neural network, parts of which are underactive in women with eating disorders. The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex.

A key role for similarity in vicarious reward

A functional magnetic resonance imaging study reveals the interactions within the brain that modulate feelings of reward on seeing a similar person win a contest. Humans appear to have an inherent prosocial tendency toward one another in that we often take pleasure in seeing others succeed. This fact is almost certainly exploited by game shows, yet why watching others win elicits a pleasurable vicarious rewarding feeling in the absence of personal economic gain is unclear. One explanation is that game shows use contestants who have similarities to the viewing population, thereby kindling kin-motivated responses (for example, prosocial behavior). Using a game show–inspired paradigm, we show that the interactions between the ventral striatum and anterior cingulate cortex subserve the modulation of vicarious reward by similarity, respectively. Our results support studies showing that similarity acts as a proximate neurobiological mechanism where prosocial behavior extends to unrelated strangers.

Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial

BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. METHODS In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. FINDINGS Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. INTERPRETATION We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.Solitary median maxillary central incisor (SMMCI) is a rare dental anomaly characterized by a symmetric central incisor of normal size, developed and erupted precisely in the midline of the maxilla in both primary and permanent dentitions. SMMCI may occur alone or be associated with other midline structures defects of the body or other systemic disorders. The best known association is holoprosencephaly (HPE). This paper reported a case of SMMCI that companied with other midline structures defects of the body.