Vividness of imagery and affective response to episodic memories and episodic future thoughts: a systematic review and meta-analysis.

Recalling personal past events and imagining personal future events are closely linked, yet also show differences. It has been claimed that episodic future thinking produces stronger intensity of in-the-moment affect than does recalling episodic memories [Schubert, T., Eloo, R., Scharfen, J., & Morina, N. (2020). How imagining personal future scenarios influences affect: Systematic review and meta-analysis. Clinical Psychology Review, 75, 101811. https://doi.org/10.1016/j.cpr.2019.101811]. In contrast, the literature indicates that memories are experienced more vividly than are episodic future thoughts, a quality that would be expected to produce a stronger rather than a weaker affective response. In this systematic review and meta-analysis, we examined (a) the intensity of affect, (b) the vividness and (c) the valence of emotion experienced in response to remembering personal past events compared to imagining personal future events. Sixteen studies with a combined sample of 1735 met criteria for inclusion. Remembered past events were experienced more vividly than imagined future events but there was no difference between the two types of representations on emotional intensity. Imagined future events were associated with more positive emotion than memories. Future research could examine factors responsible for the equivalent strength of emotional response in memories and future-thinking despite their differences in vividness.

Future-Directed Thinking and Its Relationship to Subjective Well-Being in Older Adults.

Age-related changes in future-directed thinking may be important for well-being. Older and younger adults generated idiographic anticipated experiences for the next week, the next year, and the next 5-10 years, using an adapted fluency measure. Relative to younger adults, older adults maintained a focus on the immediate future but frequency of anticipated events declined for the medium and longer term. The presence of negative thoughts for those two more distant time periods was related to lower life satisfaction in older adults. Content differences in thoughts illustrated the differing concerns of the two groups. The results align broadly with previous findings in the literature on socioemotional selectivity theory.

Evaluating Augmented Depression Therapy (ADepT): study protocol for a pilot randomised controlled trial.

BACKGROUND: While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Anhedonia (a loss of interest or pleasure) is a core symptom of depression which predicts a poor prognosis but has been neglected by existing treatments. Augmented Depression Therapy (ADepT) has been co-designed with service users to better target anhedonia alongside other features of depression. This mixed methods pilot trial aims to establish proof of concept for ADepT and to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost-effectiveness of ADepT, compared to an evidence-based mainstream therapy (Cognitive Behavioural Therapy; CBT) in the acute treatment of depression, the prevention of subsequent depressive relapse, and the enhancement of wellbeing. METHODS: We aim to recruit 80 depressed participants and randomise them 1:1 to receive ADepT (15 weekly acute and 5 booster sessions in following year) or CBT (20 weekly acute sessions). Clinical and health economic assessments will take place at intake and at 6-, 12-, and 18-month follow-up. Reductions in PHQ-9 depression severity and increases in WEMWBS wellbeing at 6-month assessment (when acute treatment should be completed) are the co-primary outcomes. Quantitative and qualitative process evaluation will assess mechanism of action, implementation issues, and contextual moderating factors. To evaluate proof of concept, intake-post effect sizes and the proportion of individuals showing reliable and clinically significant change on outcome measures in each arm at each follow-up will be reported. To evaluate feasibility and acceptability, we will examine recruitment, retention, treatment completion, and data completeness rates and feedback from patients and therapists about their experience of study participation and therapy. Additionally, we will establish the cost of delivery of ADepT. DISCUSSION: We will proceed to definitive trial if any concerns about the safety, acceptability, feasibility, and proof of concept of ADepT and trial procedures can be rectified, and we recruit, retain, and collect follow-up data on at least 60% of the target sample. TRIAL REGISTRATION: ISCRTN85278228, registered 27/03/2017.

Working adults' well-being: An online self-help goal-based intervention.

An online self-help goal-setting and planning (GAP) intervention to improve working adults' well-being was tested using a longitudinal, randomized crossover design. The study sought to (1) test the effectiveness of the intervention relative to wait-list controls; and (2) test the stability of effects over a 3-month follow-up period. Participants were recruited from the UK Civil Service and were randomized to either a GAP intervention or a wait-list control condition. Wait-list participants then crossed-over to receive GAP. Relative to wait-list controls (N = 149), GAP participants (N = 158) reported significantly higher levels of positive affect (PA) and flourishing, but similar levels of negative affect (NA) and life satisfaction immediately after the intervention. Longitudinal data were analysed for the whole sample (N = 307). Compared to the start of the intervention, participants reported an increase in PA and flourishing directly after the intervention and 3 months later. NA and life satisfaction showed no change by the end of the intervention, but had improved by 3-month follow-up. Completing more modules predicted post-intervention improvements in well-being, accounting for pre-intervention well-being levels. The online self-help format allowed the intervention to be offered with minimal therapeutic support, enabling convenient access by a large group of employees. The study provides an example of a successful adaptation of a clinically proven well-being intervention to make it accessible to working adults. PRACTITIONER POINTS: Well-being interventions proven in clinical settings can be effectively adapted for use in workplace settings with only minor alterations.Brief, online self-help interventions can improve working adults' well-being.Goal-based interventions can improve working adults' well-being when focused towards goals that are aligned with personal values and have been chosen by the individual.

Anismus, Physiology, Radiology: Is It Time for Some Pragmatism? A Comparative Study of Radiological and Anorectal Physiology Findings in Patients With Anismus.

PURPOSE: Anismus is a functional disorder featuring obstructive symptoms and paradoxical contractions of the pelvic floor. This study aims to establish diagnosis agreement between physiology and radiology, associate anismus with morphological outlet obstruction, and explore the role of sphincteric pressure and rectal volumes in the radiological diagnosis of anismus. METHODS: Consecutive patients were evaluated by using magnetic resonance imaging proctography/fluoroscopic defecography and anorectal physiology. Morphological radiological features were associated with physiology tests. A categorical analysis was performed using the chi-square test, and agreement was assessed via the kappa coefficient. A Mann-Whitney test was used to assess rectal volumes and sphincterial pressure distributions between groups of patients. A P-value of <0.05 was significant. RESULTS: Forty-three patients (42 female patients) underwent anorectal physiology and radiology imaging. The median age was 54 years (interquartile range, 41.5-60 years). Anismus was seen radiologically and physiologically in 18 (41.8%) and 12 patients (27.9%), respectively. The agreement between modalities was 0.298 (P = 0.04). Using physiology as a reference, radiology had positive and negative predictive values of 44% and 84%, respectively. Rectoceles, cystoceles, enteroceles and pathological pelvic floor descent were not physiologically predictive of animus (P > 0.05). The sphincterial straining pressure was 71 mmHg in the anismus group versus 12 mmHg. Radiology was likely to identify anismus when the straining pressure exceeded 50% of the resting pressure (P = 0.08). CONCLUSION: Radiological techniques detect pelvic morphological abnormalities, but lead to overdiagnoses of anismus. No proctographic pathological feature predicts anismus reliably. A stronger pelvic floor paradoxical contraction is associated with a greater likelihood of detection by proctography.

Total caseload of a colorectal surgical unit: baseline measurement and identification of areas for efficiency gains.

PURPOSE: Resource limitations are a concern in most modern public hospital systems. The aim of this study is to prospectively quantify the total caseload of a tertiary colorectal surgery unit to identify areas of redundancy. METHODS: Data was collected prospectively at all points of clinical care (outpatient clinic, inpatient referrals, operating theatre and endoscopy) between March 2014 and March 2015 using specifically designed templates. The final data was analysed using descriptive statistics. RESULTS: During the study period, 4012 patient episodes were recorded: 2871 in outpatient clinic, 186 as emergency patient referrals, 541 at colonoscopy and 414 at surgery. The largest component of the caseload was made up primarily of colonoscopy results follow-up, protocol review for previous cancer or polyps and post-operative review. Sixty-eight percent of these episodes did not result in any active intervention such as further tests or surgery. Most new outpatient referrals were undifferentiated, with the most common indications being minor rectal bleeding, non-specific gastrointestinal symptoms, and minor non-bleeding anorectal problems. Of the new referrals, 56 % were booked for a colonoscopy, and only 13.3 % were booked directly for elective surgery. CONCLUSION: A large component of the caseload of a tertiary colorectal surgery unit is made up of post-colonoscopy, post-operative, and surveillance protocol follow-up, with a significant proportion of patients not requiring any active intervention. The majority of new referrals are undifferentiated and result in a low rate of direct booking for operative intervention. Rationalisation of this resource using evidence-based methods could reduce redundancy, workload, and cost.

Future-directed thinking in first-episode psychosis.

OBJECTIVES: This study employed the Future Thinking Task (MacLeod et al., 2005, Br. J. Clin. Psychol., 44, 495) to investigate whether future-directed thinking in first-episode psychosis is significantly different from that of matched controls, and to identify its correlates in this patient group. DESIGN: Cross-sectional, mixed-model, case-control design. METHOD: Participants were 30 patients with first-episode psychosis and 27 matched controls. The Future Thinking Task was used to assess future-directed thinking in both groups. Anxiety and depression were also measured as well as self-report measures of hopelessness, suicide ideation and a measure of negative symptoms. RESULTS: Individuals with psychosis were impaired in future-directed thinking in both positive and negative domains, particularly with respect to the coming year. Increased self-reported hopelessness was associated with reduced positive future thinking and increased negative future thinking. Increased positive future thinking was also associated with reduced severity of negative symptoms, whilst negative future thinking was associated with suicide ideation. CONCLUSIONS: Individuals with first-episode psychosis show a reduction in positive future thinking in line with that seen in other clinical groups, but this is accompanied by an unexpected reduction in negative future thinking. The findings suggest a general disengagement with the future in this group that may affect recovery and functioning. PRACTITIONER POINTS: Individuals with first-episode psychosis may benefit from interventions to help them engage with their future, in particular in the mid-range, up to 1 year. The Future Thinking Task may be a helpful addition to the assessment of suicide risk in those with first-episode psychosis. Decreased positive future thinking was associated with increased severity of negative symptoms, indicating a potential new treatment angle for this resistant aspect of psychosis. The cross-sectional design of this study does not allow for conclusions about the causal relationship between psychosis and future-directed thinking. This study investigated future-directed thinking in individuals with a range of psychotic illnesses employing a trans-diagnostic approach; therefore, conclusions cannot be drawn about the nature of future-directed thinking in individual psychotic disorders.

Effective information management and assurance for a modern organisation during a crisis.

During a crisis, organisations face a major unpredictable event with potentially negative consequences. Effective information management and assurance can assist the organisation in making sure that they have the correct information in a secure format to make decisions to recover their operations. The main elements of effective information management and assurance are confidentiality, integrity and availability, combined with non-repudiation. Should an element of effective information management or assurance be removed it can have a detrimental effect on the other elements and render the information management and assurance practices of the organisation ineffectual.

Psychological Well-Being and Anticipated Positive Personal Events: Their Relationship to Depression.

UNLABELLED: Well-being is now defined in a number of multicomponent ways. One approach to defining well-being-psychological well-being (PWB; Ryff, )-encompasses six dimensions of positive functioning. This study's first aim was to compare PWB self-report scores from a group of depressed participants (N = 26) with a non-depressed group (N = 26). The second aim was to examine anticipated well-being, specifically, how the positive events people anticipate in the future are seen as being related to various aspects of their well-being. Participants completed the self-report scales of PWB and a task which elicited events participants were looking forward to in the future and their thoughts about what was good about those events. Responses about the value of the events were independently coded for the presence of the six PWB dimensions. The depressed group scored significantly lower on all dimensions of self-reported PWB than the control group, with particularly marked deficits on environmental mastery and self-acceptance. For anticipated events, positive relations with others was the most commonly present aspect of PWB in participants' responses about what was good about the events. The frequency of PWB dimensions present in participants' responses was similar between the two groups with the exception of the depressed group having more self-acceptance related responses and fewer positive relationship responses. The well-established lack of positive anticipation found in depressed individuals is likely to mean a diminished resource for a wide range of aspects of well-being but especially positive relationships with others. KEY PRACTITIONER MESSAGE: The treatment of depression is thought to be more effective when it enhances psychological well-being as well as reducing dysfunction. In the present study, all dimensions of psychological well-being were lower in depressed participants with particularly marked deficits in environmental mastery and self-acceptance, suggesting that these may be particularly important treatment targets. People with depression show specific deficits in being able to anticipate future positive events. The present study suggests that anticipated well-being linked to positive relationships with other people may be particularly impacted by the lack of anticipated future events found in depression.

The impact of communication on human behaviour in times of crisis.

Decision makers have constantly sought to find the most appropriate ways to use communication to influence behaviour during times of crises to assist in their recovery. This paper will investigate why policy makers wish to utilise effective crisis communications and explore the importance of crisis communication on influencing human behaviour in a time of crisis as well as the influence that the medium of communication can have. It will be noted that the medium of the message is important to ensure that the correct audience has been reached. This paper will suggest that, for decision makers to maximise the impact of crisis communications during a crisis, they must utilise rhetoric and cognitive response theory. It will also be suggested that the most importance factor in influencing behaviour in a time of crisis is that communications are provided from a credible source and are empathic in nature.

Underlying motivation in the approach and avoidance goals of depressed and non-depressed individuals.

Neurobiological theories predict decreased approach motivation and increased avoidance motivation in depression, but the results of previous studies have been equivocal. This study addressed a key limitation of previous research by assessing participants' underlying motivation for adopting their goals. Depressed (N=26) and non-depressed (N=33) participants listed approach and avoidance goals and wrote down their underlying reasons for adopting those goals. The groups did not differ on either the number of goals or underlying reasons but when underlying reasons were coded for approach or avoidance motivation depressed participants, compared to controls, showed less approach motivation and more avoidance motivation in relation to their approach goals. There were no effects related to avoidance goals. The results suggest that while the goals of depressed persons appear to be similar to those who are not depressed there are important differences at the level of underlying motivation.

A self-help, positive goal-focused intervention to increase well-being in people with depression.

Self-help interventions are an accessible, first-step treatment for depression. Well-being interventions focus on increasing people's resources and bringing about positive feelings and behaviours and could enhance self-help interventions for depression by increasing well-being as well as reducing depression. The present study tested the effectiveness of a self-help, well-being intervention (Goal-setting and Planning, GAP) in both increasing well-being and reducing depression within a sample from a depression self-help organization. We used a cross-over design, with half of the participants allocated to GAP (n = 26) and half to a wait-list control group (n = 29). After 5 weeks, the wait-list control group also received GAP. Compared with wait-list controls, those allocated to GAP showed an overall positive change, with individual significant decreases in negative affect and trends towards significant decreases in depression and increases in positive affect and life satisfaction post-intervention. Within a cross-over design, the wait-list controls also received GAP. In the whole sample that received GAP, there were significant increases in positive affect and life satisfaction and significant decreases in negative affect and depression, post-intervention and at 5-week follow-up, relative to baseline. These findings demonstrate that GAP is a useful intervention for people with symptoms of depression, influencing both levels of well-being and depressive symptoms.

Well-being, positivity and mental health: an introduction to the special issue.

Enhancing well-being, as opposed to reducing distress, has traditionally not been a focus for clinical practice. There are differences in views about the nature of well-being, but enhancing well-being in clinical settings is a straightforward goal whatever concept of well-being is adopted. Reasons for adopting a well-being enhancing, as well as a distress-reducing, focus include the fact that many psychological problems do not fit the simple acute treatment model of disorder, that positive experience inhibits negative experience, and that people can benefit from therapists seeing them as more than the sum of their problems. In recent years, well-being has been of increasing interest to researchers and clinicians, and enhancing well-being is emerging as a potentially valuable element of effective clinical practice.

Genetic copy number variation and general cognitive ability.

Differences in genomic structure between individuals are ubiquitous features of human genetic variation. Specific copy number variants (CNVs) have been associated with susceptibility to numerous complex psychiatric disorders, including attention-deficit-hyperactivity disorder, autism-spectrum disorders and schizophrenia. These disorders often display co-morbidity with low intelligence. Rare chromosomal deletions and duplications are associated with these disorders, so it has been suggested that these deletions or duplications may be associated with differences in intelligence. Here we investigate associations between large (≥500kb), rare (<1% population frequency) CNVs and both fluid and crystallized intelligence in community-dwelling older people. We observe no significant associations between intelligence and total CNV load. Examining individual CNV regions previously implicated in neuropsychological disorders, we find suggestive evidence that CNV regions around SHANK3 are associated with fluid intelligence as derived from a battery of cognitive tests. This is the first study to examine the effects of rare CNVs as called by multiple algorithms on cognition in a large non-clinical sample, and finds no effects of such variants on general cognitive ability.

Painful engagement in deliberate self-harm: The role of conditional goal setting.

Conditional goal setting is the tendency for people to see attainment of their future personal goals as necessary for their well-being. It has been argued that this represents an unhealthy way of relating to one's goals, as well as being particularly problematic when goals are perceived as unlikely. High conditional goal setting has been found to be related to depression and to hopelessness. The present study examined conditional goal setting in deliberate self-harm, where problematic thinking about the future is very prominent. A group of individuals attending hospital for a recent episode of deliberate self-harm (N=25) were compared with controls attending hospital for minor injuries (N=25) as well as a psychologically disordered but non-suicidal control group (N=25). Participants generated goals and rated goal likelihood, the extent to which those goals were seen as necessary for their future well-being (conditional goal setting), and also the extent to which the goals were seen as sufficient for their future well-being (goal sufficiency). Deliberate self-harm patients showed a higher degree of both conditional goal setting and goal sufficiency than did both of the other groups, further confirming the idea of painful engagement with personal goals, rather than disengagement, as characterising deliberate self-harm.

Severe hypomagnesaemia due to lansoprazole.

A 71-year-old woman, who had been taking lansoprazole for 18 months for dyspepsia, presented with vomiting, thought to be due to gallstones, and was found to have severe hypomagnesaemia. She was treated with intravenous and then oral magnesium, and discharged, but was soon readmitted with symptoms due to hypomagnesaemia, and again treated with magnesium supplementation. No other recognised cause for hypomagnesaemia was found. Because of recent reports of hypomagnesaemia due to other proton pump inhibitors, lansoprazole was changed to ranitidine. Her symptoms resolved and the serum magnesium returned to normal. Oral magnesium supplementation was stopped with no return of symptoms or hypomagnesaemia. Such an association must be borne in mind with suggestive symptoms in patients on long term proton pump inhibitors; their cessation or change to H(2) receptor antagonists is likely to correct the situation rapidly.

Runs of homozygosity in European populations.

Estimating individual genome-wide autozygosity is important both in the identification of recessive disease variants via homozygosity mapping and in the investigation of the effects of genome-wide homozygosity on traits of biomedical importance. Approaches have tended to involve either single-point estimates or rather complex multipoint methods of inferring individual autozygosity, all on the basis of limited marker data. Now, with the availability of high-density genome scans, a multipoint, observational method of estimating individual autozygosity is possible. Using data from a 300,000 SNP panel in 2618 individuals from two isolated and two more-cosmopolitan populations of European origin, we explore the potential of estimating individual autozygosity from data on runs of homozygosity (ROHs). Termed F(roh), this is defined as the proportion of the autosomal genome in runs of homozygosity above a specified length. Mean F(roh) distinguishes clearly between subpopulations classified in terms of grandparental endogamy and population size. With the use of good pedigree data for one of the populations (Orkney), F(roh) was found to correlate strongly with the inbreeding coefficient estimated from pedigrees (r = 0.86). Using pedigrees to identify individuals with no shared maternal and paternal ancestors in five, and probably at least ten, generations, we show that ROHs measuring up to 4 Mb are common in demonstrably outbred individuals. Given the stochastic variation in ROH number, length, and location and the fact that ROHs are important whether ancient or recent in origin, approaches such as this will provide a more useful description of genomic autozygosity than has hitherto been possible.