Experiences of Mindfulness-Based Cognitive Therapy for Premanifest Huntington's Disease.

BACKGROUND: Psychological difficulties such as anxiety, depression, and irritability are common in Huntington's disease, even for premanifest individuals. However, very little evidence exists of psychological approaches to manage this distress. We have conducted a feasibility study with an embedded qualitative component to investigate the possibility of using mindfulness-based cognitive therapy (MBCT) and present here the findings from the qualitative data. OBJECTIVE: To investigate the experience of premanifest individuals learning and practising mindfulness through completing a course of MBCT. METHODS: Twelve premanifest individuals completed a course of MBCT and attended three follow up reunion meetings over the following year. Eleven participants agreed to be interviewed post-course and ten participants one year post-course about their experience of the course and any impact on their lives. Seven participants nominated a friend or relative (supporter) to be involved in the research, of whom six agreed to be interviewed post-course and two at one year about the impact of the course on the participants. Data were analysed using reflexive thematic analysis. RESULTS: Four themes were constructed from the data: 1) A meeting of minds: the group facilitating learning and support; 2) Mindfulness is hard, but enables more effective emotional management; 3) Mindfulness can change the relationship with self and others; and 4) Benefiting from mindfulness: the importance of persistence. CONCLUSION: The participants who completed the course found it beneficial. Some participants reported reductions in psychological distress, a greater sense of calm and better emotion regulation, with some of these positive changes also noticed by supporters. MBCT is worthy of further investigation for this population.

A feasibility investigation of mindfulness-based cognitive therapy for people with Huntington's disease.

BACKGROUND: Huntington's disease (HD) is an inherited neurodegenerative condition which affects movement, coordination and cognitive functioning. Psychological difficulties are commonly experienced; however, psychological interventions have been little researched with this population. We investigated the feasibility of conducting a randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) with people with the HD genetic mutation, either pre-manifest (before onset of movement symptoms) or at an early disease stage. Specifically, we evaluated the willingness of participants to be recruited into and complete the intervention; the acceptability of the study measures in relation to completion; the feasibility of offering the standard MBCT course to people with HD; the acceptability of the intervention and the estimated effect sizes. METHODS: Participants were recruited from two UK HD centres and took part in an 8-week course of MBCT, with three reunions throughout the following year. Stress, depression, anxiety, and mindfulness were measured pre-, mid-, and post-course, at 3 months and at 1 year. Sleep, quality of life, positive affect and coping were measured pre- and post-course, at 3 months and at 1 year. Descriptive data and approximate effect sizes were calculated. Interviews were conducted post-course and at 1 year and data pertaining to the acceptability of the course were extracted. RESULTS: Twelve participants took part in two groups; all were pre-manifest. Levels of depression and anxiety were low pre-course leaving little room for improvement. Changes in stress and in some aspects of mindfulness were medium to large. The qualitative data suggested participants rated the course highly and found it helpful and no changes to the standard course were needed. Recruitment levels were below those anticipated. Most measures were found to be acceptable. CONCLUSIONS: Although the course was acceptable to those who took part, given the difficulties in recruiting and the rarity of HD, conducting an RCT of MBCT teaching groups in person does not seem feasible. However, alternative modes of course delivery (e.g. online) would allow the recruitment of people from a greater geographical area and may make an RCT feasible; this revised focus would be suitable for future feasibility studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02464293, registered 8 June 2015.

Can we make postoperative patient handovers safer? A systematic review of the literature.

Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care from the operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers. Twenty-four included recommendations for structuring the handover process or information transfer. Several recommendations were broadly supported, including (1) standardize processes (e.g., through the use of checklists and protocols); (2) complete urgent clinical tasks before the information transfer; (3) allow only patient-specific discussions during verbal handovers; (4) require that all relevant team members be present; and (5) provide training in team skills and communication. Only 4 of the studies developed an intervention and formally assessed its impact on different process measures. All 4 interventions improved metrics of effectiveness, efficiency, and perceived teamwork. Most of the papers were cross-sectional studies that identified barriers to safe, effective postoperative handovers including the incomplete transfer of information and other communication issues, inconsistent or incomplete teams, absent or inefficient execution of clinical tasks, and poor standardization. An association between poor-quality handovers and adverse events was also demonstrated. More innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes.

Contraction bias in memorial quantifying judgment: does it come from a stable compressed memory representation or a dynamic adaptation process?

A common response bias in psychophysical judgments is regression toward the mean (overestimation of small and underestimation of large values, or the response contraction bias). The same bias is observed in magnitude estimation from memorized quantities. Participants estimated alphabetic interval distances between 2 letters for different levels of interletter distances. The underestimated and overestimated values and the point of least error changed, depending on the level of alphabetic distances judged; furthermore, their estimation showed a progressively increasing tendency toward the mean, rendering the estimation progressively less accurate as the estimation task was repeated. We conclude that the regression toward the mean in memorial quantifying judgment derives from a cognitive adaptation process rather than from a permanent, compressed memory representation of the stimuli. Two opposing views on the adaptive meaning of this judgment bias are discussed.

How similar is false recognition to veridical recognition objectively and subjectively?

Three recognition memory experiments were conducted using modified Deese-Roediger-McDermott (DRM) and DRM paradigms. In Experiment 1, the reaction time (RT) of the false alarms to critical nonpresented words (false memory) was compared with the RT of hits to the critical presented words and with the RT of hits to the studied list words (true memory). The RT of the false alarms to the critical nonpresented words was significantly longer than that of the hits to the critical words and than that of the studied list words. In Experiment 2, in addition to RT, participants' confidence level was measured on a 4-point scale for a yes or no response. Confidence rating was significantly higher for the hits to the critical presented words and to the list words than for the false alarms to the critical non-presented words. Experiment 3 further showed that how similar false memory experience was to that of true memory was a function of retention size (number of lists of words retained in memory). In all three experiments, the participants' recognition RTs distinguished false memory from veridical memory, and in Experiments 2 and 3, so did their confidence ratings. Therefore, false memory and veridical memory differ at both the objective and the subjective levels. The results are consistent with a single familiarity dimension model of recognition memory.