A pilot feasibility trial of cognitive-behavioural therapy for insomnia in people with inflammatory bowel disease.

OBJECTIVE: Poor sleep is common in inflammatory bowel disease (IBD), associated with worse overall disease course and predominantly attributable to insomnia. While cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia, it is untested in IBD. It is unclear if CBT-I will be as effective in this group given the extent of night-time symptoms people with IBD experience. Thus, we evaluated the feasibility and preliminary efficacy of CBT-I in IBD. DESIGN: We comprehensively assessed sleep in people with mild-to-moderately active IBD using questionnaires, daily diaries and actigraphy. People with significant insomnia symptoms were allocated to a single-arm, uncontrolled pilot feasibility study of gold-standard CBT-I treatment. They were then reassessed post-treatment. RESULTS: 20 participants with IBD completed a baseline assessment. 10 were experiencing insomnia and were allocated to CBT-I. All participants who were offered CBT-I elected to complete it, and all completed 5/5 sessions. Participants rated treatment acceptability highly and daily diary and actigraphy completion rates were >95%. At baseline, participants with insomnia evidenced significantly worse sleep than participants without insomnia. Following CBT-I, participants reported significant improvements in diary and actigraphy measures of sleep continuity, dysfunctional sleep-related beliefs and IBD disease activity. CONCLUSION: CBT-I was feasible and acceptable and demonstrated a signal for efficacy in the treatment of insomnia in IBD. Importantly, the improvements in sleep continuity were consistent with the extant literature. Future fully powered randomised controlled studies should evaluate whether treatment of insomnia can improve other aspects of IBD, including pain and inflammation. TRIAL REGISTRATION NUMBER: NCT04132024.

Emotion regulation to idiographic stimuli: Testing the Autobiographical Emotion Regulation Task.

Mounting evidence suggests that the ability to regulate emotion is crucial for psychological well-being. However, one important limitation of prior emotion regulation studies is that they rely on standardized stimuli low in personal relevance. To address this limitation, the current study employed a novel event-related potential (ERP) paradigm designed to investigate the late positive potential (LPP) as a measure of emotional reactivity and regulation to idiographic stimuli in 49 young adults. The Autobiographical Emotion Regulation Task (AERT) is a word-viewing task in which participants identify neutral and emotionally-charged autobiographical memories and generate keywords unique to each memory. First, participants are instructed to simply view the keywords. Then, participants are presented with keywords from negative memories and are either instructed to react normally (react condition), or to use cognitive reappraisal to decrease negative emotion (reappraise condition). Results indicate that the LPP was potentiated when initially viewing keywords for negative compared to neutral memories. Furthermore, the LPP was reduced during reappraise compared to react trials, demonstrating successful down-regulation of neural activity to negative idiographic stimuli. These findings suggest that the AERT is a feasible and effective probe of emotion regulation to idiographic stimuli.

Hemoptysis in Pediatric Patients.

Hemoptysis is defined as the expectoration of blood or blood-tinged sputum. Blood-tinged sputum is a rare finding in the pediatric population. Finding the cause and treatment of the hemoptysis in pediatric patients is largely dependent on the history. In children, the most common causes of hemoptysis are infection and tracheostomy-related complications. Other causes include aberrant bronchial circulation, aspiration of foreign bodies, and bronchiectasis associated with cystic fibrosis. Due to the rarity of hemoptysis in pediatric patients, diagnosis and management of these patients can be difficult. It is important to refer to case reports and literature to best manage these patients. We report a case of a 3-year-old male patient who presented to the emergency department (ED) with a one-day history of hemoptysis. He presented with his adopted mother who was unable to provide a comprehensive past medical or family history other than stating that the patient has had recurrent bronchial infections since his adoption. She stated that the patient had only one episode of hemoptysis just prior to arrival. The patient did not appear to be in any respiratory distress and did not have any episodes of hemoptysis while in the ED. Due to his afebrile status and lack of evidence of current bleeding, the only intervention administered was an albuterol breathing treatment. He responded well to the breathing treatment and was discharged home with instructions to follow up with his primary care provider.

Neural Response to Pleasant Pictures Moderates Prospective Relationship Between Stress and Depressive Symptoms in Adolescent Girls.

Adolescent girls are at increased risk for depression, which is thought to result from the interaction of biological vulnerabilities and life stressors common to adolescent girls. A blunted late positive potential (LPP) to emotional stimuli (i.e., pleasant and unpleasant) has been associated with depressive symptoms and risk. The current study of adolescent girls examines the moderating effects of the LPP, a candidate biomarker of depression, of the link between life stress and increases in depressive symptoms over 1 year. We measured LPP to pleasant and unpleasant pictures from the International Affective Picture Set among 143 predominantly Caucasian adolescent girls ages 8 to 14, who also reported on the frequency of common life stressors. Self-reported depressive symptoms were assessed both at baseline and 1 year after the initial lab visit. The LPP to pleasant pictures moderated the relationship between baseline life stressors and the change in depressive symptoms. Specifically, life stress was associated with increases in depressive symptoms when the LPP to pleasant pictures was blunted, whereas life stress was associated with decreases in depressive symptoms when the LPP to pleasant pictures was potentiated. These effects showed some specificity to family and school-related stressors and to anhedonic and efficacy-related depressive symptoms. A similar pattern, though not statistically significant, was found for the LPP to unpleasant pictures. Together, these findings suggest that the LPP to pleasant pictures may represent a useful biomarker in identifying individuals at greatest risk of experiencing depressive symptoms following stress.

Extraversion, neuroticism, and the electrocortical response to monetary rewards in adolescent girls.

Affective personality traits, such as extraversion and neuroticism, are associated with individual differences in reward system functioning. The reward positivity (ΔRewP) is an event-related potential (ERP) component that indexes sensitivity to reward, and can be elicited by feedback indicating monetary gains relative to losses. In a sample of 508 adolescent girls, the current study examined the relationship between extraversion, neuroticism, and their respective facets and the ΔRewP. Results indicated an Extraversion × Neuroticism interaction, such that greater extraversion was associated with an increased ΔRewP, but only in the context of low neuroticism. This association was primarily due to the extraversion facet positive emotionality-high levels of positive emotionality were associated with an increased ΔRewP, but only in the context of low neuroticism. In addition, increased neuroticism diminished the age-related increase in the ΔRewP. The current study suggests that both extraversion and neuroticism are associated with reward system function in adolescence.

Unpredictability increases the error-related negativity in children and adolescents.

The error-related negativity (ERN) is a response-locked component in the event-related potential observed asa negative deflection 50-100ms following the commission of an error. An unpredictable context has been shown to potentiate amygdala activity, attentional bias toward threat, and the ERN in adults. However, it is unclear whether the impact of unpredictability on the ERN is also observed in children and adolescents. In a sample of 32 9-17year-old participants, we examined the influence of a task-irrelevant unpredictable context on neural response to errors. Participants completed a flanker task designed to elicit the ERN, while simultaneously being exposed to task-irrelevant tone sequences with either predictable or unpredictable timing. Unpredictable tones were rated as more anxiety provoking compared to the predictable tones. Fewer errors were made during unpredictable relative to predictable tones. Moreover, the ERN-but not the correct response negativity (CRN) or stimulus-locked N200-was potentiated during the unpredictable relative to predictable tones. The current study replicates and extends previous findings by demonstrating that an unpredictable context can increase task performance and selectively potentiate the ERN in children and adolescents. ERN magnitude can be modulated by environmental factors suggesting enhanced error processing in unpredictable contexts.

Reliability of the electrocortical response to gains and losses in the doors task.

The ability to differentiate between rewards and losses is critical for motivated action, and aberrant reward and loss processing has been associated with psychopathology. The reward positivity (RewP) and feedback negativity (FN) are ERPs elicited by monetary gains and losses, respectively, and are promising individual difference measures. However, few studies have reported on the psychometric properties of the RewP and FN-crucial characteristics necessary for valid individual difference measures. The current study examined the internal consistency and 1-week test-retest reliability of the RewP and FN as elicited by the doors task among 59 young adults. The RewP, FN, and their difference score (ΔRewP) all showed significant correlations between Time 1 and Time 2. The RewP and FN also achieved acceptable internal consistency at both time points within 20 trials using both Cronbach's α and a generalizability theory-derived dependability measure. Internal consistency for ΔRewP was notably weaker at both time points, which is expected from two highly intercorrelated constituent scores. In conclusion, the RewP and FN have strong psychometric properties in a healthy adult sample. Future research is needed to assess the psychometric properties of these ERPs in different age cohorts and in clinical populations.

Authoritarian parenting predicts reduced electrocortical response to observed adolescent offspring rewards.

Parenting styles are robust predictors of offspring outcomes, yet little is known about their neural underpinnings. In this study, 44 parent-adolescent dyads (Mage of adolescent = 12.9) completed a laboratory guessing task while EEG was continuously recorded. In the task, each pair member received feedback about their own monetary wins and losses and also observed the monetary wins and losses of the other member of the pair. We examined the association between self-reported parenting style and parents' electrophysiological responses to watching their adolescent winning and losing money, dubbed the observational Reward Positivity (RewP) and observational feedback negativity (FN), respectively. Self-reported authoritarian parenting predicted reductions in parents' observational RewP but not FN. This predictive relationship remained after adjusting for sex of both participants, parents' responsiveness to their own wins, and parental psychopathology. 'Exploratory analyses found that permissive parenting was associated with a blunting of the adolescents' response to their parents' losses'. These findings suggest that parents' rapid neural responses to their child's successes may relate to the harsh parenting behaviors associated with authoritarian parenting.

Depression risk and electrocortical reactivity during self-referential emotional processing in 8 to 14 year-old girls.

Cognitive vulnerabilities, such as a negative self-referential processing bias, have been theorized to play a causal role in the development of depression. Indeed, depression is associated with the endorsement and recall of more negative and fewer positive emotional words (i.e., recall biases) in the self-referential encoding task (SRET). In addition, currently depressed adults and adolescents, compared to healthy controls, show an enhanced late positive potential (LPP), an event-related potential (ERP) component that reflects sustained attentional engagement, during the processing of negative relative to positive words in the SRET. However, it is unclear whether these behavioral and neural measures in the SRET are indicators of risk for depression, or are concomitants of the disorder. The present study included 121 8 to 14 year-old girls with no lifetime history of depression, and examined the association between maternal history of depression (i.e., risk) and both behavioral and ERP measures while viewing positive and negative adjectives during the SRET. Lifetime history of major depressive disorder and/or dysthymia in the biological mother was assessed via a semistructured diagnostic interview. Results indicated that participants with maternal history of depression, compared with those with no maternal history of depression, demonstrated an enhanced LPP to negative words. There were no group differences in the LPP to positive words. Maternal history of depression was also related to faster response time when rejecting negative words. Participant's current depression symptoms were associated with increased negative recall bias and decreased positive recall bias. The present study provides novel evidence that abnormal electrocortical reactivity to negative self-referential words indexes vulnerability for depression in 8 to 14 year-old girls. (PsycINFO Database Record

Personality and emotional processing: A relationship between extraversion and the late positive potential in adolescence.

Neuroticism and extraversion are multifaceted affective-laden personality traits that have been associated with major depressive disorder (MDD). Research and theory have argued that extraversion, and particularly its facet positive emotionality, is specific to MDD, while neuroticism is common across internalizing disorders. Converging evidence has suggested that MDD is associated with reduced engagement with emotional stimuli, but it remains unclear whether either extraversion, neuroticism, or both modulate reactivity to emotional cues. The late positive potential (LPP) is an event-related brain potential that is uniquely suited to assess engagement with emotional stimuli because it reflects sustained attention toward emotional content. The current study examined the LPP in relation to personality traits that may confer risk for depression by examining the relationship between the LPP and both neuroticism and extraversion in never-depressed adolescent girls. Specifically, 550 girls aged 13.5-15.5 with no lifetime history of depression completed an emotional picture-viewing task, and the LPP was measured in response to neutral, pleasant, and unpleasant pictures. Personality traits were gathered via self- and informant report. Results indicated that high extraversion was associated with a potentiated LPP to emotional pictures-and this effect was accounted for by positive emotionality in particular. In contrast, there was no association between the LPP and neuroticism or its facets. The present study is one of the first to demonstrate that extraversion is associated with variation in neural indices of emotional picture processing, similar to what has been observed among individuals with depression and at high risk for depression.

Evaluation of group and individual change in a multidisciplinary pain management program.

OBJECTIVES: Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program. METHODS: The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change. RESULTS: Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment. DISCUSSION: The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.