"We don't really know what else we can do": Parent experiences when adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa.

BACKGROUND: Maudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child's eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents' experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment. METHODS: 13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents' experiences and identity negotiation. RESULTS: Key findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents' anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children. CONCLUSIONS: The structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child's ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents' psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.

Spatial compression: Dissociable effects at the time of saccades and blinks.

Various studies have identified systematic errors, such as spatial compression, when observers report the locations of objects displayed around the time of saccades. Localization errors also occur when holding spatial representations in visual working memory. Such errors, however, have not been examined in the context of eye blinks. In this study, we examined the effects of blinks and saccades when observers reproduced the locations of a set of briefly presented, randomly placed discs. Performance was compared with a fixation-only condition in which observers simply held these representations in working memory for the same duration; this allowed us to elucidate the relationship between the perceptual phenomena related to blinks, saccades, and visual working memory. Our results indicate that the same amount of spatial compression is experienced prior to a blink as is experienced in the control fixation-only condition, suggesting that blinks do not increase compression above that occurring from holding a spatial representation in visual memory. Saccades, however, tend to increase these compression effects and produce translational shifts both toward and away from saccade targets (depending on the time of the saccade onset in relation to the stimulus offset). A higher numerosity recall capacity was also observed when stimuli were presented prior to a blink in comparison with the other conditions. These findings reflect key differences underlying blinks and saccades in terms of spatial compression and translational shifts. Such results suggest that separate mechanisms maintain perceptual stability across these visual events.

Discrimination contours for moving sounds reveal duration and distance cues dominate auditory speed perception.

Evidence that the auditory system contains specialised motion detectors is mixed. Many psychophysical studies confound speed cues with distance and duration cues and present sound sources that do not appear to move in external space. Here we use the 'discrimination contours' technique to probe the probabilistic combination of speed, distance and duration for stimuli moving in a horizontal arc around the listener in virtual auditory space. The technique produces a set of motion discrimination thresholds that define a contour in the distance-duration plane for different combination of the three cues, based on a 3-interval oddity task. The orientation of the contour (typically elliptical in shape) reveals which cue or combination of cues dominates. If the auditory system contains specialised motion detectors, stimuli moving over different distances and durations but defining the same speed should be more difficult to discriminate. The resulting discrimination contours should therefore be oriented obliquely along iso-speed lines within the distance-duration plane. However, we found that over a wide range of speeds, distances and durations, the ellipses aligned with distance-duration axes and were stretched vertically, suggesting that listeners were most sensitive to duration. A second experiment showed that listeners were able to make speed judgements when distance and duration cues were degraded by noise, but that performance was worse. Our results therefore suggest that speed is not a primary cue to motion in the auditory system, but that listeners are able to use speed to make discrimination judgements when distance and duration cues are unreliable.

A mechanism for detecting coincidence of auditory and visual spatial signals.

Information about the world is captured by our separate senses, and must be integrated to yield a unified representation. This raises the issue of which signals should be integrated and which should remain separate, as inappropriate integration will lead to misrepresentation and distortions. One strong cue suggesting that separate signals arise from a single source is coincidence, in space and in time. We measured increment thresholds for discriminating spatial intervals defined by pairs of simultaneously presented targets, one flash and one auditory sound, for various separations. We report a 'dipper function', in which thresholds follow a 'U-shaped' curve, with thresholds initially decreasing with spatial interval, and then increasing for larger separations. The presence of a dip in the audiovisual increment-discrimination function is evidence that the auditory and visual signals both input to a common mechanism encoding spatial separation, and a simple filter model with a sigmoidal transduction function simulated the results well. The function of an audiovisual spatial filter may be to detect coincidence, a fundamental cue guiding whether to integrate or segregate.

Why trace and delay conditioning are sometimes (but not always) hippocampal dependent: a computational model.

A recurrent-network model provides a unified account of the hippocampal region in mediating the representation of temporal information in classical eyeblink conditioning. Much empirical research is consistent with a general conclusion that delay conditioning (in which the conditioned stimulus CS and unconditioned stimulus US overlap and co-terminate) is independent of the hippocampal system, while trace conditioning (in which the CS terminates before US onset) depends on the hippocampus. However, recent studies show that, under some circumstances, delay conditioning can be hippocampal-dependent and trace conditioning can be spared following hippocampal lesion. Here, we present an extension of our prior trial-level models of hippocampal function and stimulus representation that can explain these findings within a unified framework. Specifically, the current model includes adaptive recurrent collateral connections that aid in the representation of intra-trial temporal information. With this model, as in our prior models, we argue that the hippocampus is not specialized for conditioned response timing, but rather is a general-purpose system that learns to predict the next state of all stimuli given the current state of variables encoded by activity in recurrent collaterals. As such, the model correctly predicts that hippocampal involvement in classical conditioning should be critical not only when there is an intervening trace interval, but also when there is a long delay between CS onset and US onset. Our model simulates empirical data from many variants of classical conditioning, including delay and trace paradigms in which the length of the CS, the inter-stimulus interval, or the trace interval is varied. Finally, we discuss model limitations, future directions, and several novel empirical predictions of this temporal processing model of hippocampal function and learning.