Neuropsychological Functioning in Chronic Lyme Disease

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.     

Conceptions of Relationships in Children with Depressive and Aggressive Symptoms: Social-Cognitive Distortion or Reality?

This research tested skill-deficit and cognitive-distortion models of depression and aggression in 615 fifth- and sixth-grade children. Children completed a measure of their generalized conceptions of relationships in the peer domain and their level of depressive symptoms. Teachers completed measures of social competence, social status, and aggression. As anticipated, children with higher levels of depressive symptoms, either alone or in combination with aggression, demonstrated more negative conceptions of both self and peers than did nonsymptomatic children. Conceptions of relationships did not differentiate between aggressive and nonsymptomatic children. Children with depressive symptoms and children with aggressive symptoms displayed unique profiles of social competence deficits and problematic status in the peer group. Analysis of the accuracy of children's conceptions of relationships revealed support for both skill-deficit and cognitive-distortion models. Consistent with a skill-deficit model, children with depressive and depressive-aggressive symptoms were sensitive to actual differences in their social status. In contrast, aggressive children showed an insensitivity to social cues. Consistent with a cognitive-distortion model, children with depressive and depressive-aggressive symptoms had more negative conceptions than would be expected given their social status, whereas aggressive-unpopular children demonstrated a self-enhancement bias. These findings indicate the importance of integrated cognitive-interpersonal models of depression and aggression that incorporate multiple pathways among social-cognitive, interpersonal, and emotional functioning.     

Self‐Harm Focus Leads to Greater Collective Guilt: The Case of the U.S.‐Iraq Conflict

Collective guilt from harm one's group has caused an out‐group is often undermined because people minimize or legitimize the harm done (i.e., they generate exonerating cognitions). When a group action has harmed both the in‐group and an out‐group, focusing people on “self‐harm”—ways in which the in‐group has harmed itself—may elicit more collective guilt because self‐harm is less likely to be exonerated. In Study 1, American participants who focused on how the invasion of Iraq had harmed the United States expressed greater collective guilt over harm inflicted on the people of Iraq than those who focused on Iraqi suffering. Study 2 showed that this effect is due to reductions in exonerating cognitions among people focused on self‐harm. We consider the implications of these findings for intergroup reconciliation, particularly in situations where two groups have been involved in open conflict.     

Influences on the Food Choice Behaviors of Adults With Severe Mental Illness

The objective of this research was to gain a deeper understanding of factors influencing the healthiness of food choice behaviors of community-dwelling adults with severe mental illness. Semi-structured interviews were conducted in an outpatient treatment facility with 20 program participants and 10 staff. Grounded theory analysis methods were used. Five dominant themes emerged: food availability, preference for simple food preparation, perceived cost of food, complexity of choice, and relative importance of healthy food choices. The theme of medication effects only emerged from staff interviews. This research can be useful to inform the design of nutrition interventions for this population.     

Perceived Occupational Concerns and Sensory Processing Patterns of Mothers in a Temporary Assistance for Needy Families (TANF)-to-Work Program

In this study, the authors examine the perceived occupational concerns, typical daily routines, and sensory processing of mothers in a mandatory Temporary Assistance for Needy Families return to work program. Participants were five female members of a transitional work program for single parents with mental illness. The Canadian Occupational Performance Measure and the Adult Sensory Profile were administered. The study found that the most frequently identified occupational problems were leisure and self-care. All participants scored as having at least one atypical sensory processing pattern. Future research should investigate the efficacy of an occupational therapy intervention on this population's return to employment.     

Occupational Therapy Interventions for Adults at the End of Life: A Systematic Review of Dignity Therapy

The objectives of this study were to determine the effects of dignity therapy, a psychological intervention for individuals with terminal illness, and to explore whether this is an appropriate occupational therapy intervention. A literature search produced 10 dignity therapy studies for review. Four reported positive effects (decreased anxiety, depression, suffering), one reported negative effects (decreased quality of life, increased depression), and five reported no effects. With its client-centered and occupation-based approach, dignity therapy aligns with the values of occupational therapy. Practitioners should explore dignity therapy as an intervention and direct future research toward examining its efficacy as part of a holistic treatment plan.     

Complexity of referrals to a specialist psychotherapy service

Consecutive referrals to a specialist psychotherapy service were analysed for complexity. Some 71% had a severe enduring mental illness or personality disorder. Two-thirds of the rest had added psychosocial or behavioural complexity. Only 9% had no severe enduring mental illness, personality disorder, or added complexity; nearly half of these had somatoform disorder. Only 2% of the patients had uncomplicated depression or anxiety disorders.

Patients treated in this psychotherapy service are substantially different from those on whom NICE bases its guidance for the treatment of depression and anxiety, and for whom IAPT was conceived, it functions as a de facto complex case service.     

Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity

Abstract

Prolonged Grief Disorder (PGD) is a debilitating syndrome of grief. A recent cognitive behavioral model asserts that three processes are critical to this condition: (1) insufficient integration of the loss with autobiographical knowledge about the self and the lost person; (2) negative cognitions; and (3) anxious and depressive avoidance behaviors. These processes are assumed to contribute to PGD symptoms and to mediate the influence of personality-related vulnerabilities on the development and maintenance of these symptoms. The present study examined the mediational role of these three processes in the linkage between neuroticism, attachment anxiety, and attachment avoidance on the one hand and PGD symptom severity on the other hand. Self-reported data from 348 bereaved people were used. The results showed that the three personality variables were significantly associated with PGD symptom severity. Moreover, the results provided support for the mediating effects of indices of insufficient integration, negative cognitions, as well as avoidance behaviors – even after controlling for the shared variance between mediators. Theoretical and clinical implications are discussed.     

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.