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COGNITION AND EMOTION
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Barnard 0.75, Levey 1.0, MacLeod 1.84, Mathews 2.60, Nimmo-Smith 0.75, Teasdale 5.0, Watts 4.25, Williams 1.67, A Young 0.43, Dritschel (SO) 0.75, Hutton (SO) 1.08, Lloyd (SO) 0.6, Milroy (HSO) 2.0, Scott (SO) 0.15, Taylor (HSO) 1.75
Total Person Years: Scientists 18.3; Research Support 5.9
Abstract
Objectives
Work in this programme aims to investigate the cognitive processes that are involved in the elicitation, maintenance, and control of normal and abnormal emotional states. This knowledge is applied to the development and evaluation of psychological treatments for emotion-related disorders. With regard to anxiety and worry, the goal is to characterise the processing of emotionally-threatening information, differences between anxious and non-anxious individuals, the role of threat-related biases in maintaining anxious mood, and the extent to which these processes are automatic and invariable, or are modifiable in nature. Work in depression aims to develop and evaluate information-processing accounts of the nature of mood-dependent negative thinking and its role in the onset and maintenance of depression, and to study ways in which negative thinking and affect can be brought under attentional control. The resulting knowledge is applied to understand how psychological treatments prevent depressive relapse and to develop and evaluate improved treatments. The objective of research on the recognition of emotion is to fractionate components of the perception of emotional expression, to determine the relation between processing of facial emotional expression and both vocal expression and personal identity, and to investigate cognitive and emotional components of delusions, especially delusional misidentification.
Scientific progress and achievements over the past five years
Work in anxiety and worry has suggested that these states are associated with increased attention to threatening information in the environment; for example, threatening distractors may capture attention in anxious subjects, even when the emotional stimuli are presented outside awareness. In non-clinically anxious subjects, interfering effects of threatening material were modified by experimental manipulations, and in anxious patients, interference was no longer apparent after recovery; these results suggest a degree of plasticity of threat-related biases, of obvious therapeutic relevance. Although given greater attentional priority, threatening words were not found to be especially well recalled by anxious subjects, suggesting that the subjects may inhibit elaborative processing of threat-related material. Relatedly, heightened subjective risk for negative events in anxious subjects was found to be associated with difficulties in generating reasons why such events would not happen. The overall pattern of anxiety-related biases observed could act to maintain anxious mood and increase vulnerability to emotional disorder.
Comparisons of worriers and insomniacs have shown clear dissociations between concerns about sleep and other concern-related cognition. A novel cognitive treatment of insomnia has been piloted.
A comprehensive information-processing account of cognitive-affective interaction in depression has been developed that resolves difficulties in the existing experimental and clinical literature. Counterintuitive predictions from this account have been confirmed, suggesting that depressive cognitive biases result from shifts in generic schematic mental models, rather than changes in accessibility of individual constructs. Methods to assess affect-related schematic mental models have been developed and evaluated. Production of stimulus-independent thought has been shown to depend on central executive resources of working memory. Overgeneral memory deficit in depression has been shown to be associated with poor problem-solving, difficulty in generating images of prospective events, and poor clinical prognosis. A collaborative clinical trial of cognitive therapy for residual depressive chronicity has been mounted, including new measures of cognitive mediating variables. A new form of attentional control treatment to prevent depressive relapse has been developed and shown to be acceptable and applicable.
Neuropsychological investigations on the recognition of emotion have demonstrated that processing of facial expression and processing of identity from the face are independent.
Future plans for the next five years
Studies in high-anxious normal and patient subjects will investigate the following specific components of a model of cognitive bias in anxiety/worry: (i) early non-conscious detection of threat (ii) implicit perceptual encoding of threatening stimuli (iii) intentional inhibition of elaborative encoding (iv) the extent to which instructional control is possible, and (v) the role of schematic learning.
Studies in depressed patients and (high neuroticism) individuals vulnerable to depression will investigate aspects of the theoretical model of affect maintenance/regulation developed in the current grant period: (i) the nature of depression-related schematic models and their influence on thinking (ii) the role of central executive resources in the maintenance of affect and in affective re-appraisal (iii) the voluntary redeployment of central attentional resources in the regulation of affect (iv) the cognitive mediation of any prophylactic effects of cognitive therapy observed in the collaborative clinical trial (v) the development of more cost-effective methods to prevent relapse following treatment for the presenting episode of depression.
Investigations on the recognition of emotion will clarify whether facial expression processing is implemented by neural mechanisms which are face-specific or supramodal, and whether these are emotion-specific or used in all forms of social interaction. Neuropsychological case studies of impairments in expression processing after bilateral amygdalotomy and frontal lobe lesions will be combined with studies of priming and related effects on the recognition of facial expressions by normal people. Deficits predicted from theoretical models of delusional misidentification will be investigated.
Implications for improving health, health care and wealth creation
Mental Illness is a Health of the Nation Priority Area, and Prevention of Relapse and Recurrence in Depression is a Health Department R and D Priority Area. Work on anxiety and depression provides a basis for developing objective methods to assess risk of developing emotional disorders and for improving interventions to reduce risk of onset and relapse. In depression, the effectiveness and mechanisms of action of an existing method of treatment (cognitive therapy) are being investigated, and a novel preventive intervention is being developed. Work on face and emotion recognition should lead to improved understanding of social disabilities due to brain injury, dementing and psychiatric illnesses. Increasing the effectiveness and efficiency of treatments for emotional disorders also has potential for considerable wealth savings as the social and familial costs of these frequent disorders are considerable: in a study by Wells et al. (1989), measures of functioning showed significantly greater disability in depression than in six out of eight major chronic medical conditions with which it was compared
NATURE OF COGNITIVE BIAS AND COGNITIVE CONTENT IN WORRY AND ANXIETY (Dalgleish, Mathews, Watts, Williams)
Introduction
The purpose of this project is to characterise the manner in which emotionally threatening information is processed, and how these processes differ between anxious and non-anxious individuals. It builds on previous work in which it has been demonstrated that anxious individuals (clinical patients and, to a lesser extent, normal subjects who are often anxious) differ in several important respects from non-anxious controls. These differences include: elevated estimations of the risk of future negative events; selective attention to threatening stimuli; greater interference on task performance from threatening distractors that are incidentally present; and selection of the more threatening interpretation of ambiguous events (Williams et al., 1988). The evidence for equivalent effects in memory, however, is mixed and contradictory: anxious patients do recall more such personally threatening events in tests of autobiographical memory, but do not consistently recall more threatening stimuli in experiments when extent of exposure is controlled. On the basis of these results, Mathews & MacLeod (6.66) have proposed that anxiety-related biases in the processing of emotional information are such as to increase the intake of information from the environment that is related to possible danger, although not always in a form that can be consciously recalled. Furthermore, it is possible that this encoding bias could play a role in maintaining anxious mood and/or increasing vulnerability to emotional disorder under stressful conditions.
A Nature of Interference Effects due to Threatening Distractors(Mathews)
Robust interference effects have been found in the speed of colour-naming emotional words, such that anxious patients are slowed by the presence of words related to the content of their worries and concerns. There are several possible mechanisms that could account for this effect, including an automatic (pre-attentive) decision mechanism that allocates processing priority to some emotional words, or a conscious (post-attentional) process in which subjects voluntarily focus on the words or their implications.
A1. Paradoxical Suppression of Interference by Fear Arousal: The presence of a controllable component in the emotional interference effect is suggested by three experiments on normal subjects with fears of non-poisonous snakes. Attempting to replicate the slowing due to phobic words documented earlier (Watts, McKenna, Sharrock & Trezise, 1986), Mathews and Sebastian (6.30) unexpectedly failed to find any interference in mildly phobic subjects when tested in the presence of a harmless snake. Interference was re-established in a second experiment without a snake present, with phobic but not control subjects being slower to name the ink colour of snake-related words. Finally, in a third experiment, induction of fear by another means (the presence of a large but harmless tarantula) also abolished interference due to snake-related words. It was concluded that under conditions of fear arousal, non-clinical subjects may be able to prevent the allocation of processing priority to the relevant words.
A2. Interference Without Awareness in Anxious Patients: In other experiments (6.65) interference due to threatening words in anxious patients persisted even under conditions that prevented subjects being aware of the nature of the relevant words. In a further study, words were presented either for 16ms and followed by a mask that prevented subjects from being able to read them, or the words remained visible until the background colour was named. In both cases, anxious patients were slowed by the presence of threatening words, but depressed patients and controls were not (6.31). Since the extent of interference was not affected by exposure condition, it would appear that the processes causing interference are not under direct conscious control. Two conclusions are possible: either subjects can control interference provided that they are aware of the words, or such post-awareness control is possible for normal subjects but not for anxious patients. The latter seems more likely, because patients do not seem able to prevent interference, despite high levels of current anxiety. The emerging hypothesis, therefore, is that high-anxious normals can effortfully counter-act the effect of interfering emotional stimuli of which they are aware, but that this control is reduced or lost with the onset of an anxiety disorder.
B. Memory for Threatening Events and Reactions (Watts, Dalgleish, Coyle)
Other results suggest that effortful control processes might help to explain the mixed findings of mood-congruent memory experiments in anxious subjects. Normal subjects reporting fear of harmless spiders, shown words that were either neutral or related to spiders, later recalled fewer fear-related than neutral words. In a second experiment, fearful subjects recalled fewer spider-related words than did controls, but only when tested in the presence of a live spider (6.47). Despite their poor recall, these subjects had a number of intrusion errors related to spiders, suggesting that they had encoded the words in terms of general emotional category, rather than the exact form that was presented. In two further experiments, this bias against threatening words proved difficult to replicate, and there were no consistent differences between groups either for spider-related or for fear-response words (6.44, 6.45). Overall, consistent with previous findings, these results confirm that anxious subjects do not usually show enhanced recall of fear-related words, perhaps because they encode by generic emotional meaning, and avoid processing other details.
C. Effects of Treatment on Cognitive Bias(Mathews)
The hypothesis advanced earlier, to the effect that interference from threatening cues can be inhibited by high-trait anxious normals but not by currently anxious patients, suggests that control over interference effects may return following successful treatment. The alternative view, that interference is independent of current state, would predict that effects would persist beyond apparent recovery. To examine this issue, patients were assessed before and after anxiety management training, using measures that had previously been found to distinguish them from normal controls. Before treatment, anxious patients (but not controls) were significantly slowed by threatening distractors, both in colour-naming and during attentional search for a neutral target. After treatment, and at follow-up, no significant interference effects remained, and there were no differences in this respect between recovered anxious and control subjects (6.29). This outcome is taken as provisional support for the view that attentional interference from threat distractors is not invariably present in anxiety-prone subjects, but depends on current state factors (e.g. mood or stress) that elicit a vigilant processing style in vulnerable individuals. This hypothesis predicts that stressful events would re-instate interference and other vigilance effects in recovered patients, but not in low anxiety-prone subjects.
D. Cognitive Characteristics of Worry
Self-report of excessive worry is the main symptom required for a DSM III diagnosis of generalised anxiety disorder, as well as being an important component of many other emotional disorders. Subjects recruited from advertisements for "worriers" typically report levels of anxiety in the low clinical range, and many have sought help for anxiety symptoms in the past. The nature of excessive worry therefore seems worthy of further study, both in its own right, and to establish whether these worry-prone subjects show the same processing style that has been found in anxious patients.
D1. Worry and Subjective Risk (MacLeod, Williams, Bekerian, Mathews): Anxious and depressed patients estimate the risk of hypothetical negative events happening to them in the future as significantly higher than do normal controls. This inflation of risk was investigated by requiring subjects, who were either high- or low-frequency worriers, to think about possible future events, and to list reasons why these events might or might not happen to them. Consistent with expectations, worriers always revealed higher subjective probabilities for negative events, and the most anxious among them also had greater difficulty in generating reasons why such events would not happen to them. When they did generate such reasons, however, this reduced their subjective risk estimates, although these remained higher than for non-worriers, whose estimates were unchanged (6.23).
In another study, subjects imagined a series of positive or negative events and generated reasons why they might happen. This manipulation induced mildly positive or negative mood state, depending on valence of the events, together with an elevation in subjective risk for all other events of the same valence. Two further experiments demonstrated that this elevation in subjective risk was made up of two components: a global effect on the perceived risk for all mood-congruent events, and a specific priming effect associated with greater elevations in the risk of events that subjects had thought about (6.8). In general, these results support the hypothesis that worry about a topic increases the subjective risk that the feared event will actually occur, and may thus serve further to increase anxiety.
D2. Worry and Speed of Access to Negative Meaning (Mathews, Milroy): The above results, and related findings obtained with anxious patients, suggested that frequent worriers should be highly practiced in perceiving the negative meaning of events. This was tested in three experiments in which subjects made a variety of speeded affective judgements about threatening or non-threatening words. Contrary to prediction, no significant differences were found between high- and low-frequency worriers. Frequency of worry is thus not associated with accessibility of negative meaning, at least in the case of simple verbal stimuli, but may depend on other automatic processes that are unrelated to these conscious judgements (6.28).
D3. Effect of Instructions on Worry (Mathews, Milroy): Instructions not to think about a topic have been claimed to result in a later paradoxical rebound in the unwanted thought. Since this suggests that treatments based on suppressing worry might be counter-productive, instructions not to worry about a specified topic for five minutes were compared to two control conditions: one in which high- and low-worry subjects were told to worry about a specified topic for the same time, and one in which they were asked to think about another interesting and pleasant topic. In the 20 minutes following, when no special instructions were in effect, subjects were periodically interrupted for a report on mental content. The main result was that the high-worry subjects always reported more negative content, regardless of condition, but the suppression condition was followed by slightly increased frequencies of pleasant thoughts (6.27). It is concluded that treatments involving suppression of worry are more likely to be helpful than harmful.
Conclusions
The studies summarised above suggest the following conclusions: (a) Emotional interference effects can persist even when threatening stimuli are presented outside awareness. With awareness, interference may be inhibited under some conditions in non-clinical fearful subjects, but probably not in anxious patients. (b) Despite causing interference, threatening words are not better recalled by anxious subjects, perhaps due either to generic emotional encoding, or avoidance of elaboration. (c) After people recover from an anxiety state, interference from threatening stimuli is no longer apparent. Further research is needed to determine the limits of this change. (d) Preliminary investigations show that subjects describing themselves as "worriers" are similar to anxious patients in having increased subjective risk of negative events, but despite this, do not have faster conscious access to negative meanings. Suppression of worry, and generation of reasons why negative events might not happen, could be explored for therapeutic potential in future research.
FUTURE PROPOSALS
Introduction: Selective Encoding of Emotional Information in Worry and Anxiety States
Earlier research has shown that individuals prone to anxiety (whether within clinical or high-trait anxious normal populations) selectively process information relating to threat or danger, in comparison with non-anxious controls. Anxious subjects attend to threatening words in preference to other competing information, and select the more threatening interpretation of ambiguous events (6.66). These selective processes occur even when the relevant stimuli are presented under conditions that prevent subjects being fully aware of them, implying that at least some of the processes involved are automatic and non-conscious in nature. In contrast, anxious subjects are not necessarily better at remembering threatening stimuli in "explicit" tests of memory, although there are some indications that they are primed more strongly in "implicit" tests, when subjects are not attempting to recall but performance will be facilitated by prior exposure. The implication is that anxiety-prone subjects are biased towards processing information in a manner that will enhance the impression of being in danger, without necessarily being able to recall or even be aware of the cues that evoke this impression. Thus, even if an anxiety state has its origins elsewhere, the associated pattern of selective processing will tend to enhance vigilance and anxious expectation (worry), and in this way serve to maintain anxious mood.
The emerging hypothesis is that anxiety is characterised by a "vigilant" operating mode of the cognitive system, in which processes involved in the detection of threat are facilitated, and others are inhibited. In vigilant mode, threatening components or aspects of events are automatically selected at an early (pre-attentive and non-conscious) stage, and are subsequently given priority for attentional resources in preference to competing stimuli. In addition, perceptual properties of threatening events are selectively encoded, thus priming subsequent detection of the same event. However, because anxious subjects may try to reduce distress by inhibiting conscious processing (such as elaborative thought about the details of the threat), the event will not be well encoded in other ways. The hypothesis thus predicts that anxiety-prone individuals will encode events according to the following sequence: (i) an early automatic mechanism detects threatening aspects of a stimulus; (ii) these aspects are then given attentional priority over competing aspects; (iii) perceptual properties of the threatening stimulus are preferentially encoded; (iv) further semantic processing may then be inhibited with varying success; (v) the same process will then be re-enacted more fluently when related cues are encountered again, without requiring the subject's awareness or intent.
Non-anxious individuals do not selectively encode mildly threatening stimuli in the same way, and are either attentionally indifferent, or more attentive to positive stimuli. It is assumed, however, that if more intense stimuli signalling imminent danger are detected, then all subjects become vigilant. That is, normal subjects are assumed to react in an adaptive way, dependent on the current state of danger, while high anxiety-prone subjects remain chronically in a vigilant mode. A final part of this hypothesis is that the main coping strategy available to a high-trait anxious individual is the inhibition of conscious rehearsal, by using distraction from, or efforts to suppress, upsetting thoughts. Since such coping strategies are effortful (in that they call on limited cognitive resources), they will eventually fail if anxious mood and/or perceived threats become too severe. This eventual failure is postulated to correspond to the onset of clinical disorder. Progress in establishing or refuting these hypotheses is therefore likely to provide clues as to what methods should reduce excessive levels of anxiety or worry and the risk of developing emotional disorders.
Because previous research has already provided strong evidence for selective attentional and interpretive bias in anxiety-prone subjects, future work will focus on the remaining parts of the hypothesis. In each study the performance of anxious subjects will be contrasted with that of matched controls, on experimental tasks that require processing emotionally threatening and neutral information. Subject groups will be selected using questionnaires measuring trait-anxiety, negative emotionality, or frequency of worry, from among our existing panel (some of whom have been recruited using newspaper advertisements requesting volunteers who have problems with excessive anxiety and worry), or from among patients being treated elsewhere for anxiety disorders (we are currently investigating collaboration in this respect with the Department of Psychology at the Institute of Psychiatry, London).
A. Early Detection of Threatening Meaning (Mathews, Milroy)
It was predicted above that high-anxious subjects should be more sensitive to the threat value of stimuli than controls, even at the earliest (pre-attentive) stage of processing. This hypothesis derives from the finding that threatening words slow performance in anxious subjects even when the interfering stimuli are presented out of attention (6.66) or awareness (6.53). However, in three preliminary experiments (6.28) no differences were found between anxious and non-anxious groups in speed of making affective decisions for threatening words (e.g. cancer: good or bad?). This result appears paradoxical, as it is difficult to understand why anxious (but not control) subjects show differential interference reactions to threatening words, if there are no differences in their assessment of stimulus threat value. Several alternative explanations will be considered.
(1) It may be that anxious subjects are faster in detecting threat pre-attentively, but that this is not revealed by decisions that can be made using access to general knowledge about words, because the latter is equally available to all subjects.
(2) Alternatively, perhaps there are no differences in speed of pre-attentive detection of threat, but anxious subjects give higher priority to assessing threat value after initial pre-attentive detection, when in competition with other types of information.
(3) Finally, it could be that emotional encoding differences do not arise unless events are interpreted within a priming context that activates a relevant concern.
A1. Affective Decisions without Word Identification: If the use of general knowledge about words obscures possible differences, then effects could still emerge when subjects are forced to guess based on their "intuition", because direct knowledge of word identity cannot be used. Threatening words (e.g. cancer), non-threatening words (e.g. carpet), or non-word letter-strings will be presented briefly (e.g. 16-100ms), followed by an obscuring pattern mask. The information available at different exposure times can be assessed by immediately subsequent forced guessing tasks, for example: word present or absent?, valence (good or bad?), or (3) word form (cancer or tumour?). Hypothesis (1) would be supported if the performance of anxious subjects on the valence task differs from controls, for trials when other types of guesses remain at chance level. If not, we will proceed on the assumption that any differences in early detection of threat do not influence conscious report.
A2. Effects of Dividing Attention: Assuming that anxious subjects give priority to assessing threat value after pre-attentive detection, then differences would only be observed when subjects are simultaneously required to perform another task. This will be tested by briefly exposing subjects to threatening and non-threatening words under conditions of full or divided attention (e.g. by simultaneously presenting two digits that are to be summed in the divided attention condition), and then assessing the type of information that is extracted using tasks similar to those described above. Hypothesis (2) would be supported by finding that threat-related judgements are facilitated in anxious subjects relative to controls, but only in the divided attention condition.
A3. Contextual Priming Effects: A third alternative would be to suppose that affective decisions will only differ if a relevant personal concern has been primed by the context. Priming of this type could be accomplished in several ways: for example, subjects could first be asked to think about an area of personal concern, followed by a task, as in (A2) above, that involves threatening words related or unrelated to that concern. Alternatively, brief scenarios related to personal concerns may be constructed, ending in a word whose meaning is determined by the context in which it occurs. Subjects will thus make speeded affective decisions for the same word, but with emotional meaning determined by context. For example, the word "lump" should be judged as "bad" in the context of the sentence "You are looking at your face in the mirror when you notice a .......", but as "good" in the context of "You are looking for your lost wallet in the bedclothes when you notice a .......". Hypothesis (3) would be supported if decisions for threatening words are speeded for anxious subjects only in the context of an active concern.
B. Implicit Perceptual Encoding of Threatening Stimuli(Mathews, Milroy)
B1. Primed Word Completion: Evidence has been obtained previously that anxious subjects are primed more by prior exposure to threatening words, in a subsequent word-stem completion task. Because this has proved difficult to replicate, and word completion is sometimes thought to be contaminated with conscious recall processes, this tentative finding will be checked using methods that allow estimation of automatic priming effects, independent of conscious recollection. Two options are being piloted (by Ann Rafter): (i) instructing subjects either to include or to exclude previously seen words in each stem completion trial should allow separate estimates of conscious and unconscious influences (conscious influences are estimated by subtracting the proportion of hits obtained under "exclude" instructions from the proportion obtained under "include" instructions); (ii) requiring subjects to report whether each completed word had been seen previously or not. The hypothesis above predicts that only the estimate of unconscious influences will show evidence that anxious subjects encode more information about threatening stimuli.
B2. Primed Word Identification: The tachistoscopic identification task, in which subjects attempt to read words that are displayed very briefly and then masked, has been claimed to be less contaminated with conscious memory processes. Pilot work with this method has shown a significantly greater repetition priming effect for threatening stimuli in high-worry subjects, but this was associated with a less accurate baseline for new threatening words, making interpretation difficult. Studies of this effect will be continued, starting with an attempted replication, and going on to vary the task so as to check for response bias explanations (e.g., by including foils that resemble target words to allow signal detection analysis, or using forced choices between target and foils). The prediction is that, after taking account of any response bias effects, this task should reveal more accurate identification of previously exposed threatening words in anxious subjects, even in the absence of differences in tasks dependent on conceptual processing (such as better recall).
C. Failure to Encode Other Aspects of Meaning (Dalgleish, Mathews, Milroy)
This hypothesis arose from failures to find better recall or recognition for threatening words in anxious subjects, despite evidence of selective attention to the same stimuli. Such effects could occur if, after a threatening event had been emotionally and/or perceptually encoded, anxious subjects inhibit further elaborative processing, thus handicapping subsequent retrieval. If true, this generates a new prediction: that semantic links between memories for threatening events and other information in memory would be relatively poor. Within this framework, psychological therapy can be seen as the process of establishing new links in memory with other (less threatening) information.
C1. Intentional Forgetting: One method of studying intentional inhibition is via the "directed forgetting" paradigm, in which subjects instructed to forget some of the words after they have seen them are then less likely to be able to recall these items on later test. Pilot work by Dalgleish suggests that subjects are more able to "forget" threatening than neutral words in this way, and he will extend this work to include anxious patients. If these subjects are particularly able to "forget" threatening words, this would support an intentional inhibition explanation for failure to find evidence of selective memory in anxious patients. By presenting some words before, and others after, instructions to forget, it will be possible to test the extent to which any differences are due to initial encoding effects, or to some later inhibitory process. The nature of any inhibitory effects that are found will be further investigated using implicit tests, such as anagram solution, to determine if priming effects persist for words that cannot be recalled, as suggested in section (B).
C2. Elaboration and Word Association: The hypothesis that inhibition results in impoverished links in memory between threatening and other types of information will be tested by Mathews and Milroy using word associations given to threatening or non-threatening cues. Subjects will be asked to generate as many different associates as possible to standard cues, with each associate being generated by going back to the original cue. Predictions for anxious subjects (relative to controls) are (i) absence of positive associates to threatening cues, (ii) successive associates to threatening words that are more similar in content to each other, and (iii) more identical associations to repetitions of a threatening cue.
The above predictions are based on the assumption that associations reflect automatic activation of related information in memory, and can thus be used to assess how this information is structured. However, they may also reflect the processing priorities in effect at the time. For this reason, associations will also be generated while subjects simultaneously carry out another task taking up attentional capacity (as in section A2). The former account would predict no effects due to divided attention, while the latter suggests that only under conditions of competition (and/or contextual priming) would the above predictions hold.
D. Instructional Control of Cognitive Processes Associated with Anxiety (Mathews, Milroy)
Although automatic processes are clearly implicated in the selective encoding of threat, it is very likely that intentional components are also involved, as suggested in (C1). It is proposed to investigate the role of these processes by testing the extent to which instructions or training can modify encoding operations characteristic of anxious versus non-anxious subjects.
D1. Consequences of Emotional Encoding: Subjects will be instructed to encode some words in terms of potential threat (e.g., What is the worst thing that this word suggests to you?), and to encode others non-emotionally. The words will then be tested for differences in capacity to capture attention and elicit perceptual priming. If the threat encoding instructions result in non-anxious subjects coming to respond similarly to anxious subjects, this would suggest that the relevant processes might be brought under intentional control.
D2. Consequences of Instructed Worry: In a previous study of worry (6.27), anxious and non-anxious subjects were asked to worry, suppress worrying, or think about an unrelated topic for five minutes, and thought content was sampled for the 20 minutes following. Anxious subjects always reported more negative thoughts, but there was a trend for suppression to result in more pleasant ideation. This paradigm will be used to establish a baseline for studying the cognitive consequences of instructed worry (e.g. on subjective risk), and to test the effects of training in different techniques to control excessive worry (e.g. by learning to generate reasons why the feared events may not happen).
E. Implicit Learning of Emotional Encoding Rules (Mathews, Milroy)
Explicit training may be a useful way to explore treatment implications, but is likely to be a poor model of any learning processes that might be involved in producing emotional encoding biases in anxious individuals. Anxious subjects often find it difficult to explain why they feel as they do, suggesting that any learning of encoding bias is implicit in nature. Biologically vulnerable individuals may acquire emotional encoding rules through exposure to event-outcome relationships, with the implicit rules being retained in memory in schematic form, without subjects necessarily being able to report on them verbally. Two possible methods of investigating this hypothesis are being developed, both involving unobtrusive measures of text comprehension.
E1. Inferences in Emotional Texts: In the first method, subjects high or low in anxiety about particular situations (e.g. interviews) read texts describing threatening or neutral situations. The interpretation imposed by subjects is probed by speeded word decisions at critical points in the text. Data collected so far (by Colette Hirsch) suggest that probes requiring decisions about whether the offered word is a possible continuation of the text do show the predicted reaction- time differences between groups. This finding will be extended using different decisions (lexical, affective, etc.) and different types of emotional material.
E2. Implicit Learning of Emotional Associations: In the second method, subjects read a series of texts introduced by contextual settings that initially have no specific emotional meaning, but follow an implicit rule such that particular types of context are associated with either negative or positive outcomes. Subjects are later asked to imagine themselves in these contexts and then to rate how they feel at critical points. Pilot results show evidence of learning, in that contexts that have been associated with a positive outcome are then rated as more pleasant. However, the data so far are not definitive, being based only on subjective ratings, and because subjects can recall the emotional outcomes quite accurately. In further developments more objective probes will be used, together with longer delays, to test whether any effects persist in the absence of explicit recall.
COGNITIVE INVESTIGATIONS OF INSOMNIA (Watts)
Insomnia represents a very common condition, and a source of distress to a large proportion of the population. Recent years have seen a growing awareness that treatment by medication is not an optimal approach, and there has been increasing interest in psychological alternatives. The two most extensively researched forms of psychological treatment involve physical relaxation and behavioural (stimulus-control) methods. However, evidence from various sources indicates that the cognitive components of insomnia are particularly important. Surprisingly, in view of this, relatively little attention has so far been given to the development of cognitive treatments for insomnia. The project presented here had two main components: (a) a refinement and clarification of previous self-report studies of the cognitive factors important in insomnia; (b) the development of cognitive methods of treatment for insomnia.
The first psychometric study (6.9), designed to clarify the cognitive aspects of insomnia, took as a starting point a previously-developed sleep dissatisfaction questionnaire, but added additional items and administered it to a larger population. In this revised form, two distinct cognitive factors emerged, one relating to concerns about sleep, the other concerned with more general nocturnal mentation. The latter showed a strong correlation with general traits of worry and neuroticism, and was more prevalent in young insomniacs. To disentangle more clearly the role of worry in insomnia, a study was designed to examine in a 2 x 2 design subjects who were/were not worried and were/were not insomniacs (6.46). This study confirmed, in terms of the two different cognitive subscales of the sleep dissatisfaction questionnaire, that general worry, as measured by a standard psychometric instrument, predicted nocturnal mentation but not thoughts related specifically to sleep. In this study, another instrument was developed in which subjects were asked to complete a check list in the mornings concerned with what they had thought about in any time during which they had been awake during the night. Again, there was a clear dissociation between concerns about sleep and other mental activity. Worriers showed more thoughts in almost every category except sleep, whereas insomniacs showed more thoughts about sleep, but hardly anything else. The kind of cognitive treatment most helpful for insomnia will probably depend on whether the predominant night-time thoughts are about sleep or other things.
A final psychometric study focused on insomniacs' sense of control over sleep (6.49). The fact that sleep is inherently difficult to control makes it a prime candidate for performance anxiety. As would be expected, insomniacs had less sense of control than other subjects. However, this sense of lack of control focused particularly on sleep itself rather than on pre-sleep drowsiness. Within pre-sleep states, the sense of lack of control focused particularly on mental activity rather than physical tension and arousal. It was also found that insomniacs' expectations of sleep were not based on the quality of sleep in recent nights, in the same orderly way as is found in controls. Most attributions of bad sleep are used more by insomniacs than non-insomniacs. One interesting exception is that poor sleep is frequently attributed to "heat and noise" by non-insomniacs, but seldom by insomniacs. Consistent with other research emphasising the importance of cognitive factors in insomnia, both insomniacs and controls regarded having an over-active mind as the most common explanation of insomnia.
The second part of the insomnia research has been concerned with the development of cognitive treatments. Particular attention has been given two main forms of intervention (6.17). One is a pre-sleep exercise in which subjects are required to identify, before going to bed, things they are likely to think about during the night, and to "put these to one side". This procedure seems to allow records to be tagged, in some way, as not requiring an immediate response. The result is that they are less likely to trigger the cognitive system into active processing when the subject goes to bed. It can be seen as analogous to the postponement approach to the treatment of worry developed by Borkovec, in which subjects identify worry topics and postpone concern with them. Another cognitive treatment, with a more explicit theoretical basis in Baddeley's working memory theory, involves a form of articulatory suppression to block intrusive thoughts which arise during the night. Our clinical work on the development of this technique suggests that, unlike laboratory articulatory suppression, it is best for the subjects just to think a blocking word such as "the", and also that they should 'repeat' the word at a relatively slow, relaxed speed. In working memory terms, we see this as taking up enough central executive capacity to disrupt thoughts that would otherwise interfere with sleep. When articulatory suppression becomes highly practiced, it can become less effective in blocking alternative thoughts. If this happens, there seems to be an advantage in adding an extra mental load, such as that involved in requiring repetition of the blocking word at randomly spaced intervals.
Work on this project has now been discontinued with Watts' move to the post of Starbridge Lecturer in the University of Cambridge.
COGNITIVE-AFFECTIVE INTERACTION IN DEPRESSION (Barnard, Dalgleish, Teasdale, Williams)
Introduction
Cognitive approaches have yielded both effective therapy procedures and new ways of understanding depression. Previous work has suggested that it is useful to think in terms of a reciprocal relationship between cognitive and affective components of depressive disorders; on the one hand, certain negative appraisals of experience may create or maintain depressed affect; on the other hand, depressed mood is associated with biases in memory, judgement, and interpretation that make such negative appraisals more likely. Such reciprocal relationships may act to maintain depressed states, and are reflected in the patterns of negative thinking characteristic of this disorder. Work in the current grant period has investigated further (1) the nature of cognitive-affective interaction in depression; (2) biases in interpretation and memory associated with depression; (3) the production of thought sequences related to negative thought streams; and (4) cognitive methods for treating and preventing depression.
A. Negative Thinking and the Maintenance of Depression
A1. Theory Development (Teasdale, Barnard): Better understanding of the interaction of cognition and emotion, and the clinical application of this knowledge, require theoretical frameworks that can integrate and explain the often complex findings of experimental studies and guide the application of these findings to the analysis and treatment of mood disorders. Over the last decade, Bower's (1981) associative network theory has provided the dominant theoretical framework guiding experimental investigations in this area, and Beck's (1976) cognitive model has informed clinical approaches. Recently, the weaknesses of these approaches have become more apparent (6.34, 6.69), as has the need for alternative conceptual frameworks.
We have devoted a major effort to the development, evaluation, application and communication of a new integrative theoretical approach to cognitive-affective interaction in both experimental and clinical contexts (6.1, 6.6, 6.34, 6.37, 6.70). This work has been presented most comprehensively in Teasdale and Barnard's book Affect, Cognition, and Change: Re-modelling Depressive Thought, published in October, 1993. This book: (i) provides a critique of Bower's and Beck's approaches to understanding cognitive-affective interaction in the area of depression; (ii) presents an extended description of a new, alternative, conceptual framework; (iii) applies this framework to an analysis of experimental findings on mood-related biases in memory and judgement, and shows that the new framework accounts for the detailed pattern of findings more satisfactorily than existing theories; (iv) presents a novel analysis of mood states; (v) describes a detailed analysis of the production of stimulus-independent thought, and of depressive thinking and its role in the maintenance of depression, testing these accounts against existing empirical findings; (vi) integrates the proposed analysis of the maintenance of depression with existing self-regulatory and motivational models of depression; (vii) contrasts the proposed account with Beck's, and shows how the new analysis resolves, within a precise, explicit theory, difficulties of earlier versions of the clinical cognitive model, and captures more recent, often imprecisely articulated, developments of that model; and (viii) applies the proposed analysis to the psychological treatment of depression, to provide a novel perspective on cognitive-behaviour therapy, and to suggest specific, testable hypotheses of the mediation of the short-term and long-term effects of this treatment. The considerable investment of effort in the theory development described in, and stimulated by, this book has been justified by the heuristic, guiding, and integrative function it has provided to the Unit's work in this area, and by the positive response it has already received more widely.
The new theoretical approach is an extension and elaboration of Barnard's (1985) Interacting Cognitive Subsystems (ICS) framework, and treats emotion within a comprehensive information processing framework. ICS distinguishes between representations at two levels of meaning. In addition to a specific, propositional, level of meaning, similar to that represented in Bower's associative network theory, ICS proposes a more generic, holistic level of meaning. At this level, schematic mental models encode high order themes and patterns of sensory information co-occurring across situations that, although superficially different, share certain "deep" commonalities. According to ICS, only this more generic level of meaning is directly related to affect; the synthesis of affect-related schematic models is the immediate antecedent to production of an emotional response, and such synthesis also underlies mood-related cognitive biases. Within ICS, reciprocal interactions and information exchanges between the cognitive subsystems that handle the two levels of meaning constitute a central feature of many aspects of cognitive processing, including the maintenance of affects associated with the subjective experience of streams of negative thoughts.
The distinction between two qualitatively different types of meaning, only the more generic of which is directly linked to affect, enables ICS to resolve many of the difficulties encountered by Bower's theory. Equally, Beck's original clinical cognitive model appeared to recognise only a single, propositional, level of meaning, and consequently encountered difficulties in explaining, for example, the contrast between "intellectual" and "emotional" belief, or the effectiveness of therapy procedures that provide no evidence for assessing the truth value of distorted beliefs. Application of the ICS account to understanding and treating depression from a cognitive perspective resolves many of these difficulties (6.1, 6.34, 6.71). It also suggests novel approaches to prevention (6.37) and provides guidelines for assessment in the treatment of recurrent mood disorders (6.70).
A2. Mood-State Dependency of Depressive Thinking: Changes in the Accessibility of Negative Constructs or Shifts in Schematic Mental Models? (Teasdale, Taylor): The elevated scores on measures of negative thinking of depressed patients in episode typically return to normal levels with recovery of euthymic mood. For example, although patients, when depressed, may express agreement with a statement such as "If someone dislikes me it means I'm no good as a person", they will express disagreement when the same item is presented after recovery. Teasdale and colleagues have examined competing explanations, offered by associative network theory and by ICS, for the mood-state dependency of such dysfunctional attitudes.
The Bower network model suggests that endorsement of dysfunctional beliefs when depressed reflects a general increase in activation and accessibility of negative constructs, such as "myself-as-a-no-good-person", that have previously been associated with the depressed state. As mood recovers, activation to this construct from the depressed state will reduce and so endorsement of the dysfunctional attitude is less likely.
By contrast, the ICS account suggests that changes in the endorsement of dysfunctional attitudes reflect a shift, with the move from one mood state to another, in high order mental models of self and world. In depressed patients, it is suggested, the depressed state is associated with dysfunctional models, such as those implying that personal worth (or lack of it) depends on the approval (or disapproval) of other people. By contrast, the non-depressed state is associated with functional models that imply more independence of personal worth and the reactions of others. The focus of such schematic models is the inter-relationships between constellations of constructs rather than simply the level of activation of individual constructs.
Teasdale Taylor, Cooper, Hayhurst & Paykel (6.38) created sentence stems in which the dysfunctional models suggested by the ICS analysis would lead to completions by positive constructs, whereas functional models would lead to completions by negative constructs. For example, dysfunctional completions of the stem "Always to put others' interests before your own is a recipe for __________" would involve positive constructs such as "happiness", whereas more functional completions would involve negative constructs such as "disaster". Using these stems, ICS makes the counterintuitive prediction that depressed patients will make more positive completions than non-depressed controls, and that, with recovery, there will be a decrease in the number of positive completions. By contrast, the associative network theory predicts that depressed patients will make more negative completions and this tendency will decrease with recovery. Results of a study in which patients with major depression were tested initially while depressed, and again three months later, supported the counterintuitive predictions of the ICS account. Similar results have been obtained in a subsequent study of depressed patients, and in a community sample of 99 depressed subjects recruited from a depressives' self-help organisation. Overall, these findings lend considerable empirical support to the ICS account of mood-dependent depressive thinking.
A3. Assessment of Affect-Related Schematic Mental Models: Reflecting the influence of the associative network theory of mood and memory, most laboratory paradigms in cognition and emotion research have focused on the level of individual constructs or representations of specific events. There is a need to develop new methodologies for the assessment of the affect-related schematic models that play a pivotal role in the ICS analysis.
A3.1. Contextual priming and assessment of affect-related schematic models (Teasdale, Taylor): Teasdale and colleagues have examined the utility of contextual priming paradigms, related to those used in studies of text comprehension, as methods for assessing affect-related schematic models.
In three studies, Teasdale and Taylor used computerised presentation of the sentence stems developed in A2 above. Each stem was presented twice, followed by words (matched for length and word frequency) that made either functional or dysfunctional completions (e.g. "Always to put others' interests before your own is a recipe for: survival/disaster"). Latencies to make decisions on functional versus dysfunctional completions to each stem were examined in relation to subjects' attitudinal models (assessed by self-report). Study 1 used a lexical decision paradigm, and found no significant differences in the relative latencies for functional and dysfunctional completions according to subjects' attitudinal models. Study 2 required subjects to make semantic decisions ("makes a meaningful completion or a meaningless completion?") and found significant effects; congruence between completion and attitude was associated with faster latencies. Study 3 included both lexical and semantic decision paradigms within the same experiment and again found significant effects with the semantic paradigm, but not with the lexical paradigm, the difference between the two paradigms being itself significant.
These studies suggest the usefulness of this novel form of contextual priming, using semantic decisions, as a measure of affect-related attitudinal models. Subsequent work has shown related paradigms to be sensitive to differences in intention-related representations (6.86) and to reveal differences between social phobics and normal subjects in their processing of threat-related passages (see Area 1, Proposals E1).
In studies of text comprehension, reading times for critical sentences in passages have been used to infer the nature of readers' mental models. In collaboration with Sheppard in the Cambridge University Department of Psychiatry, Teasdale has explored the usefulness of this strategy as a way of assessing the schematic models of depressed patients. Times to read sentences indicating positive or negative outcomes in scenarios involving themes of self-sacrifice or self-assertion were examined. Compared to controls, depressed patients took relatively longer to read sentences indicating positive outcomes in scenes in which they had sacrificed their own interests in order to win others' approval, but differences only appeared on the second presentation of the sentences. The results suggested that patients' schematic models created continuing processing priorities for thematically relevant material, but were not reflected in differences from normal subjects in the outcomes expected as the scenarios were read.
A3.2. Case grammar analyses (Barnard, Scott): Within ICS, the proposed generic and yet generative nature of schematic meaning has relatively clear consequences for the development of assessment techniques. Generic meanings, particularly those involving self-related constructs, may be highly variable in terms of the specific meanings they create, but should, nonetheless, show underlying systematicity in high level semantic abstractions. Schematic meaning can be explored by examining the abstract properties of "propositional" products which emerge over a range of expressed meanings. Potential abstractions of clinical relevance are likely to include dimensions such as being in control or being affected by events or other people. Interestingly, at least some of these dimensions map quite readily onto formal case grammar distinctions. These specify the general semantic roles that nouns may fulfil in relation to the main verb of a proposition. Examples for animate nouns are the "agent", "dative", "object", or "experiencer" case roles.
Initial investigations have provided evidence that case grammar classifications can be used to detect generic effects of this type. The Winicott Unit of the Department of Psychiatry in Cambridge made available protocol data of children describing the activity of their family in a doll's house play setting. The data were analysed for two groups -- children whose mothers had had a significant episode of post-partum depression (index group), and a control group of children whose mothers had no history of depression. Although the actual protocols were very heterogeneous in terms of surface form and content, case grammar analysis did reveal systematic differences in the generic properties of underlying propositional content.
The children in the index group consistently showed lowered reference to themselves in the "agent" role and an increased reference to themselves in the "experiencer" and, for girls, in the "dative" roles when compared to self-reference in comparable protocols obtained from the control group. Likewise, the index group used syntactic negatives far more often than the control group when referring to themselves. There were no such differences in case utilisation or negative syntax use between the index and control groups where reference was to siblings or parents. Children with markedly different patterns of early experience appear to develop quite different self-related schematic representations, with negativity and agentfulness being discriminative dimensions. The children of depressed mothers are at risk for later problems in affect regulation; and the properties on which differences have been detected bear an interesting relationship to those hypothesised to underlie depressive schematic representations. This is an important development which forms the basis for specific future proposals (section A3. below).
A4. Production of Stimulus-Independent Thought (Teasdale, Hutton, Lloyd, Taylor): Stimulus-independent thought refers to the streams of thoughts and images, with content quite unrelated to immediate stimulus input, that are often experienced when demands to process information from external sources are low. Production of stimulus-independent thoughts (SITs) in normal subjects has been studied for its inherent interest, and also as an analogue of the streams of negative thoughts that, according to cognitive models, contribute to the maintenance of depression. Teasdale and Barnard's analysis (6.1) suggests that production of SITs, in both normal and depressed subjects, depends on continuing cycles of interaction between the cognitive subsystems that handle, respectively, the schematic, model-based, level of representation and the level of representation corresponding to specific, propositional, meanings. Schematic models generate specific meanings, which feed back, in turn, to contribute to the production of further schematic models. According to ICS, similar cycles of reciprocal interaction between representations at these two levels subserve "central executive" functions, so that both thought production and executive control functions depend on the same processing resources, and would be expected to show mutual interference.
Earlier research, conducted within a working-memory framework, suggested that production of SITs depends on limited central executive resources of control and co-ordination. Subsequent studies have demonstrated interfering effects of memory load on SIT production and greater interference with thought production when task performance was associated with reports of high subjective awareness of task stimuli, and have suggested that interference is specific to connected sequences of SITs (6.36). Experiments have also specifically examined the hypothesis that SIT production and "central executive" functions compete for the same limited resources (6.35). This latter hypothesis makes the following predictions: (1) prior practice on concurrent tasks, by reducing the demands made on central resources for task control, will reduce the extent to which such tasks interfere with SIT production; and (2) if thought content is periodically sampled during a random number generation task, randomness (regarded as a paradigmatic indicator of central executive function) will be less preceding probes on which SITs are reported than preceding probes where no task-irrelevant thought is reported. Teasdale et al. (6.35) confirmed both these predictions.
Studies by Teasdale and colleagues have repeatedly found greater interference with SIT production when subjects report being highly aware of task stimuli than when they report being less aware, even when task performance is similar in the two conditions. These findings are consistent with the general suggestion that "controlled processing" is associated with greater awareness and interferes more with SIT production than more "automatic" processing. Subsequent studies have examined whether simply instructing subjects to maintain awareness on an attentional focus would, itself, interfere with SIT production. Teasdale and Hutton (6.60) found that instructing depressed subjects to keep their attention focused on their breathing reduced the frequency of negative thoughts. Teasdale and Hutton, in a subsequent study (6.61) instructed normal subjects to maintain an attentional focus on their breath and compared the thought contents reported at probes on which subjects indicated being highly aware and less aware of their breath. Results showed that stimulus-independent thoughts were reported less often at high awareness probes than at low awareness probes, but that stimulus-dependent thoughts were reported equally often in the two conditions. As well as pointing to differences in the processes underlying the production of these two types of thoughts, these findings are important because they suggest that the observed association between awareness and SIT frequency is not simply an artifactual consequence of the difficulties of attending to, or reporting on, both task and thought content. Rather, these results suggest that high awareness marks a type of processing, associated with the deployment of central executive resources, that interferes particularly strongly with production of stimulus-independent thoughts. These studies provide the basis of future work that will continue to investigate the effects of the breath-focus task in experimental and clinical settings.
B. Overgeneral Memory in Parasuicide and Depression (Williams, MacLeod)
This project, which ended when Williams moved to UCNW, Bangor, investigated the causes and mechanisms of a particular aspect of memory performance in emotional disorder. In Williams' previous work, he had found that suicidal and depressed patients show a deficit in autobiographical memory characterised by a difficulty in focusing on specific events. Such patients tend to give taxonomic categories of personal events (e.g., "going for walks", "being with my girlfriend"). The effect was not due to short-term mood disturbance, suggesting that it represented a longer-term cognitive retrieval style. During the period covered by this Report, the project investigated how this retrieval deficit contributes to hopelessness, problem solving and depression, and what mechanism might explain the phenomenon.
The research focused on the question of whether hopelessness and problem solving deficits were mediated by difficulty in generating specific images of the future. Williams predicted that such difficulty might arise because over-general retrieval of autobiographical events inhibits the use of specific memories in imagining such future events and in producing effective solutions to current problems. Consistent with this, Williams and colleagues found that parasuicide patients who have more difficulty in retrieving specific memories have greater difficulty in generating effective solutions on the Means-Ends Problem-Solving Test (6.14). Further, parasuicide patients with more problems in memory specificity produce less specific images of events that might occur in the future. Manipulating experimentally the retrieval style of normal subjects (generic versus specific) significantly affects the specificity of images of prospective events. In further work, Williams and colleagues in the Department of Psychiatry in Newcastle found that depressed patients who had more general autobiographical memory at admission were more likely to remain depressed seven months later (Brittlebank et al., 1993). These studies confirmed that this aspect of autobiographical memory is an important factor contributing to the maintenance of emotional disturbance.
Williams and Dritschel investigated the mechanisms underlying over-general retrieval (6.78). Previous work had assumed that patients were accessing an "intermediate description" in memory retrieval, but were stopping short of a specific example. While the general notion of a hierarchical search strategy remained useful, the theory made no distinction between different types of hierarchy a person might use. Williams and Dritschel distinguished two forms of super-ordinate memory. The first, categoric memory refers to descriptions containing generic summaries of events (such as "drinking in pubs"). The second, extended memories refers to descriptions containing extended event time lines (such as "my first term in Oxford"). The significance of the distinction is that, whereas categoric memories are useful in summarising a number of similar situations, a nested structure of extended memories is necessary to orient people in space and time, and to keep people up to date in relation to both short-term and long-term goals. Williams and Dritschel found these two forms of intermediate description to be independent from each other, and that only categoric memories correlated with neuropsychological tests of Supervisory Attentional Control. Further, they found that excessive overgeneral memory in emotional disturbance is associated only with an excess of categoric memories but no increase in extended memories (6.78). A project still in progress on elderly people with dementia has found a significant association between severity of general cognitive deficit and categoric memories but not extended memories, providing further confirmation of the independence of these types of overgenerality in memory.
These results have important implications for the treatment of emotional disorders (Scott et al., 1989; Williams & Wells, 1989; Williams, 1992). Many psychotherapeutic strategies depend upon the ability of patients to retrieve specific events from the remote or recent past, or to keep diaries of day-to-day events. Current research is examining the prediction that effectiveness of psychotherapies will in large part be determined by how well they are able to encourage the recollection of specific events. Such specific retrieval predicts good outcome because it allows the recoding of depressive interpretations of the past and the construction of more specific images of the future, and because it enhances problem-solving skills.
C. Prevention of Relapse and Recurrence in Depression (Teasdale)
Prevention of relapse and recurrence in depression has been identified as an R and D Priority Area by the Department of Health. There is encouraging evidence for prophylactic effects of a psychological treatment, cognitive therapy. In collaborative studies, funded by external grants, Teasdale is investigating the effectiveness and mode of action of cognitive therapy, and developing new forms of preventive treatments that operate through related mechanisms. His participation in these projects has involved elaboration of the ICS theoretical perspective on treatment and prevention (6.1, 6.37, 6.71) and provides an opportunity to examine the validity of these hypotheses.
C1. Cognitive Therapy for Residual Depressive Chronicity: In collaboration with Paykel in the Cambridge University Department of Psychiatry and Scott in Newcastle, Teasdale is involved in a controlled clinical trial, investigating the short-term and long-term (prophylactic) effects and mode of action of cognitive therapy in patients who still have residual depressive symptoms after an adequate trial of anti-depressant medication. Recent research in Cambridge suggests that this group has a poor long-term outcome with existing treatments: 78% had relapsed within 9 months of discharge. The trial compares the combination of anti-depressant medication and clinical management to this combination plus cognitive therapy. To investigate the mediation of effects of cognitive therapy, new cognitive measures have been developed, and are being administered in addition to measures suggested as important in previous studies. For example, Teasdale's theoretical analysis (6.1, 6.67, 6.71) suggests that cognitive therapy operates through (a) reducing patients' perception of depression as evidence of their personal inadequacy and (b) increasing their perceptions of control over depression. Measures to assess these variables have been developed on a group of 250 depressed volunteers from the organisation Depressives Associated, and have been shown to possess excellent internal consistencies (Cronbach's alphas > .93). This large data set is also being used to examine, through structural modelling techniques, the relationship of these variables with measures of dysfunctional attitudes and of global negative self-schema that have been shown to predict outcome in previous studies. Further measures and their underlying rationale are described in Proposals C1.
Patient entry into this trial began in April 1994, and the project will be completed in January 1998.
C2. Attentional Control Training to Prevent Depressive Relapse: There is encouraging evidence for the effectiveness of cognitive therapy in reducing the risk of relapse (or the need for further treatment). Cognitive therapy in its present form, however, depends on extensive individual contact with highly trained therapists; therefore, even if its prophylactic effects are confirmed by further studies, it may not be available to more than a small proportion of the very large numbers of patients who might benefit. In collaboration with Williams (UCNW, Bangor) and Segal (Clarke Institute of Psychiatry, Toronto), and with support from the MacArthur Foundation, Teasdale has been developing and piloting a novel cost-efficient approach to psychological prophylaxis for depression - Attentional Control Training (ACT). Based on a theoretical analysis of relapse and its prevention (6.1, 6.37), ACT is designed to produce prophylactic effects similar to those of cognitive therapy, using skills-based group training in patients who have recovered from their acute episode following conventional treatment by anti-depressant medication. The treatment procedure combines aspects of cognitive therapy with training in attentional control skills similar to those included in a stress-reduction programme developed by Kabat-Zinn at the University of Massachusetts, for which there is promising evidence of effectiveness in the treatment of chronic pain, anxiety and panic, and other stress-related disorders (e.g. Kabat-Zinn et al., 1992). A preliminary treatment manual has been produced (6.87), and pilot groups in Toronto, Bangor, and Bury St. Edmunds have demonstrated the acceptability of this approach and provided encouraging clinical evidence for the utilisation and effectiveness of the skills taught.
FUTURE PROPOSALS
Introduction: Schematic Models and Central Executive Resources in the Maintenance and Regulation of Affect
The aim of work in this area is to increase our understanding of processes related to the maintenance and regulation of affect in situations where otherwise transient affective states may escalate and persist to become disabling emotional disorders. This knowledge will be applied to the development of more effective and efficient methods for reducing relapse and recurrence in depression. These proposals are based on the theoretical analysis of (neurotic) depression developed by Teasdale and Barnard in the current grant period. This analysis suggests that depression depends on the synthesis of schematic representations that encode the high order themes and recurring sensory patterns extracted from previous depressing experiences. The maintenance (and escalation) of depression depends on the continuing regeneration of such affect-related schematic mental models. Often, particularly in states associated with reports of streams of negative thoughts, this regeneration will be the result of self-perpetuating cycles of cognitive activity. These cycles, it is suggested, depend on the same "central executive" resources that are also required for many other tasks involving "controlled processing". As these resources are limited, mutual interference between affect maintenance and other aspects of "central executive" functions would be expected. In these circumstances, affect regulation can be achieved by re-allocating limited central resources to process information that will not perpetuate affects. Such reallocation, it is suggested, depends on changes in the "schematic-model-in-place" that, from moment to moment, sets the priorities for control resources to process different classes of information. Affect regulation in such situations can be improved by training individuals in attentional skills that, effectively, give them greater control over the "schematic-model-in-place", and so allow them to switch out of the cycles that might otherwise escalate or maintain depression. The availability of affect-related schematic models in memory will be an important factor influencing the ease with which this switching can be achieved or maintained.
Work in this area has the following objectives. First, it is important to extend our understanding of the nature of depression-related schematic models and the ways that they influence thinking. Second, the proposal that maintenance of certain affective states depends on limited cognitive resources that also subserve "central executive" functions will be subjected to detailed examination. Third, the effects of attentional training on the ability to redeploy central resources from affect-related processing, and the involvement of such resources in affective "re-appraisal", will be examined. Finally, the application of the proposed theoretical analysis to the prevention of relapse and recurrence in depression will be examined in the context of investigations of the prophylactic effects of an existing treatment (cognitive therapy), and of the development of cost-efficient methods of attentional control designed to achieve similar effects.
A. Affect-Related Schematic Models, Central Executive Resources, and the Maintenance of Mood
A1. Schematic Mental Models and Reasoning in Depression (Dalgleish): Relatively little experimental work has examined biases in higher-order cognitive processing, such as reasoning and decision-making, in depression. The theoretical model described by Teasdale and Barnard (6.1) suggests that reasoning depends on iterative cycles of interaction between representations at the schematic mental model level and at the level of more specific propositional meanings. This analysis suggests that, in depressed patients, aspects of the affect-related schematic models maintaining depression may become incorporated into the mental models used to generate and evaluate candidate propositional meanings as solutions to reasoning tasks. It follows that performance on reasoning tasks involving different types of content can be used to draw inferences concerning the schematic mental models associated with the maintenance of depression, and to compare the strength of the biases resulting from such affect-related models with those resulting from more "factual" (affect-unrelated) models. Dalgleish will exploit this possibility to investigate the hypothesis that biases in reasoning are greater when processing emotional material that is inconsistent with the affect-related mental models (assumed to be involved in the maintenance of depression) than when processing non-emotional material that is inconsistent with "factual" mental models, unrelated to affect. Consider, for example, two statements that might contradict the models of the world of a depressed individual:
1) Elephants are bigger than mountains
2) My neighbour is more worthless than I am.
The first statement contradicts a factual model of the world, whereas the second statement contradicts an affect-related model of the world (i.e., a model which might give rise to statements such as "I am more worthless than anyone I know"). Dalgleish will examine the performance of depressed subjects on reasoning problems that require them to generate such statements as answers, for example:
1) The elephant is bigger than the mouse
The mouse is bigger than the mountain
Which is biggest (elephant or mountain)?
2) My neighbour is more worthless than my postman
The postman is more worthless than me
Who is most worthless (me or my neighbour)?
It is predicted that depressed subjects will show greater differences (in terms of speed of processing or error rate) from normal controls on the second type of syllogism (which contradicts a depression-related world model) than on the first type of syllogism (which contradicts a world model unrelated to affect). It is predicted that normal controls will also experience difficulty solving syllogisms that cause them to generate conclusions that contradict affect-related models of the world. However, the syllogisms will be different than for depressed subjects; for example, a syllogism that required them to conclude that they were more worthless than their neighbour would pose difficulties for normal subjects. If the predicted results of this initial study are obtained, subsequent studies would examine the extent to which such effects are mood dependent using mood induction procedures.
A2. Assessment of Affect-Related Schematic Models (Barnard, Scott): Extending the application of the ICS framework to maintenance, regulation, and control of affect requires further advances in our understanding and assessment of the schematic organisation of self-related meaning. This form of meaning is assumed to be generic in nature and built up from information with propositional, sensory and proprioceptive origins. Three lines of future enquiry are proposed, all of which will focus upon schematic organisations of meaning related to core constructs of the self ("self-related models"). Each requires the systematic, but exploratory analysis of protocol data using case grammar techniques. The first line of enquiry concentrates on the developmental form and content of self-related models, the second introduces an emphasis on tracking changes in schematic processing with alterations of mood state, whilst the third line emphasises transient sensory influences. The first two rely upon established external collaborative links for the provision of the data to be analysed.
The first line of enquiry is a direct extension of the recent work with children and involves two stages. In the first stage, the immediate question concerns the generality of the initial results suggesting that the children of depressed mothers develop markedly different models of the self than the children of mothers who do not suffer a period of depression. With our support, the Winicott Unit has undertaken to analyse a much larger sample of protocol data from 5 year olds. In this way the generality of earlier findings can be tested and the robustness of the case grammar analysis can be assessed and, where necessary, refined. In the second stage, the questions of interest concern (a) the stability over time of the children's self-related models and (b) the extent to which the detailed form and content of these models predict predisposition to later cognitive-affective dysfunction. It is proposed to obtain verbal protocols from the same cohort of children at age 8 in a setting directly comparable to doll's house play. The case grammar profiles will be related to a variety of behavioural and affect related indices. If a lowered sense of agency and heightened negativity are essential aspects of depression-related schematic models, then their influence should be apparent in behavioural or self-report indices. The logistics for this strand of research are all specified in a recently awarded MRC Programme Grant to the Winicott Unit (Murray & Cooper) on which Barnard is a named collaborator.
The analysis proposed by Teasdale & Barnard (6.1) holds that self-related models differ between clinical and normal populations. The analysis also holds that affect regulation within the same individual depends upon the particular "schematic-model-in-place" and that these can switch over time. The second line of enquiry involves applying the case grammar technique to compare the self-related models of depressives in different mood states with those of control subjects. For an initial pilot, the Winicott Unit have agreed to make available data from adult attachment interviews involving a sample of normal mothers, a sample of depressed mothers where the interview was actually obtained during a depressive episode, and a sample of mothers who have experienced a period of depression but who were not depressed at the time of the interview. If the case analysis of these data reveals systematic differences between these adult groups, then it would confirm the sensitivity and potential utility of the technique. For subsequent work, it is proposed to focus upon patients with bipolar affective disorder, whose mood state swings radically from depression, through neutral, to mania. Informal clinical observation suggests that generic features of the case analysis -- those of agency and negativity as applied to the self -- change radically with the change of mood state evidenced in these patients. The empirical work would be carried out in collaboration with Ann Palmer of the Norwich Clinical Psychology Department, who has agreed to provide the basic protocol data for case grammar analysis. Should this form of investigation prove productive, existing collaborations could readily support extensions to several other populations including other classes of depressives, certain anxiety conditions, and schizophrenics (see also the Programme on Attention and Cognitive Control).
The third line of enquiry asks the question: Under what conditions can properties of the "schematic-model-in-place" be modified or even switched completely under the influence of direct external sensory information? Recent research has made use of computer controlled video, voice and facial animation to assist in the elicitation of verbal protocols (for example in obtaining assessments of computer-based tutoring and learning systems). Normal peoples' responses are systematically influenced by both voice characteristics and facial expressions. Attributions of agency in the context of computer-based dialogues (Nass et al., 1994) can vary quite markedly depending on whether the questions are asked by the same computer agent ("self") or a different computer agent ("other"), and this can be signalled by the "voice" of the computer agent itself. Likewise, enquiries made by a "stern" computer animated face lead to lengthier and more detailed replies than responses to a neutral face, but are less likeable experiences for the respondent (Walker et al., 1994). It is proposed to capitalise on APU skills in HCI research to pilot work on the computer-based presentation of full face agents to elicit protocols on topics related to the self or to others. Voice and expression will be varied, possibly in conjunction with other well-established mood manipulations such as the Velten procedure. The effect of these manipulations on the protocols elicited will be examined using case-grammar techniques, effectively providing an opportunity to examine the effects of specific experimental manipulations on the schematic models assumed to mediate the observed changes in behaviour. Use of computer facilities for presenting faces may share key technical resources with work on facial expression being proposed by Young (Cognition and Emotion Area 4).
Within the linguistic literature the semantic notion of agency is itself rather complex, involving elements of control, causality and change (e.g. see Schlesinger, 1992). In addition, nouns obviously occur in quite different case frames depending upon the specific class of verbs involved. Interestingly, similar general themes, including perceived controllability and persistence, recur in the literature on depression (e.g. 6.67) or anxiety conditions such as PTSD (Foa & Riggs, 1993). By systematically developing and refining the application of the case constructs to the protocol data, we hope to develop more precise practical techniques for representing the form and content of self-related models as well as developing a closer synergy between cognitive-linguistic concepts and the terminology of clinical practice.
A3. Affect Maintenance and Central Executive Resources (Teasdale, Hutton): Affective states associated with streams of negative thoughts (depressive ruminations) often persist in the absence of immediate sensory input from actual affect-inducing events. Teasdale and Barnard's theoretical analysis suggests that the maintenance of such states depends crucially on the processing of affect-maintaining information by the same cognitive resources that subserve the control and co-ordination functions often ascribed to a "central executive". To date, support for this central aspect of the proposed account has been largely indirect: for example, studies of stimulus-independent thoughts in normal subjects have been used as analogues of the streams of negative automatic thoughts in depression. Teasdale and Hutton will conduct a series of studies specifically examining the hypothesis that maintenance of affects associated with negative thought streams depends on cycles of cognitive processing (marked by reportable negative stimulus-independent thoughts) that require central executive resources of control and co-ordination. Studies will focus on populations scoring high on the personality dimension of neuroticism, as these subjects have a heritable predisposition to affective lability that puts them at enhanced risk of affective disorders such as major depression. Subjects will also have to demonstrate evidence of the ruminative response style (Nolen-Hoeksema, Morrow & Fredrickson, 1993) associated with elevated risk for persistent depression.
The investigative strategies will be based on those that have already been successfully employed in studies of stimulus-independent thoughts in normal subjects. Future investigations will take advantage of methodological improvements in the assessment of central executive functions, and will assess affective state as well as the mental contents sampled at thought probes.
Using the random finger movement task, recently developed at the APU, as a measure of central executive function, the following predictions will be tested:
(1) Randomness of finger presses will be lower prior to thought probes on which negative thoughts are reported than on probes with no task-irrelevant thoughts. This prediction is based on findings showing an inverse relationship between randomness in number generation and the occurrence of stimulus-independent thoughts in normal subjects (6.35).
(2) With continuous on-line measurement of randomness of finger presses to determine when to probe for thoughts, negative thoughts (and momentary negative mood) will be more likely at times when randomness is low than when it is high.
(3) Extent of mood improvement during performance of the randomness task will be related to the extent to which random performance has been achieved.
(4) Negative thoughts will be less likely at probes where subjects report greater subjective awareness of task stimuli than at probes where subjects report less awareness; this effect will be greater for stimulus-independent thoughts that are parts of connected sequences than for fragmentary thoughts, and will be greater for stimulus-independent thoughts than for stimulus-dependent thoughts. These predictions are based on, and extend, previous findings on stimulus-independent thoughts in normal subjects (e.g. 6.36).
(5) With pursuit rotor and memory tasks, prior practice on a task (assumed to reduce the central executive resources required to control task performance) will reduce the extent to which the task interferes with negative stimulus-independent thoughts, and the extent to which it alleviates negative mood. Teasdale et al. (6.35) report related findings in normal subjects.
A4. Working Memory and "Re-Working" Affect-Related Schematic Models (Teasdale, Hutton): Depressed patients show greater evidence of the influence of dysfunctional schematic models than normal controls. It is possible that depressed and normal subjects may differ, not so much in the schematic models synthesised initially, but in the extent to which these models, and their products, are re-worked or re-appraised by subsequent controlled processing, requiring central working memory resources. If this is the case, normal subjects in whom working memory resources are occupied by a concurrent task, such as a memory load, would be expected to show evidence of the effects of dysfunctional schematic models, similar to that shown by depressed patients.
In preliminary studies, Teasdale and Hutton have found that a concurrent digit load increased the number of dysfunctional completions made by normal subjects on a sentence completion task, previously developed specifically as a measure of dysfunctional models. Under a cognitive load, the performance of normal subjects approximated more closely that shown by depressed patients. Further, the effects of having completed the sentence test under a digit load persisted after the load was removed; subjects re-tested immediately afterwards, with no load, still showed elevated levels of dysfunctional completions. Such persisting effects could be abolished if, prior to completing the sentence task, subjects were asked to rate the extent to which they agreed or disagreed with statements such as "My value as a person depends greatly on what others think of me" from the Dysfunctional Attitude Scale (DAS) (Weissman & Beck, 1978). The effects of such prior experience were not observed in subjects who responded to DAS items while under a concurrent digit load.
The pattern of results suggests that re-working of the initial products of dysfunctional models, using central working memory resources, may be an important factor in the functional thinking of normal subjects. The results also suggest that the effects of recent schematic processing can continue to influence subsequent performance, presumably through effects of priming or accessibility of stored representations in memory. The finding that the effects of recently producing dysfunctional completions can be undone, but only if controlled processing resources are currently available and there is a history of recently processing related material with full access to working memory resources, is particularly interesting. Presumably, subjects who had previously responded to DAS statements without a load had had the opportunity to evaluate, and re-evaluate, dysfunctional models as they completed the DAS. These re-worked models were then available to influence subsequent processing, but only did so if controlled processing resources were also available.
These preliminary findings are consistent with the possibility that functional thinking in normal subjects may depend, at least in part, on the re-appraisal of initially synthesised dysfunctional models. Such re-appraisal appears to depend on the availability of (central) working memory resources and the availability, in memory, of representations of related, but modified, schematic models. This possibility is directly relevant to our interest in the role of controlled processing resources, and the availability of representations of modified schematic models, in the maintenance and regulation of affective states (see B and C below). In further studies, Teasdale and Hutton will examine the replicability of these preliminary findings, and employ parametric studies to examine factors such as the nature of the DAS items presented (functional versus dysfunctional; closely versus distantly related to the models assessed by the sentences), the interval between the encoding and test phases, and effects in subjects in whom dysfunctional models are more salient.
B. Attentional Control and Affect Regulation (Teasdale, Hutton)
Teasdale and Barnard's theoretical analysis (6.1) suggests that the maintenance (and escalation) of certain affects depends on self-perpetuating cycles of cognitive processing. Such cycles, it is proposed, depend on limited "central executive" processing resources, and are controlled by affect-related schematic models. In this situation, affect regulation can be achieved by using supervisory attentional functions (Norman & Shallice, 1980) to re-allocate limited central resources to process information that will not perpetuate affects. Teasdale and Barnard's analysis also suggests that lasting effects of affect-regulation depend on creating, or accessing from memory, alternative schematic representations of affect-related material; otherwise, representations of the original, affect-maintaining, models may be accessed from memory and redirect processing back into affect-perpetuating cycles.
High subjective awareness of task stimuli, or of an attentional focus such as the breath, marks a form of processing that is particularly effective at disrupting streams of stimulus-independent thoughts. If we accept the suggestion that such awareness indicates the deployment of central resources to the processing of current task or sensory content, rather than thought content, these findings suggest that procedures which train subjects to maintain subjective awareness of current experience may be useful as a way of regulating affects associated with streams of negative stimulus-independent thoughts.
Such a programme has been developed and evaluated by Kabat-Zinn and colleagues at the University of Massachusetts Medical Center (Kabat-Zinn et al., 1992), and includes training in : 1) maintenance of an attentional focus (e.g. awareness of the breath); 2) detection of loss of awareness and wandering from that focus to thoughts and feelings; 3) recognition of those thoughts and feelings as mental events rather than the "realities" that they represent; and 4) the re-direction of attention back to the focus of awareness.
In a theoretical analysis of this programme, Teasdale, Segal and Williams (6.37) have identified two central aspects: 1) continuing high subjective awareness of the attentional focus marks deployment of limited central processing resources to that topic rather than to competing demands, such as the cognitive cycles that maintain affects; 2) awareness of thoughts and feelings as "mental events" depends on, and contributes to, the creation of modified schematic models. Such models, although related to the same topic as the schematic models driving affect- or intention-related processing cycles, are sufficiently different from those models that subsequent processing is re-directed out of affect-maintaining configurations. This analysis suggests that the effects of such programmes will be different from those of simple distraction procedures. Both approaches, by taking over central resources that are required for affect maintenance, may lead to concurrent alleviation of mood. However, it is predicted that the attentional re-focusing procedure, involving the creation and storage of modified schematic models, will lead to more enduring effects. In particular, it is predicted that, following the period of active distraction or attentional re-focusing, it will be easier to avoid the re-establishment of affect-maintaining cycles following the more elaborate procedure.
These predictions will be tested with respect to the maintenance of states of negative self-focus that, according to self-regulatory models of depression (e.g. Pyszczynski & Greenberg, 1987), maintain the depressed state. Negative self-focus is assumed to involve repetitive (unsuccessful) cycles of processing motivated to reduce the discrepancy between representations of current self-related outcomes and representations of intended goal states for those outcomes. This formulation shares many features with the analysis of the maintenance of depression proposed by Teasdale and Barnard.
Teasdale and Hutton will test the following predictions in studies on (high neuroticism) subjects with high trait levels of negative self-focus: 1) focusing attention on an aspect of the self (the breath) will, somewhat counterintuitively, lead to reductions in self-focus similar to those reported with external distraction; 2) following the breath focus procedure, compared to the distraction procedure, reductions in negative self-focus will persist longer, processing priorities for self- and depression-related information will be reduced more, and related stimuli will, subsequently, be less likely to "recapture" attentional resources. These predictions will be examined following different durations of breath focus and distraction, each preceded by varying levels of prior practice. Negative self-focus will be measured using memory and production tasks shown to be sensitive to changes in negative self-focus in published studies, as well as measures of self-related and depressive content in the stream of spontaneous thought. Effects on processing priorities for depression- or intention-related material will be examined using a) incidental encoding and reading time measures for material that is specifically related to depressogenic models, depressive self-guides (Higgins, 1987), and ruminative sentences (Nolen-Hoeksema, Morrow & Fredrickson, 1993); and b) measures of capacity to sustain attention to non-affective stimuli in undemanding experimental situations. For example, it is predicted that the breath focus task will lead to greater reductions in reading times for sentences expressing (individually relevant) ruminative thoughts such as "Why do I have problems that other people don't seem to have?" and will reduce the extent to which such sentences evoke further ruminative content in subsequently sampled thought streams.
If the predicted differences emerge, the specific contributions of different aspects of the breath focus task will be examined. For example, the importance of recognising thoughts and feelings as "mental events" could be examined by comparing two versions of the task. In one, subjects, after acknowledging and recognising the nature of the thought streams and feelings to which their attention has strayed, will re-direct their own attention back to their breath, as in the conventional procedure. In the other, subjects will be periodically signalled to return attention to the breath without any requirement for self-monitoring. Similarly, the contribution to the breath focus task from its emphasis on "direct" processing of immediate experience, rather than on discrepancies between such experience and intended outcomes, could be examined by comparing versions of the task that emphasise the former features with versions that emphasise goal-orientation and performance standards for maintaining the attention focused on the breath.
The results of the experimental studies in this section will provide detailed guidance for the development and assessment of improved clinical programmes of attentional control training (C2).
C. Prevention of Relapse and Recurrence in Depression (Teasdale)
The strategic importance, existing collaborations, and clinical background to work on this project were described in Section C of the report of previous work. The theoretical background to this work (6.1, 6.37) is based on previous studies showing that individuals who have recovered from depression can be distinguished from those with no history of depression in the patterns of negative thinking that become activated in states of mild negative affect; recovered patients are more likely to show patterns similar to those observed in episodes of major depression. Such evidence suggests that relapse may depend on the re-activation, in situations of dysphoria or environmental stress, of the depressogenic cognitive cycles, dependent on central executive resources, that were active in the preceding episode of depression. On this view, psychological prophylaxis involves the "normalisation" of the thinking patterns that become activated in these situations in vulnerable individuals. This can be achieved, it is suggested, by arranging repeated experiences in which patients synthesise modified (non-depressogenic) depression-related schematic representations in many different potentially depressing contexts. In this way, patients have available in memory a store of modified schematic representations that can be accessed in preference to depressogenic representations at times of potential relapse, so preventing the re-establishment of depressive thinking patterns.
C1. Cognitive Therapy for Residual Depressive Chronicity: Teasdale will continue to be involved in a collaborative clinical trial (end date 1.2.1998) evaluating the short-term and long-term (preventative) effects of cognitive therapy for patients who still show residual depressive symptoms following an adequate trial of anti-depressant medication. The cognitive mediation of any prophylactic effects obtained will be examined by including, in addition to cognitive measures to replicate findings reported in previous trials, measures specifically developed to test the theoretical analysis described above: 1) a measure of the availability, in memory, of representations of depressing situations to which patients have responded with evidence of coping and awareness of negative thoughts and feelings as "mental events" (cf. A4) and 2) a measure of the extent to which negative cognitive patterns related to a globally negative self-view are activated in depressed moods. It is predicted that cognitive therapy will reduce these measures more than the comparison condition, that post-treatment scores on these measures will predict relapse over the follow-up period, independently of the prediction from post-treatment severity of depression, and that prophylactic effects of cognitive therapy can be accounted for, statistically, through effects on these variables.
It is anticipated that, if this trial suggests positive effects of cognitive therapy, an application will be made for external funding for a further trial to examine the relative effectiveness of cognitive therapy and alternative psychological treatments. Such a trial would provide an opportunity to investigate further the conclusions concerning therapeutic mechanisms emerging from the present trial.
C2. Attentional Control Training to Prevent Depressive Relapse: Teasdale will continue collaborative work to develop and evaluate Attentional Control Training, a novel cost-efficient approach to psychological prophylaxis for depression, specifically designed on the basis of an analysis of relapse and its prevention that he and his collaborators have proposed (6.37). The treatment procedure (6.87) combines aspects of cognitive therapy with a form of training in attentional skills similar to those studied experimentally in B, and fruitful interactions between work in these two projects is anticipated.
Further development work will depend on a continuing collaboration with Williams, Segal, and Kabat-Zinn, and extra travel costs to facilitate liaison with these workers, and to attend a training course at the Stress Reduction and Relaxation Program, University of Massachusetts Medical Center, are requested.
It is anticipated that, following further development work and pilot evaluations, external funding will eventually be sought for a randomised controlled trial. This will evaluate the prophylactic effects of Attentional Control Training in patients with at least one prior episode of major depression who have recovered from their current episode following treatment with antidepressant medication.
RECOGNITION OF EMOTION (A Young)
Introduction
Young having joined APU in September 1993, this progress report is effectively based on 6 months work.
An important component of any emotional behaviour is how we interpret the moods and feelings of other people. A central claim of theoretical approaches to face processing developed in the 1980s was that different neural mechanisms are involved in recognition of a face's identity and determining its emotional expression (Bruce & Young, 1986), and that these proceed in parallel, to a large extent independent from each other. The evidence to support this position was, however, limited and incomplete. A main focus of recent work thus concerns the processing of facial expressions, and how this relates to the processing of identity. The work follows directly from studies completed or initiated at the University of Durham (Young, Newcombe, de Haan, Small & Hay, 1993a), and has involved both neuropsychological studies and laboratory experiments. A subsidiary interest is in malfunction of emotional mechanisms in cases of delusional misidentification.
A. Neuropsychological Impairments (Young, Aggleton)
Joint work with Dr. John Aggleton (University of Durham) involves detailed investigation of face processing abilities in a woman with a severe impairment of expression-processing after amygdalotomy, exploring her ability to match the same set of stimuli on identity (intact) and expression (impaired). The interest of this finding is that, although it is often claimed that there is a double dissociation between neuropsychological impairments affecting the processing of facial expression and identity, few studies have looked in any detail at selective impairments that compromise the recognition of facial expressions.
B. Experiments with Normal Subjects (Young, Calder, Etcoff, Perrett)
A current project is exploring categorical perception of identity and expression, using computer-generated blends of different faces (joint research under an existing ESRC grant; with Dr. Andy Calder, University of Durham, Dr. David Perrett, University of St. Andrews, and Professor Nancy Etcoff, Massachusetts Institute of Technology). Categorical perception is said to occur when people are more sensitive to changes which lie across a boundary between two perceptual categories than they are to changes of the same physical magnitude within a perceptual category. This can arise because a common requirement in perception is to assign the things we see or hear to discrete categories, which simplifies the task of interpreting what is happening and selecting appropriate actions. Previous work by Etcoff and Magee (1992) had shown categorical perception of facial expressions with line drawings. The current research is exploring categorical perception using images depicting facial continua (expressions, familiar and unfamiliar identities, age, and sex) in photographic quality. The stimuli and findings are likely to have applications in future neuropsychological studies.
C. Delusional Misidentification (Young, de Pauw, Ellis, Hellawell, Reid, Szulecka)
A second topic of current interest involves the link between face processing impairments and delusional misidentification, with particular reference to the Capgras delusion (with Professor Hadyn Ellis, University of Wales College of Cardiff, Drs. Karel de Pauw and Dr. Krystyna Szulecka, Doncaster Royal Infirmary, and Dr. Ian Reid, University of Aberdeen). Here, the aim is to determine whether the general approach used in cognitive neuropsychology can usefully be extended to delusions and related 'psychiatric' phenomena. In cognitive neuropsychology, a model of normal performance is used to account for different types of impairment; at issue is whether this will also prove fruitful for delusions. Delusional misidentification has been chosen as a starting point because a reasonably articulated theoretical model of normal face processing and appropriate tests are available.
The Capgras delusion involves the belief that familiar people have been replaced by 'dummies' or impostors. Ellis and Young (1990) explicitly made a link to work on covert recognition in prosopagnosia (Young, 1993; Young and de Haan, 1992), suggesting that the Capgras delusion might usefully be seen in part as a mirror-image of the problem found in prosopagnosia. For prosopagnosic patients, the face is not recognised overtly but some automatic reactions, including those involving its emotional significance, are typically preserved. In Capgras cases, the face is recognised but its emotional significance is lost. A review of these areas has recently been completed (Young, 1994), and the idea has been further developed into the proposals (a) that the Capgras delusion represents the patient's attempt to make sense of the fact that visual stimuli no longer produce appropriate affective responses, and (b) that the genesis of this delusion therefore involves an interaction of impairments at two levels (6.32). One set of contributory factors create anomalous perceptual experience, and the other factors lead to an incorrect interpretation of this experience, with misattributions due to suspiciousness playing an important role (Wright, Young & Hellawell, 1993; Young, Reid, Wright & Hellawell, 1993).
FUTURE PROPOSALS
Introduction
The general direction of the work is towards examining expression processing and social perception in more detail. A continuing concern involves the relation of the recognition of identity and expression from the face. This will be explored by attempting to fractionate components of emotional expression perception, using an approach that combines studies of neuropsychological cases and experiments with normal people, along the lines adopted in previous work on the recognition of identity. In addition, the relation between the processing of facial and vocal expressions will be investigated.
For these purposes, specific planned projects are case studies of bilateral amygdalotomy, an investigation of face processing impairments after frontal lobe lesions, and studies of priming effects on the recognition of facial expressions.A separate area of further work concerns cognitive and emotional components of delusions, and especially delusional misidentification.
A. Neuropsychological Impairments(Young, Aggleton)
The significance of planned work on the neuropsychology of expression perception is that it will try to identify precisely the functional locus of observed deficits and clarify whether facial expression processing is implemented by neural mechanisms which are face-specific or supramodal, and whether these are emotion-specific or used in all forms of social interaction.
A1. Case Studies of Amygdalotomy: The case studies of amygdalotomy will continue the work started as a single case study with Dr. John Aggleton (University of Durham), exploring further this patient's deficit in expression processing. An issue of particular interest concerns whether processing of expressions is as impaired for voices as for faces; i.e. whether there is an impairment of some form of supramodal expression mechanism rather than a mechanism specific to faces. Received wisdom in the neuropsychological literature is that deficits affecting the recognition of facial and vocal expressions are dissociable, but the relevant studies are sparse and unconvincing as to the level at which such fractionation occurs. It is known that visuo-verbal fusions are important in speech perception (Campbell, 1992), which gives grounds for speculating that an equivalent phenomenon might operate in the perception of emotion, for which some (but not all) of the same constraints apply.
Additional contacts with other researchers who have studied cases of bilateral amygdalotomy should also lead to the testing of further patients with the same tasks.
A2. Face Processing Impairments after Frontal Lobe Lesions: Although it is known that regions of posterior cortex involved in face perception are linked to particular areas in the frontal lobes (Wilson, ó Scalaidhe & Goldman-Rakic, 1993), and social and emotional changes are commonly reported after frontal lobe damage, there have only been patchy and unsystematic investigations of any corresponding face processing impairments. A more systematic study would show whether there is significant frontal lobe involvement in different aspects of face (and voice) processing, and could lead to the identification of individual patients with theoretically important deficits in expression perception. For this purpose, patients with lesions of different frontal regions will be compared on recognition of familiar faces, recognition of facial expressions, recognition memory for faces, and unfamiliar face matching, using updated versions of tasks from previous work (Young et al., 1993a). If possible, lesions centred on ventromedial and dorsolateral frontal cortex will be contrasted. Equivalent tests of voice processing will be developed to allow investigation of whether any impairments found affect only faces, or are multimodal in nature. This will also provide an important point of comparison to the case studies of amygdalotomy (A1).
A3. Development of Test Materials: A lot of the work needed for these proposed neuropsychological studies involves preparing and assembling appropriate materials. The Ekman and Friesen (1976) pictures of facial affect are readily available and have formed the basis of tests used previously (Young et al., 1993a), and some of the necessary tests of vocal emotion processing have also been prepared (6.32). For both visual and auditory presentation, however, a more thorough approach is needed. For example, it is necessary to have tasks involving moving facial stimuli. Although the emotions portrayed in the Ekman and Friesen (1976) face photographs are accurately recognised by normal observers, it remains the case that in everyday life emotions are often seen as fixed action patterns of facial movement. There is evidence that information about movement is carried by a separate neural channel to information about static form, and this has been found important in work on the recognition of expression and identity both in normal people (Bruce & Valentine, 1988) and after brain injury (Humphreys, Donnelly & Riddoch, 1993). In addition, stimuli are needed to test the comprehension of emotional terms. This is usually done very informally, but for multimodal deficits especially it will be important to rule out (or rule in) the possibility that failure to recognise emotions reflects failure properly to comprehend what it means to be angry, sad, afraid etc.
Tasks are also needed to look more systematically at the processing of emotional and conventional facial and vocal gestures. Goldblum (1980) reported a double dissociation between deficits in recognising emotional facial expressions and conventional facial gestures used in social interaction. Although this finding is consistent with other evidence on the dissociation of lipreading and expression perception (Campbell, 1992), it has not been followed up. In addition, further tests are needed to explore the relation between facial expression processing and recognition of other visual signals that convey emotion, such as body posture.
B. Experiments with Normal Subjects (Young)
As in previous work on face recognition, a fruitful approach should be to integrate neuropsychological and experimental approaches wherever possible. In tandem with the neuropsychological work on expression perception, therefore, experimental studies of priming and related effects on the recognition of facial expressions will be conducted.
B1. Short- vs. Long-Term Priming of Expression Recognition: An intriguing finding has been that there is no long-term benefit (across intervals of around 20 minutes) of having previously classified the expression shown in a face photograph on performing the task again (i.e., there is no subsequent benefit on making the same classification to the same photograph). Put another way, there do not seem to be long-term repetition priming effects in the processing of a particular face's expression (Ellis, Young & Flude, 1990). The expression recognition system may be set up this way because of the need to monitor constant but often subtle changes in the moods of other people; for this purpose, analysing someone's current mood by biasing your judgement toward their mood of 20 minutes ago might not be an optimal way to proceed. However, it seems likely that other forms of priming effect might occur, either short-term effects on analysing the expression on a particular person's face or, perhaps more importantly, a short-term or long-term bias toward the perception of particular emotions on any face. A finding of the latter type would, of course, fit neatly into other work at APU on cognition and emotion (6.1).
Investigations of short-term benefits in processing expressions will therefore be carried out, in which we will investigate the influence of having previously classified expression A in person X's face on subsequent recognition of the same emotion on the same face, the same emotion on a different face, or a different emotion on the same face.
B2. Within and Cross-Domain Priming of Expression Recognition: A technique which has proved very useful in experiments on the recognition of identity is to contrast priming effects which only arise within the same domain (e.g., from face to face) with effects which can cross stimulus domains (e.g., from face to name). This can be adapted to the investigation of the processing of emotion by comparing priming effects from facial expressions onto the recognition of expression labels. Since the structure of within and cross-domain priming effects on the recognition of identity has been both documented and simulated (Burton & Bruce, 1993), it should be possible to make relatively rapid progress in understanding priming effects on the recognition of expressions.
C. Delusional Misidentification(Young, de Pauw, Ellis, Szulecka)
A separate focus of interest is in investigations of face processing impairments and other cognitive components of delusions and delusional misidentification.
C1. Relation between Capgras and Cotard Delusions: Face processing impairments are often found in cases of delusional misidentification (Young, Ellis, Szulecka & de Pauw, 1990; Young et al., 1993b). This observation has led to the idea that the Capgras delusion (in which relatives are claimed to have been replaced by impostors) reflects an interaction of impairments. One set of contributory factors involves anomalous perceptual experience, and especially impaired emotional reactions to faces and other familiar visual stimuli (Ellis & Young, 1990); the second set of factors lead to an incorrect interpretation of this, creating a misattribution which is particularly likely in people who are in a highly suspicious mood (Young et al., 1993b). This general approach can also encompass other forms of delusion.
Delusional misidentification may thus relate closely to other forms of delusion that would otherwise appear highly distinct, since the same anomalous experiences can be misinterpreted in different ways. This insight can be used to explore a potential link to the Cotard delusion, in which patients are convinced that they are dead. In such cases, the patients are nearly always severely depressed, but it is known from other studies that people who are depressed will be more likely to misattribute loss of affective responses to themselves instead of others. This may explain similarities between the brain lesions, neuropsychological test profiles, and subjective reports of people experiencing the Cotard delusion and cases of Capgras delusion (6.56). The hypothesis is that patients who are suspicious will experience the Capgras delusion because they attribute their loss of affective reactions to others; those who are depressed but not suspicious will be more likely to experience the Cotard delusion because they correctly attribute the loss to themselves, but exaggerate its effects (Wright et al., 1993).
The usefulness of this hypothesis will be further investigated by examining other cognitive components of such delusions. For example, recent work being developed by postgraduate student Kate Leafhead has shown the usefulness of the notion that delusions are in part maintained by similar factors to those involved in anxiety states. Using the emotional Stroop paradigm (Bentall & Kaney, 1989; Williams & Broadbent, 1986), it can be shown that items which relate to the patient's delusions readily engage their attention.
C2. Domain-Specific vs. General Impairments in Delusional Misidentification: A key feature of Ellis and Young 's (1990) account of delusional misidentification is that it suggests a basis in malfunction of the visual system. However, other accounts, such as Cutting's (1991) categorisation failure hypothesis, predict a more central breakdown of semantic representations. For hypotheses which treat reduplication as a malfunction of the visual recognition system, specifically visual deficits are to be expected, whereas on the categorisation failure hypothesis, the problem should arise regardless of input domain. Such predictions should be readily testable, and can be investigated with the tasks being developed for neuropsychological studies (A3).
PUBLICATIONS (Excluding work done prior to arrival at APU)
Authored Books
6.1. TEASDALE, J.D. & BARNARD, P.J. (1993). Affect, Cognition and Change. Hove: Lawrence Erlbaum Associates.
6.2. WILLIAMS, J.M.G. (1992). The Psychological Treatment of Depression (second edition). London: Routledge.
Edited Books
6.3.* BADDELEY, A.D., WILSON, B.A. & WATTS, F.N. (Eds.) (in press). Handbook of Memory Disorders. Chichester: John Wiley & Sons.
6.4. Parry, G. & WATTS, F.N. (Eds.). (in press). Behavioural and Mental Health Research: A Handbook of Skills and Methods, second edition. Hove, Sussex: Lawrence Erlbaum.
6.5. WATTS, F.N. (Ed.). (1993). Neuropsychological perspectives on emotion. Special issue of Cognition and Emotion. Hove: Sussex: Lawrence Erlbaum Associates.
Refereed Articles
6.6. BARNARD, P.J. & TEASDALE, J.D. (1991) (equal authorship). Interacting cognitive subsystems: A systemic approach to cognitive-affective interaction and change. Cognition and Emotion, 5, 1-39.
6.7. Carr, S.J., TEASDALE, J.D. & Broadbent, D.E. (1991). Effects of induced elated and depressed mood on self-focused attention. British Journal of Clinical Psychology, 31, 273-275.
6.8. Constans, J.I. & MATHEWS, A.M. (1993). Mood and the subjective risk of future events. Cognition and Emotion, 7, 545-560.
6.9. COYLE, K. & WATTS, F.N. (1991). The factorial structure of sleep dissatisfaction. Behaviour Research and Therapy, 29, 513-520.
6.10. Dalgleish, T. & WATTS, F.N. (1990). Biases of attention and memory in disorders of anxiety and depression. Clinical Psychology Review, 10, 589-604.
6.11. DRITSCHEL, B. & TEASDALE, J.D. (1991). Individual differences in affect-related cognitive operations elicited by experimental stimuli. British Journal of Clinical Psychology, 30, 151-160.
6.12. EAST, M.P. & WATTS, F.N. (in press). The inner articulation rate of stutterers. European Journal of Disorders of Communication.
6.13. EAST, M.P. & WATTS, F.N. (in press). Worry and the suppression of imagery. Behaviour Research and Therapy.
6.14. Evans, J.M., WILLIAMS, J.M.G., O'Loughlin, S. & Howells, K. (1992). Autobiographical memory and problem-solving strategies of patients who parasuicide. Psychological Medicine, 22, 399-405.
6.15. Jack, R.L. & WILLIAMS, J.M.G. (1991). The role of attribution in self-poisoning. British Journal of Clinical Psychology, 30, 25-35.
6.16. Jack, R.L. & WILLIAMS, J.M.G. (in press). Attribution and intervention in self-poisoning. British Journal of Medical Psychology.
6.17. LEVEY, A.B., Aldaz, J.A., WATTS, F.N. & COYLE, K. (1991). Articulatory suppression and the treatment of insomnia. Behaviour Research and Therapy, 29, 85-89.
6.18. LEVEY, A.B. & Martin, I. (1990). Evaluative conditioning: Overview and further options. Cognition and Emotion, 4, 31-37.
6.19. LEVEY, A.,B. & Martin, I. (1991). Psychophysiology and the inner world. Journal of Psychophysiology, 5, 1-3.
6.20. MACLEOD, A.K., Rose, G.S. & WILLIAMS, J.M.G. (in press). Components of hopelessness about the future in parasuicide. Cognitive Therapy and Research.
6.21. MACLEOD, A. & WILLIAMS, J.M.G. (1990). Overgeneralization: An important but non-homogeneous construct. British Journal of Clinical Psychology, 29, 443-444.
6.22. MACLEOD, A.K. & WILLIAMS, J.M.G. (1991). Moderate levels of chronic mood disturbance are associated with increased cognitive complexity about the self. British Journal of Medical Psychology, 64, 179-188.
6.23. MACLEOD, A.K., WILLIAMS, J.M.G. & Bekerian, D.A. (1991). Worry is reasonable: The role of explanations in pessimism about future personal events. Journal of Abnormal Psychology, 100, 478-486.
6.24. MACLEOD, A.K., WILLIAMS, J.M.G. & Linehan, M.M. (1992). New developments in the understanding and treatment of suicidal behaviour. Behavioural Psychotherapy, 20, 193 - 218.
6.25. Markar, H.R., WILLIAMS, J.M.G., Wells, J. & Gordon, L. (1991). Occurrence of schizotypal and borderline symptoms in parasuicide patients: Comparison between subjective and objective indices. Psychological Medicine, 21, 385-392.
6.26. Marx, E.M., WILLIAMS, J.M.G. & Claridge, G.C. (1992). Depression and social problem solving. Journal of Abnormal Psychology, 101, 78-86.
6.27. MATHEWS, A. & MILROY, R. (in press). Effects of priming and suppression of worry. Behaviour Research and Therapy.
6.28. MATHEWS, A. & MILROY, R. (in press). Processing of emotional meaning of anxiety. Cognition and Emotion.
6.29. MATHEWS, A., Mogg, K., Kentish, J. & Eysenck, M. (in press). Effect of psychological treatment on cognitive bias in generalized anxiety disorder. Behaviour Research and Therapy.
6.30. MATHEWS, A. & Sebastian, S. (1993). Suppression of emotional Stroop effects by fear-arousal. Cognition and Emotion, 7, 517-530.
6.31. Mogg, K., Bradley, B., Williams, R. & MATHEWS, A. (1993). Subliminal processing of emotional information in anxiety and depression. Journal of Abnormal Psychology, 102, 304-311.
6.32. Reid, I., YOUNG, A.W. & Hellawell, D.J. (1993). Voice recognition impairment in a blind Capgras patient. Behavioural Neurology, 6, 225-228.
6.33. Roberts, A. & WILLIAMS, J.M.G. (1992). Effect of olfactory stimuli on mood: A case for aromatherapy? British Journal of Medical Psychology, 65, 197 199.
6.34. TEASDALE, J.D. (1993). Emotion and two kinds of meaning: Cognitive therapy and applied cognitive science. Behaviour Research and Therapy, 31, 339-354.
6.35. TEASDALE, J.D., DRITSCHEL, B.H., TAYLOR, M.J., Proctor, L., LLOYD, C.A., NIMMO-SMITH, I. & BADDELEY, A. D. (in press). Stimulus-independent thought depends on central executive resources. Memory and Cognition.
6.36. TEASDALE, J.D., Proctor, L., LLOYD, C.A. & BADDELEY, A.D. (1993). Working memory and stimulus-independent thought: Effects of memory load and presentation rate. European Journal of Clinical Psychology, 5, 417-433.
6.37. TEASDALE, J.D., Segal, Z.V. & WILLIAMS, J.M.G. (in press). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? An information-processing analysis. Behavioural Research and Therapy.
6.38. TEASDALE, J.D., TAYLOR, M.J., Cooper, Z., Hayhurst, H. & Paykel, E.S. (in press). Depressive thinking: Shifts in construct accessibility or in schematic mental models? Journal of Abnormal Psychology.
6.39. WATTS, F.N. (1990). Aversion to personal body hair: A case study in the integration of behavioural and interpretative methods. British Journal of Medical Psychology, 63, 335-340.
6.40. WATTS, F.N. (1992). Applications of current cognitive theories of the emotions to the conceptualization of emotional disorders. British Journal of Clinical Psychology, 31, 153-167.
6.41. WATTS, F.N. (in press). An information processing approach to compulsive checking. Clinical Psychology and Psychotherapy.
6.42. WATTS, F.N., Apps, J. & EAST, M.P. (1993). Personality change produced by expedition stress: A controlled study. Personality and Individual Differences, 15, 603-605.
6.43. WATTS, F.N., Cohen, J. & TOPLIS, R. (in press). Personality and coping strategies on a stressful expedition. Personality and Individual Differences.
6.44. WATTS, F.N. & COYLE, K. (1992). Recall bias for stimulus and response: Anxiety words in spider phobics. Anxiety Research, 4, 315-323.
6.45. WATTS, F.N. & COYLE, K. (1993). Phobics show poor recall of anxiety words. British Journal of Medical Psychology, 66, 373-382.
6.46. WATTS, F.N., COYLE, K. & EAST, M.P. (1994). The contribution of worry to insomnia. British Journal of Clinical Psychology, 33, 211-220.
6.47. WATTS, F.N. & Dalgleish, T. (1991). Memory for phobia-related words in spider phobics. Cognition and Emotion, 5, 313-329.
6.48. WATTS, F.N., Dalgleish, T., BOURKE, P. & Healy, D. (1990). Memory deficit in clinical depression: Processing resources and the structure of materials. Psychological Medicine, 20, 345-349.
6.49. WATTS, F.N., EAST, M.P. & COYLE, K. (in press). Insomniacs' perceived control over sleep. Psychology and Health.
6.50. WATTS, F.N., Webster, S.M., Morley, C.J. & Cohen, J. (1992). Expedition stress and personality change. British Journal of Psychology, 83, 337-341.
6.51. WATTS, F.N., Webster, S.M., Morley, C.J. & Cohen, J. (1993). Cognitive strategies in coping with expedition stress. European Journal of Personality, 7, 255-266.
6.52. WILLIAMS, J.M.G., Healy, D., TEASDALE, J., White, W. & Paykel, E.S. (1990). Dysfunctional attitudes and vulnerability to persistent depression. Psychological Medicine, 20, 375-381.
6.53. WILLIAMS, J.M.G. & Markar, H.R. (1991). Money hidden and rediscovered in subsequent manic phases: A case of action dependent on mood state? British Journal of Psychiatry, 159, 579-581.
6.54. YOUNG, A.W., Flude, B.M., Hellawell, D.J. & Ellis, A.W. (in press). The nature of semantic priming effects in the recognition of familiar people. British Journal of Psychology.
6.55. YOUNG, A.W., Humphreys, G., Riddoch, J., Hellawell, D, & de Haan, E. (1994). Recognition impairments and face imagery. Neuropsychologia, 32, 693-702.
6.56. YOUNG, A.W., Robertson, I.H., Hellawell, D.J., de Pauw, K.W. and Pentland, B. (1992). Cotard delusion after head injury. Psychological Medicine, 22, 799-804.
Submitted
6.57. LLOYD, C.A. & TEASDALE, J.D. Context-dependent availability of intentions. (Manuscript submitted to Motivation and Emotion)
6.58. Segal, Z.V., WILLIAMS, J.M.G., TEASDALE, J.D. & Gemar, M. A cognitive science perspective on kindling and episode sensitization in recurrent affective disorder. (Manuscript submitted to British Journal of Psychiatry)
6.59. TEASDALE, J.D. & DRITSCHEL, B.H. Mood congruous memory: Self-relevance is not sufficient. (Manuscript submitted to British Journal of Clinical Psychology)
6.60. TEASDALE, J.D. & HUTTON, J.M. (a) Maintaining an attentional focus reduces depressive thinking. (Manuscript submitted to British Journal of Clinical Psychology)
6.61. TEASDALE, J.D. & HUTTON, J.M. (b) Sociotropy and response to brief social isolation. (Manuscript submitted to British Journal of Clinical Psychology)
Invited Chapters and Commentaries
6.62. Eves, F., Blizard, R., LEVEY, A. & Martin, I. (1990). Cardiac reactions to passive stimulation in twins. In P.J.D. Drenth, J.A. Sergeant & R.J. Takens (Eds.), European Perspectives in Psychology, Vol. 2 (pp. 443-457). Chichester: John Wiley & Sons.
6.63. MACLEOD, A. (in press). Judgemental biases in anxiety. In J.P. Caverni, J.-M. Fabre & M. Gonzalez (Eds.), Cognitive Biases. North-Holland: Elsevier.
6.64. MACLEOD, A.K. & WILLIAMS, J.M.G. (1992). The cognitive psychology of parasuicidal behaviour. In P. Crept, G. Ferrari, S. Platt & M. Bellini (Eds.), Suicidal Behaviour in Europe: Recent Research Findings. Rome: John Libbey,
6.65. MATHEWS, A. (1993). Anxiety and the processing of emotional information. In L.J. Chapman, J.P. Chapman & D.C. Fowles (Eds.), Progress in Experimental Personality and Psychopathology Research, Vol. 16 (pp. 254-280). New York: Springer Publishing Company.
6.66. MATHEWS, A. & MacLeod, C. (1994). Cognitive approaches to emotion and emotional disorders. Annual Review of Psychology, 45, 25-50.
6.67. TEASDALE, J.D. (1991). Cognitive vulnerability to persistent depression. In P. Slade (Ed.), The Psychology of Depression: Current Issues in Research and Practice (pp. 42-51). Deparment of Psychology, University of Sheffield.
6.68. TEASDALE, J.D. (1992). Cognitive models of depression: The state of the notion. Psychological Inquiry, 3, 269-271.
6.69. TEASDALE, J.D. (1993). Selective effects of emotion on information processing. In A.D. Baddeley & L. Weiskrantz (Eds.), Attention: Selection, Awareness and Control: A Tribute to Donald Broadbent (pp. 374-389). Oxford: Clarendon Press.
6.70. TEASDALE, J.D. (in press). A cognitive-behavioral perspective on assessment in the investigation of recurrent mood and anxiety disorders. In S. Hollon & B.E. Wolfe (Eds.), Methodological Issues in the Investigation of Treatment of Chronic and/or Recurrent Anxiety and Mood Disorders. Washington, D.C.: American Psychological Association Books.
6.71. TEASDALE, J.D. (in press). Clinically relevant theory: Integrating clinical insight with cognitive science. In P. Salkovskis & D.M. Clark (Eds.), Frontiers of Cognitive Therapy. New York: Guilford Press.
6.72. WATTS, F.N. (1993). Problems of memory and concentration. In C.G. Costello (Ed.), Symptoms of Depression (pp. 113-140). New York: John Wiley & Sons.
6.73. WATTS, F.N. (1993). The current state of jealousy: A review of recent books. Cognition and Emotion, 7, 217-223.
6.74. WATTS, F.N. (in press). Depression and anxiety. In A.D. Baddeley, B. Wilson & F.N. Watts (Eds.), Handbook of Memory Disorders. Chichester: John Wiley.
6.75. WATTS, F.N. (in press). Health and illness. In C. Fraser & G. Duveen (Eds.), Social Psychology. Cambridge: Polity Press.
6.76. WILLIAMS, J.M.G. (1990). When stress becomes depression. In J.A. Graham & L. Wallace (Eds.), The Complete Mind and Body Book (pp. 44-45). New York: Simon and Schuster.
6.77. WILLIAMS, J.M.G. (1992). Autobiographical memory in emotional disorder. In S.A. Christianson (Ed.), Handbook of Emotion and Memory (pp. 451-477). New York: Lawrence Erlbaum Associates.
6.78. WILLIAMS, J.M.G. & DRITSCHEL, B. (1992). Categoric and extended autobiographical memories. In M.A. Conway, D.C. Rubin, H. Spinnler & W. Wagenaar (Eds.), Theoretical Perspectives on Autobiographical Memory (pp. 391-409). Dordrecht: Kluwer Academic Publishers.
6.79. WILLIAMS, J.M.G. & MACLEOD, A.K (1990). Cognitive processes in parasuicide: Memory, hopelessness and schizotypal phenomena. In G. Ferrari, M. Bellini & P. Crepet (Eds.), Suicidal Behaviour and Risk Factors. Bologna: Monduzzi Editore.
Conference Proceedings
6.80. MATHEWS, A. (1993). Biases in processing emotional information. The Psychologist, 6, 493-499.
6.81. MATHEWS, A. (in press). Selective memory for emotional information. In D. Herrmann, M. Johnson, C. McEvoy, C. Hertzog & P. Hertel (Eds.), Proceedings of the Third Practical Aspects of Memory Conference. Lawrence Erlbaum Associates.
6.82. WATTS, F.N. (1990). Emotion and Thinking. In K.J. Gilhooly, M.T.G. Keane, R.H. Logie & G. Erdos (Eds.), Lines of Thinking: Reflections on the Psychology of Thought, Vol. 2 (pp.117-119). Chichester: John Wiley & Sons Ltd.
6.83. WATTS, F.N. (1990). The cohesiveness of phobic concepts. In K. Gilhooly, M. Keane, R. Logie & G. Erdos (Eds.), Lines of Thinking. Reflections on the Psychology of Thought, Vol. 2 (pp.145-155). Chichester: John Wiley.
6.84. WATTS, F.N. (Ed.). (1990). The Undergraduate Curriculum in Psychology. The British Psychological Society, Vol. 9. (Proceedings of a symposium held at the London Conference of the British Psychological Society on 20 December 1988).
6.85. WATTS, F.N. (1992). Is psychology falling apart? The Psychologist, 5, 489-494.
Technical Reports and Theses
6.86. LLOYD, C.A. (1993). Empirical investigations of self-regulatory models of behaviour and their implications for clinical depression. Unpublished PhD Thesis, University of Cambridge.
6.87. Segal, Z.V., WILLIAMS, J.M.G. & TEASDALE, J.D. (1994). Cognitive Behaviour Therapy - Maintenance Treatment: Therapist Manual for Group Treatment.
Dissemination
6.88. Good, D.A. & WATTS, F.N. (in press). Qualitative research. In G. Parry & F.N. Watts (Eds.), Behavioural and Mental Health Research: A Handbook of Skills and Methods, second edition. Hove, Sussex: Lawrence Erlbaum.
6.89. Lavender, A. & WATTS, F.N. (in press). Rehabilitation: Assessment. In S. Lindsay & G. Powell (Eds.), A Handbook of Clinical Adult Psychology. London: Routledge.
6.90. Lavender, A. & WATTS, F.N. (in press). Rehabilitation: Intervention. In S. Lindsay & G. Powell (Eds.), A Handbook of Clinical Adult Psychology. London: Routledge.
6.91. WATTS, F.N. (1993). The role of research. In G. Powell, R. Young & S. Frosh (Eds.), Curriculum in Clinical Psychology (pp. 32-35). Leicester: British Psychological Society.
6.92. WATTS, F.N. (in press). Experimental abnormal psychology. In G. Parry & F.N. Watts (Eds.), Behavioural and Mental Health Research: A Handbook of Skills and Methods, second edition. Hove, Sussex: Lawrence Erlbaum.
REFERENCES TO OTHER WORK
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Beck, A.T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.
Bower, G.H. (1981). Mood and memory. American Psychologist, 36, 129-148.
Brittlebank, A., Scott, J., Ferrier, N. & WILLIAMS, J.M.G. (1993). Autobiographical memory in depression: State or trait marker? British Journal of Psychiatry, 162, 118-121.
Bruce, V. & Valentine, T. (1988). When a nod's as good as a wink. The role of dynamic information in facial recognition. In M.M. Gruneberg, P.E. Morris & R.N. Sykes (Eds.), Practical Aspects of Memory: Current Research and Issues. Volume 1: Memory in Everyday Life (pp. 169-174). Chichester: Wiley.
Bruce, V. & YOUNG, A. (1986). Understanding face recognition. British Journal of Psychology, 77, 305-327.
Burton, A.M. & Bruce, V. (1993). Naming faces and naming names: exploring an interactive activation model of person recognition. Memory, 1, 457-480.
Campbell, R. (1992). The neuropsychology of lipreading. Philosophical Transactions of the Royal Society, B335, 39-45.
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Ekman, P. & Friesen, W.V. (1976). Pictures of Facial Affect. Palo Alto, California: Consulting Psychologists Press.
Ellis, A.W., YOUNG, A.W. & Flude, B.M. (1990). Repetition priming and face processing: priming occurs within the system that responds to the identity of a face. Quarterly Journal of Experimental Psychology, 42A, 495-512.
Ellis, H.D. & YOUNG, A.W. (1990). Accounting for delusional misidentifications. British Journal of Psychiatry, 157, 239-248.
Etcoff, N.L. & Magee, J.J. (1992). Categorical perception of facial expressions. Cognition, 44, 227-240.
Foa, E.B. & Riggs, D.S. (1993). Post-traumatic stress disorder in rape victims. American Psychiatric Press Review of Psychiatry, 12.
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Healy, D. & WILLIAMS, J.M.G. (1989). Mood, misattribution and mania: an interaction of biological and psychological factors in the pathogenesis of mania. Psychiatric Developments, 1, 49-70.
Higgins, E.T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319-340.
Humphreys, G.W., Donnelly, N. & Riddoch, M.J. (1993). Expression is computed separately from facial identity, and it is computed separately for moving and static faces: Neuropsychological evidence. Neuropsychologia, 31, 173-181.
Kabat-Zinn, J. et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936-943.
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Nolen-Hoeksema, S., Morrow, J. & Fredrickson, B.L. (1993). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102, 20-28.
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Walker, J.H., Sproull, L. & Subramat, R. (1994). Using a human face in an interface. In B. Addison, S. Dumais & J. Olson (Eds.), CHI '94: Human Factors in Computing Systems (pp. 85-91). New York: ACM
WATTS, F.N., McKenna, F.P., Sharrock, R. & Trezise, L. (1986). Colour naming of phobia-related words. British Journal of Psychology, 77, 97-108.
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WILLIAMS, J.M.G. & Broadbent, K. (1986). Distraction by emotional stimuli: Use of a Stroop task with suicide attempters. British Journal of Clinical Psychology, 25, 101-110.
WILLIAMS, J.M.G. & Moorey, S. (1989). Cognitive therapy: The end of the beginning. In J. Scott, J.M.G. Williams, & A.T. Beck (Eds.), Cognitive Therapy in Clinical Practice. London: Routledge.
WILLIAMS, J.M.G., WATTS, F.N., MacLeod, C. & MATHEWS, A.M. (1988). Cognitive Psychology and Emotional Disorders. Chichester: John Wiley and Sons.
WILLIAMS, J.M.G. & Wells, J. (1989) Cognitive therapy with suicidal patients. In J. Scott, J.M.G. Williams, & A.T. Beck (Eds.), Cognitive Therapy in Clinical Practice. London: Routledge.
Wilson, F.A.W., ó Scalaidhe, S.P. & Goldman-Rakic, P.S. (1993). Dissociation of object and spatial processing domains in primate prefrontal cortex. Science, 260, 1955-1958.
Wright, S., YOUNG, A.W. & Hellawell, D.J. (1993). Sequential Cotard and Capgras delusions. British Journal of Clinical Psychology, 32, 345-349.
YOUNG, A.W. (1993). Covert recognition. In M. Farah & G. Ratcliff (Eds.), The Neuropsychology of Higher Vision: Collected Tutorial Essays. Hillsdale, New Jersey: Lawrence Erlbaum.
YOUNG, A.W. (1994). Conscious and nonconscious recognition of familiar faces. In C. Umiltà & M. Moscovitch (Eds.), Attention and Performance, XV: Conscious and Nonconscious Information Processing (pp. 153-178). Cambridge, Massachusetts: MIT Press/Bradford Books.
YOUNG, A.W. & de Haan, E.H.F. (1992). Face recognition and awareness after brain injury. In A.D. Milner & M.D. Rugg (Eds.), The Neuropsychology of Consciousness (pp. 69-90). London: Academic Press.
YOUNG, A.W., Ellis, H.D., Szulecka, T.K. & de Pauw, K.W. (1990). Face processing impairments and delusional misidentification. Behavioural Neurology, 3, 153-168.
YOUNG, A.W., Newcombe, F., de Haan, E.H.F., Small, M. & Hay, D.C. (1993a). Face perception after brain injury: Selective impairments affecting identity and expression. Brain, 116, 941-959.
YOUNG, A.W., Reid, I., Wright, S. & Hellawell, D.J. (1993b). Face-processing impairments and the Capgras delusion. British Journal of Psychiatry, 162, 695-698.
Collaborations
Barnard
UK based
Murray - Psychiatry, Cambridge
Cooper - Psychology, Cambridge and Reading
Mathews
UK based
Bradley - Psychology, Cambridge
Mogg - Psychology, Cambridge
Outside UK
Borkovec - Pennsylvania State University
MacLeod - University of Western Australia
Teasdale
UK based
Paykel - Psychiatry, Cambridge
Scott - Psychiatry, Newcastle-upon-Tyne
Williams - Psychology, Bangor
Cooper - Psychiatry, Cambridge
Sheppard - Psychiatry, Cambridge
Kelvin - Psychiatry, Cambridge
Outside UK
Segal - Psychiatry, Toronto
A Young
UK based
Aggleton - Psychology, Durham
Calder - Psychology, Durham
Perrett - Psychology, St. Andrews
Ellis - Psychology, Cardiff
de Pauw, Szulecka - Psychiatry, Doncaster
Reid - Psychiatry, Aberdeen
Outside UK
Etcoff - Psychology, Massachusetts Institute of Technology