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Cognition, Emotion and Mental Health
Cognition, Emotion and Mental Health
Our programme has two aims: 1) To utilise a developmental cognitive neuroscience framework to understand the core processes involved in the onset, maintenance, and recovery from mood and anxiety disorders (such as depression and posttraumatic stress disorder [PTSD]) in children, adolescents, and adults. 2) To translate this understanding to generate novel forms of psychological treatment for these syndromes and to provide greater clarity concerning the mechanisms of action of existing treatments.
Our research is guided by the MRC’s framework for developing complex interventions and occupies a trajectory ranging from basic cognitive neuroscience through to randomised clinical trials. This work is grounded within a transdiagnostic framework, taking the view that the greatest potential for understanding and treating affective disorders is to focus on maladaptive underlying psychological and biological processes that cross traditional diagnostic boundaries, rather than pursue diagnosis-led research. We use cognitive-experimental, psychophysiology, genetic, and neuroimaging methodologies in the laboratory and prospective longitudinal and clinical trial designs outside the laboratory.
Our basic and pre-clinical science is carried out at the CBSU. Our clinical research is carried out at the Cambridge Centre for Affective Disorders (C2:AD) directed by Tim Dalgleish.
Intrusive and distressing memories of past negative and traumatic experiences characterise the range of mood and anxiety disorders and are strongly implicated in the maintenance of disorder. Ongoing studies focus on developing methods for controlling and regulating the content and intrusiveness of these emotional memories and on understanding how such control works; for example, using training with Anderson’s (hyperlink) memory inhibition procedures; developing broader perspectives on memories across time, space and social context; and combating negative memory biases with systematic cognitive training. Two planned proof-of-principal clinical projects (at the Haven, London, involving sexual assault and abuse victims, and in Cambridge, involving depressed individuals) will combine these methods developed in the laboratory with existing clinical techniques to form a targeted intervention for patients for whom dysregulated distressing memories are a dominant clinical feature.
Mood and anxiety disorders are characterised by deficits in executive control that seem particularly marked in the context of affectively-laden self-relevant information. We are exploring the potential of working memory training using such emotional material to deliver transferable gains in affective processing across diverse cognitive domains. Ongoing studies focus on healthy participants and patient groups with depression and PTSD, and utilise behavioural and fMRI evaluation methods to examine the size of training and transfer effects and the brain systems that underlie them.
Both a history of childhood adversity, and the presence of a particular genetic signature (the short-variant polymorphism of the serotonin [5-HTT] transporter gene which regulates removal of serotonin from the synaptic cleft), are distal risk factors for the onset of depression. The nature of the psychological processes that mediate the effects of these risks on vulnerability is unclear. Strong candidates are individual differences in emotion response and regulation. In collaboration with colleagues in the Cambridge University Department of Psychiatry we are investigating, using functional brain imaging (fMRI), the effects of these risks on emotion responses and their regulation on a number of tasks in 4 groups of adolescents (high vs low adversity x short vs long polymorphism) with, as yet, no history of depression. Participants are being recruited from the ROOTS cohort; an ongoing Wellcome Trust funded study that has followed 1192 Cambridgeshire teenagers from age 13. We are looking at the effects of gene and environment on self-report, psychophysiological, and neural responses to the experimental manipulations, along with functional and structural neural connectivity.
Mindfulness-Based Cognitive Therapy (MBCT) is an 8-week, group based intervention that teaches skills to prevent relapse/recurrence of depression in long-term sufferers of the condition who are currently feeling well. MBCT was originally co-developed at the CBSU by John Teasdale and is based on theoretical and empirical work showing that relapse is associated with the reinstatement of modes of thinking, feeling and behaving that in fact counter-productively maintain depression (e.g., self-critical appraisals and behavioural avoidance). In MBCT participants learn to recognise these modes and to develop executive control over them; in particular, by fostering a mindful accepting stance.
We are co-investigators on the PREVENT trial (led by Willem Kuyken in Exeter), an NIHR-funded phase III Randomised Controlled Trial (RCT) that asks the clinical question: is MBCT a more effective means of relapse prevention than maintenance anti-depressants (mADM) for patients at risk of depression? We are leading on the embedded experimental medicine studies that investigate MBCT’s mechanisms of action; in particular, whether relapse prevention is a function of alterations in cognitive perspective over negative thoughts and emotions.
The Cambridge Specialist Depression Service: A sizeable minority of patients with depression are resistant to current gold standard clinical treatments. We have recently been funded by the NIHR as one centre in a pragmatic RCT comparing specialist services for these treatment resistant depressed patients against usual care and we have set up the Cambridge Specialist Depression Service (CSDS) to support this work. Patients in the Service will receive collaborative, specialist care from psychiatry, nursing clinical psychology and social services. A core component of this specialist service will be the availability to patients of emerging, novel treatment components to augment the core intervention of pharmacology and intensive cognitive behaviour therapy (CBT). This feature of the service will permit pilot open-trials of our protocols for augmenting positive affect, training executive control of emotional material, and enhancing mnemonic regulation, that have been translated from our basic research.
Complementing our basic research work on affective memories and their control, we are running three exploratory randomised clinical trials (RCTs) testing new clinical interventions for PTSD where the core focus of the active treatment is on restructuring trauma memories and enhancing the ability to regulate them. The CANRest trial compares the efficacy of a brief (1-2 session) memory intervention against treatment-as-usual for adult PTSD patients recently discharged from intensive care (in collaboration with physicians at Addenbrooke’s Hospital). The MRC-funded ASPECTS trial led by Meiser-Stedman is an MRC-funded study examining the efficacy of memory-focused CBT as an early intervention for school-aged children and adolescents with PTSD. The NIHR-funded PYCES trial extends the intervention trialled in ASPECTS to very young children (3-8 years old) with PTSD. All 3 trials contain embedded basic science components to investigate the hypothesis that the active interventions exert their effects by changing the nature of traumatic memories and their regulation.