• Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective

      Soosaipillai, G; Wu, A; Dettorre, GM; Diamantis, J; Chester, J; Moss, C; Aguilar-Company, J; Bower, M; Sng, CCT; Salazar, R; et al. (Sage, 2021-09-02)
      Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository (n=1,318), we analysed cancer patients aged ≥18 diagnosed with COVID-19 between 26th February and 22nd June 2020 who had complete specialist palliative care team (SPCT) data (SPCT+ referred; SPCT- not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had >1 co-morbidity. 206 patients received SPCT input for symptom control (80.1%), psychological support (54.4%), and/or advance care planning (51%). SPCT+ patients had more DNACPR orders completed prior to (12.6% vs. 3.7%) and during admission (50% vs 22.1%, P<0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% vs. 22.1%, P<0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% vs. 0%, P<0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% vs. 47.1%) and benzodiazepines (82.9% vs. 41.2%) being used frequently for symptom control. Conclusions: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCT for patients with cancer during the pandemic and should inform service planning for this population.
    • Gut thinking and eye tracking: Evidence for a central preference heuristic

      Thoma, Volker; Rodway, Paul; Tamlyn, Guy; University of East London; University of Chester (Taylor and Francis, 2021-09-01)
      People prefer the central item in an array of items. This could be due to applying a decision heuristic or greater visual attention to the central item. We manipulated task instructions as participants chose one from three consumer items. The instructions were to “think carefully” in one block and to “use gut feeling” in another. A centrality preference appeared only in the “gut” condition, which was also negatively correlated with self-reported reflective thinking disposition (Need-for-Cognition). Eye-movement patterns, however, were equivalent across both instruction conditions with more frequent and longer fixations on the middle items. The findings demonstrate an effect of instructions on the centrality preference for non-identical consumer items, and provide evidence for a heuristic cause of the centrality preference rather than the allocation of visual attention. The results also show that the centrality preference is more likely to be present when people choose quickly and intuitively.
    • Valence of agents and recipients moderates the side-effect effect: Two within-subjects, multi-item conceptual replications

      Stewart, Suzanne L. K.; Kennedy, Bradley J.; Haigh, Matthew.; University of Chester; Northumbria University (Taylor & Francis, 2021-08-27)
      The side-effect effect (SEE) demonstrates that the valence of an unintended side effect influences intentionality judgements; people assess harmful (helpful) side effects as (un)intentional. Some evidence suggests that the SEE can be moderated by factors relating to the side effect’s causal agent and to its recipient. However, these findings are often derived from between-subjects studies with a single or few items, limiting generalisability. Our two within-subjects experiments utilised multiple items and successfully conceptually replicated these patterns of findings. Cumulative link mixed models showed the valence of both the agent and the recipient moderated intentionality and accountability ratings. This supports the view that people represent and consider multiple factors of a SEE scenario when judging intentionality. Importantly, it also demonstrates the applicability of multi-vignette, within-subjects approaches for generalising the effect to the wider population, within individuals, and to a multitude of potential scenarios. For open materials, data, and code, see https://www.doi.org/10.17605/OSF.IO/5MGKN.
    • Between-task consistency, temporal stability and the role of posture in simple reach and fishing hand preference in chimpanzees (Pan troglodytes)

      Diaz, Sergio; Murray, Lindsay; Roberts, Sam; Rodway, Paul; Universidad Autónoma de Madrid; University of Chester: Liverpool John Moores University (Elsevier, 2021-07-31)
      Studying hand preferences in chimpanzees can provide insights into the evolutionary origins of human hemispheric specialization. Research on chimpanzee hand preference requires careful examination of important factors such as posture, between-task consistency and temporal stability, although few studies have investigated all of these factors in combination. We investigated hand preference in simple reach and fishing behaviours in a group of 19 chimpanzees at Chester Zoo in the UK. Simple reach was defined as extending a hand to grasp a small object, then flexing the limb in a continuous motion, and was examined in quadrupedal, sitting and climbing postures. Fish in hole was defined as inserting a stick into a hole in the wall with one hand and then extracting it with the same hand. Between-task consistency of hand preference was assessed by comparing simple reach and fish in hole, while temporal stability was assessed by comparing simple reach from two points in time: 2017 and 2019. The data showed no significant influence of posture on the strength of hand preference, which contrasts with previous research. The findings of this study show temporal stability in simple reach, although only partial between-task consistency. Overall, the results indicate that simple reach elicits laterality at the individual level and is consistent across postures and stable over time, which is consistent with the literature. These results suggest that posture stability may be important in affecting hand preference. Further, whilst there was overall stability in hand preference across time periods, some individuals changed their preferred hand, suggesting there may be individual level temporal instability of hand preference for certain tasks.
    • The Neural Correlates of a Central Coherence Task in Young Women with Anorexia Nervosa

      Leslie, Monica; Halls, Daniel; Leppanen, Jenni; Sedgewick, Felicity; Lang, Katie; Fonville, Leon; Simic, Mima; Mandy, William; Nicholls, Dasha; Williams, Steven; et al. (Wiley, 2021-07-18)
      Objective: Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. Methods: We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. Results: There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. Conclusions: These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.
    • The Finding My Way UK Clinical Trial: Adaptation report and protocol for a replication randomised controlled efficacy trial of a web-based psychological programme to support cancer survivors

      Hulbert-Williams, Nicholas J; Leslie, Monica; Hulbert-Williams, Lee; Koczwara, Bogda; Watson, Eila K; Hall, Peter S; Ashley, Laura; Coulson, Neil S; Jackson, Richard; Millington, Sue; et al. (JMIR, 2021-07-12)
      Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished, and are predictive of psychological distress and poor health-related quality of life. Online interventions demonstrate good efficacy in addressing these concerns and are more accessible than face to face interventions. Finding My Way is an online, psycho-educational and cognitive behaviour therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated Finding My Way to be acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life, whilst leading to cost-savings through health-resource use reduction. Objectives: Our study will adapt the Australian Finding My Way website for a UK cancer care context, and then undertake a single-blinded, randomised controlled trial (RCT) of Finding My Way UK against a treatment-as-usual waitlist control. Methods: As much as possible, our trial design replicates the existing Australian RCT of Finding My Way. Following a comprehensive adaptation of the web-resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will: (i) have been diagnosed with cancer of any type in the last six months, (ii) have received anti-cancer treatment with curative intent, (iii) be over 16 years of age, (iv) be proficient in English and (v) have access to the internet and an active email address. Participants will be identified and recruited through the NIHR Clinical Research Network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report online questionnaire at baseline, mid-treatment, post-treatment and both three- and six-month follow-up. Quantitative data will be analysed using intention-to-treat Mixed-Model Repeated Measures analysis. Embedded semi-structured qualitative interviews will probe engagement with, and experiences of using, Finding My Way UK and suggestions for future improvements. Results: Website adaptation work was completed in January 2021. A panel of cancer survivors and healthcare professionals provided feedback on the test version of Finding My Way UK. Feedback was positive overall, though minor updates were made to website navigation, inclusivity, terminology and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid 2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literatures, and especially in different geographical settings. Prior to replicating the Finding My Way trial in the UK setting, some content updating was required. If Finding My Way UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for UK cancer survivors.
    • Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): Results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer.

      Hulbert-Williams, NJ; Norwood, S; Gillanders, D; Finucane, AM; Spiller, J; Strachen, J; Millington, S; Kreft, J; Swash, B; University of Chester; The University of Edinburgh; Marie Curie Hospice Edinburgh (BMC, 2021-06-25)
      Objectives: Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods: Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results: At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions: This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting.
    • OVPSYCH2: A randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer

      Frangou, E; Bertelli, G; Love, S; Mackean, MJ; Glasspool, RM; Fotopoulou, C; Cook, A; Nicum, S; Lord, R; Ferguson, M; et al. (Elsevier, 2021-05-29)
      Background: Fear of disease progression (FOP) is a rational concern for women with Ovarian Cancer (OC) and depression is also common. To date there have been no randomized trials assessing the impact of psychological intervention on depression and FOP in this patient group. Patients and methods: Patients with primary or recurrent OC who had recently completed chemotherapy were eligible if they scored between 5 and 19 on the PHQ-9 depression and were randomized 1:1 to Intervention (3 standardized CBT-based sessions in the 6 -12 weeks post-chemotherapy) or Control (standard of care). PHQ-9, FOP-Q-SF, EORTC QLQ C30 and OV28 questionnaires were then completed every 3 months for up to 2 years. The primary endpoint was change in PHQ-9 at 3 months. Secondary endpoints were change in other scores at 3 months and all scores at later timepoints. Results: 182 patients registered; 107 were randomized; 54 to Intervention and 53 to Control; mean age 59 years; 75 (70%) had completed chemotherapy for primary and 32 (30%) for relapsed OC and 67 patients completed both baseline and 3-month questionnaires. Improvement in PHQ-9 was observed for patients in both study arms at three months compared to baseline but there was no significant difference in change between Intervention and Control. A significant improvement on FOP-Q-SF scores was seen in the Intervention arm, whereas for those in the Control arm FOP-Q-SF scores deteriorated at 3 months (intervention effect= -4.4 (-7.57,-1.22), p-value = 0.008). Conclusions: CBT-based psychological support provided after chemotherapy did not significantly alter the spontaneously improving trajectory of depression scores at three months but caused a significant improvement in FOP. Our findings call for the routine implementation of FOP support for ovarian cancer patients.
    • Tears Evoke the Intention to Offer Social Support: A Systematic Investigation of the Interpersonal Effects of Emotional Crying Across 41 Countries

      Zickfeld, Janis H.; van de Ven, Niels; Pich, Olivia; Schubert, Thomas W.; Berkessel, Jana B.; Pizarro, José J.; Bhushan, Braj; Mateo, Nino Jose; Barbosa, Sergio; Sharman, Leah; et al. (Elsevier, 2021-04-13)
      Tearful crying is a ubiquitous and likely uniquely human phenomenon. Scholars have argued that emotional tears serve an attachment function: Tears are thought to act as a social glue by evoking social support intentions. Initial experimental studies supported this proposition across several methodologies, but these were conducted almost exclusively on participants from North America and Europe, resulting in limited generalizability. This project examined the tears-social support intentions effect and possible mediating and moderating variables in a fully pre-registered study across 7,007 participants (24,886 ratings) and 41 countries spanning all populated continents. Participants were presented with four pictures out of 100 possible targets with or without digitally-added tears. We confirmed the main prediction that seeing a tearful individual elicits the intention to support, d = .49 [.43, .55]. Our data suggest that this effect could be mediated by perceiving the crying target as warmer and more helpless, feeling more connected, as well as feeling more empathic concern for the crier, but not by an increase in personal distress of the observer. The effect was moderated by the situational valence, identifying the target as part of one’s group, and trait empathic concern. A neutral situation, high trait empathic concern, and low identification increased the effect. We observed high heterogeneity across countries that was, via split-half validation, best explained by country-level GDP per capita and subjective well-being with stronger effects for higher-scoring countries. These findings suggest that tears can function as social glue, providing one possible explanation why emotional crying persists into adulthood.
    • Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial)

      Hulbert-Williams, Nicholas J.; Hulbert-Williams, Lee; Flynn, Ryan J.; Pendrous, Rosina; MacDonald-Smith, Carey; Mullard, Anna; Swash, Brooke; Evans, Gemma; Price, Annabel; University of Chester; North Wales Cancer Treatment Centre; Ysbyty Gwynedd; Addenbrooke's Hospital Cambridge (F1000Research, 2021-03-29)
      Background: Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. Methods: We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. Results: We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety (p<.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient- driven needs for group-based support, and (b) the sustainability of this intervention programme. Conclusions: This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors.
    • The Emotional Face of Anorexia Nervosa: The Neural Correlates of Emotional Processing

      Halls, Daniel; Leslie, Monica; Leppanen, Jenni; Sedgewick, Felicity; Surguladze, Simon; Fonville, Leon; Lang, Katie; Simic, Mima; Nicholls, Dasha; Williams, Steven; et al. (Wiley, 2021-03-19)
      Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN.
    • Development and usability testing of a web-based psychosocial intervention for women living with metastatic breast cancer: Finding My Way-Advanced

      Beatty, Lisa; Koczwara, Bogda; Butow, Phyllis; Turner, Jane; Girgis, Afaf; Schofield, Penelope; Hulbert-Williams, Nicholas J; Kaambwa, Billingsley; Kemp, Emma; Flinders University; Flinders Medical Centre; Sydney University; University of Queensland; University of New South Wales; Swinburne University of Technology; University of Chester (Springer, 2021-03-15)
      Purpose: Women living with metastatic breast cancer (MBC) face significant distress and unmet needs, yet few resources have been developed for this population. The current study aimed to develop and evaluate the usability of Finding My Way-Advanced (FMW-A), a web-based self-guided psychosocial program for women with MBC. Methods: FMW-A was co-designed through (a) adapting an efficacious online program for people with curatively treated cancer, and (b) receiving iterative rounds of input and feedback from a multidisciplinary co-design team including consumers, clinicians and academics. A think-aloud protocol was then implemented to test the usability of the resulting 6-module prototype, with women living with MBC accessing up to three modules with an interviewer sitting along-side. Participants were recruited until saturation of themes occurred. Data were analysed thematically. Results: Participants (n=8) were, on average, 65.3 years old, mostly partnered (n=5), retired (n=6), post-secondary school educated (n=6), with non-dependent children (n=7). Feedback fell into 6 themes. Positive feedback about FMW-A summarised the supportive and informative nature of the programme, supplemented by comments about broadly relatable content. However, one size clearly did not fit all: within themes, diverging experiences emerged regarding navigability, worksheets and layout. Participants noted that having/making time for the intervention would be important to program engagement. Conclusions: Usability testing indicated participants found content helpful and relatable, and identified significant pragmatic improvements to be made prior to further testing. Implications for cancer survivors: The development of FMW-A represents an important step in providing acceptable resources to support women living with MBC.
    • Setting an International Research Agenda for Fear of Cancer Recurrence: an online delphi consensus study

      Shaw, Joanne; Kamphuis, H; Sharpe, Louise; Lebel, Sophie; Smith, Allan Ben; Hulbert-Williams, Nicholas J; Dhillon, Haryana M; Butow, Phyllis; University of Sydney; University of Ottawa; University of New South Wales; University of Chester (Frontiers Media, 2021-02-22)
      Background: Fear of cancer recurrence (FCR) is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritise research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research. Methods: Members of the International Psycho-oncology Society (IPOS) Fear of Cancer Recurrence Special Interest Group (FORwards) were invited to participate in an online Delphi study. Research domains identified in Round 1 were presented and discussed at a focus group (Round 2) to consolidate the domains and items prior to presentation in further survey rounds (Round 3) aimed at gaining consensus on research priorities of international significance. Results: Thirty four research items were identified in Round 1 and 33 of the items were consolidated into 6 overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2 and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further 4 research items were identified by panellists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panellists. Given the high levels of consensus and stability between rounds no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panellists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions, was the third highest priority identified. Conclusions: The findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment, are based on a flexible approach based on symptom severity and can be delivered within routine clinical care, were identified as research areas to prioritise. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need.
    • Building the capacity for psycho-oncology research: A survey of the research barriers and training needs within the International Psycho-Oncology Society (IPOS)

      Lambert, SD; Coumoundouros, C; Hulbert-Williams, NJ; Shaw, J; Schaffler, J; McGill University; University of Chester; University of Sydney (Wolters Kluwer, 2020-07-28)
      Background: The International Psycho-Oncology Society (IPOS) is a multidisciplinary professional network that aims to improve psychosocial care for individuals impacted by cancer. IPOS encourages research activity, recognising that a high-quality evidence-base is essential to provide best-practice, data-driven clinical care. This study aimed to determine the barriers to research involvement and the training needs and priorities of IPOS members, with the goal of facilitating the development of training resources tailored to the needs of IPOS members. Methods: A link to an online, cross-sectional survey was disseminated to all registered members of IPOS via email. The online survey platform SimpleSurvey was used, and questions included demographic characteristics and items related to research interests, involvement, and training needs. High priority research training needs were identified as research tasks respondents rated as highly important, yet possessed a low perceived skill level in. Results: 32% of IPOS members (n = 142) completed the survey. Participants represented 49 countries and were at a variety of career stages. Overall, participants reported spending an average of 17.3 hours per week on research (range = 0 to 80 hours per week), with 69% of respondents wanting to increase their research involvement. The main barriers to research participation included lack of research funding (80%) and lack of protected time (63%). IPOS members identified five high priority training needs: (1) preparing successful grant applications; (2) preparing research budgets; (3) community-based participatory research; (4) working with decision makers; and (5) finding collaborators or expert consultants. Participants suggested funding access, statistical advisors and networking and mentorship opportunities as ways to enhance research involvement. Members preferred online training modules (39%) and mentorship programs (19%) as methods by which IPOS could provide research support. IPOS was viewed as being able to contribute to many aspects of research capacity building such as networking, training, and dissemination of research findings. Conclusions: IPOS has an important role in encouraging research capacity building among members. This survey provides an agenda for workshops and training opportunities. Mainly, for respondents it was less about training in research methods and more about training in how to prepare successful grant applications, including budgets, and receiving mentorship on this as well as having opportunities to collaborate with other researchers.
    • A Novel Approach for Autism Spectrum Condition patients with Eating Disorders: Analysis of Treatment Cost-savings

      Tchanturia, Kate; Dandil, Yasemin; Li, Zhuo; Smith, Katherine; Leslie, Monica; Byford, Sarah; King's College London; South London and Maudsley NHS Foundation Trust; Illia University (Wiley, 2020-07-10)
      Objective: In the current economic context, it is critical to ensure that eating disorder (ED) treatments are both effective and cost-effective. We describe the impact of a novel clinical pathway developed to better meet the needs of autistic patients with EDs on the length and cost of hospital admissions. Method: The pathway was based on the Institute for Healthcare’s Model of Improvement methodology, using an iterative Plan, Do, Study, Act format to introduce change and to co-produce the work with people with lived experience and with healthcare professionals. We explored the change in length and cost of admissions before and after the pathway was introduced. Results: Preliminary results suggest that the treatment innovations associated with this pathway have led to reduced lengths of admission for patients with the comorbidity, which were not seen for patients without the comorbidity. Estimated cost-savings were approximately £22,837 per patient and approximately £275,000 per year for the service as a whole. Conclusion: Going forward, our aim is to continue to evaluate the effectiveness and cost-effectiveness of investment in the pathway to determine whether the pathway improves the quality of care for patients with a comorbid ED and autism and is good value for money.
    • A leftward bias for the arrangement of consumer items that differ in attractiveness

      Rodway, Paul; Schepman, Astrid; University of Chester (Taylor & Francis, 2020-06-24)
      People are frequently biased to use left side information more than right side information to inform their perceptual judgements. This research examined whether the leftward bias also applied to preferences for the arrangement of everyday consumer items. Pairs of consumer items were created where one item was more attractive than the other item. Using a two-alternative forced choice task, Experiment 1 found a robust preference for arrangements with the more attractive consumer item on the left side rather than the right side of a pair. Experiment 2 reversed the judgement decision, with participants asked to choose the arrangement they least preferred, and a bias for arrangements with the more attractive item on the right side emerged. Experiment 3 failed to find an effect of the ‘attractive left’ preference on participants’ purchasing intentions. The preference for attractive left arrangements has implications for the display of consumer products and for the aesthetic arrangement of objects in general. The findings are discussed in relation to hemispheric asymmetries in processing and the role of left to right scanning.
    • There is no Other Monkey in the Mirror for Spider Monkeys (Ateles geoffroyi)

      Murray, Lindsay; Schaffner, Colleen; Aureli, Filippo; Amici, Federica; University of Chester, Adams State University, Universidad Veracruzana, Liverpool John Moores University, Max Planck Institute for Evolutionary Anthropology (American Psychological Association, 2020-06-18)
      Mirror self-recognition (MSR), usually considered a marker of self-awareness, occurs in several species and may reflect a capacity that has evolved in small incremental steps. In line with research on human development and building on previous research adopting a gradualist framework, we categorized the initial mirror responses of naïve spider monkeys (Ateles geoffroyi) according to four levels. We compared social, exploratory, contingent and self-exploratory responses to a mirror and faux mirror during three short trials. If spider monkeys respond as most monkey species, we predicted they would perform at level 0, mainly showing social behavior toward their mirror-image. However, because spider monkeys show enhancement of certain cognitive skills comparable to those of great ape species, we predicted that they would perform at level 1a (showing exploratory behavior) or 1b (showing contingent behavior). GLMMs revealed that monkeys looked behind and visually inspected the mirror significantly more in the mirror than the faux mirror condition. Although the monkeys engaged in contingent body movements at the mirror, this trend was not significant. Strikingly, they showed no social behaviors toward their mirror-image. We also measured self-scratching as an indicator of anxiety and found no differences in frequencies of self-scratching between conditions. Therefore, in contrast to most findings on other species, spider monkeys did not treat their image as another monkey during their initial exposure to the mirror. In fact, they reached at least level 1a within minutes of mirror exposure. These responses recommend spider monkeys as good candidates for further explorations into monkey self-recognition.
    • Investigating resting brain perfusion abnormalities and disease target-engagement by intranasal oxytocin in women with bulimia nervosa and binge-eating disorder and healthy controls

      Martins, Daniel; Leslie, Monica; Rodan, Sarah; Zelaya, Fernando; Treasure, Janet; Paloyelis, Yannis; King's College London; University College London (Springer, 2020-06-08)
      Advances in the treatment of bulimia nervosa and binge eating disorder (BN/BED) have been marred by our limited understanding of the underpinning neurobiology. Here we measured regional cerebral blood flow (rCBF) to map resting perfusion abnormalities in women with BN/BED compared to healthy controls and investigate if intranasal oxytocin (OT), proposed as a potential treatment, can restore perfusion in disorder-related brain circuits. Twenty-four women with BN/BED and 23 healthy women participated in a randomised, double-blind, crossover, placebo-controlled study. We used arterial spin labelling MRI to measure rCBF and the effects of an acute dose of intranasal OT (40IU) or placebo over 18-26 minutes post-dosing, as we have previously shown robust OT-induced changes in resting rCBF in men in a similar time-window (15-36 min post-dosing). We tested for effects of treatment, diagnosis and their interaction on extracted rCBF values in anatomical regions-of-interest previously implicated in BN/BED by other neuroimaging modalities, and conducted exploratory whole-brain analyses to investigate previously unidentified brain regions. We demonstrated that women with BN/BED presented increased resting rCBF in the medial prefrontal and orbitofrontal cortices, anterior cingulate gyrus, posterior insula and middle/inferior temporal gyri bilaterally. Hyperperfusion in these areas specifically correlated with eating symptoms severity in patients. Our data did not support a normalizing effect of intranasal OT on perfusion abnormalities in these patients, at least for the specific dose (40 IU) and post-dosing interval (18-26 minutes) examined. Our findings enhance our understanding of resting brain abnormalities in BN/BED and identify resting rCBF as a non-invasive potential biomarker for disease-related changes and treatment monitoring. They also highlight the need for a comprehensive investigation of intranasal OT pharmacodynamics in women before we can fully ascertain its therapeutic value in disorders affecting predominantly this gender, such as BN/BED.
    • Predictors of individual differences in emerging adult theory of mind

      Stewart, Suzanne L. K.; Kirkham, Julie A.; University of Chester (SAGE, 2020-05-21)
      Little is known about what factors are associated with emerging adult theory of mind (ToM). We predicted that childhood fantasy play (CFP), need for cognition (NfC), and fiction reading would be positive predictors due to their deliberative, perspective-taking nature while engagement with media and technology would be a negative predictor due to increased interpersonal distance. The best-fit mixed logit model (n = 369) showed that CFP, texting frequency, and NfC were significant positive predictors while smartphone usage and preference for task switching were significant negative predictors. Email and phone call usage were contributing non-significant negative predictors. Our study extends previous findings regarding NfC, and highlights the importance of CFP engagement for ToM beyond immediate childhood. Future research should investigate how subtly different media (e.g., texting vs smartphone use) have differential predictive relationships with social cognition. Data and code are available at doi: 10.17605/OSF.IO/CBD9J.
    • Developing an Integrated Approach

      Tod, David; Lafferty, Moira; Liverpool John Moores University; University of Chester (Routledge, 2020-05-05)
      Integration occurs when consultants combine multiple theoretical orientations and ways of operating to enhance the efficacy, effectiveness, efficiency, and ethical standing of services they provide clients. There is no one model of integration. The models practitioners develop are shaped by their histories, inclinations, and proclivities; the contexts and cultures in which they operate; the types of work they undertake; and the clients they serve. Integrated models allow practitioners to feel congruent, authentic, and comfortable with the ways they help clients. In this chapter, we define integration, discuss why it is viable in our field, examine ways practitioners integrate service delivery systems, consider obstacles to integration, and suggests ways educators and supervisors can assist practitioners.