Cognitive training designed to recalibrate maladaptive aspects of cognitive-affective processing associated with the presence of emotional disorder can deliver clinical benefits. This study examined the ability of an integrated training in self-distancing and perspective broadening (SD-PB) with respect to distressing experiences to deliver such benefits in individuals with a history of recurrent depression (≥3 prior episodes), currently in remission. Relative to an overcoming avoidance (OA) control condition, SD-PB: a) reduced distress to upsetting memories and to newly encountered events, both during training when explicitly instructed to apply SD-PB techniques, and after-training in the absence of explicit instructions; b) enhanced capacity to self-distance from and broaden perspectives on participants' experiences; c) reduced residual symptoms of depression. These data provide initial support for SD-PB as a low-intensity cognitive training providing a spectrum of cognitive and affective benefits for those with recurrent depression who are at elevated risk of future episodes.

Background: The 11th edition of the International Classification of Diseases (ICD-11) made a number of significant changes to the diagnostic criteria for post-traumatic stress disorder (PTSD). We sought to determine the prevalence and 3-month predictive values of the new ICD-11 PTSD criteria relative to ICD-10 PTSD, in children and adolescents following a single traumatic event. ICD-11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD-11 CPTSD features following exposure to a single-incident trauma. Method: Data were analysed from a prospective cohort study of youth aged 8-17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post-trauma, allowing us to calculate and compare the prevalence and predictive value of ICD-10 and ICD-11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions. Results: At Week 9, 15 participants (7%) were identified as experiencing ICD-11 PTSD, compared to 23 (11%) experiencing ICD-10 PTSD. There was no significant difference in comorbidity rates between ICD-10 and ICD-11 PTSD diagnoses. Ninety per cent of participants with ICD-11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria. Conclusions: Reduced prevalence of PTSD associated with the use of ICD-11 criteria is likely to reduce identification of PTSD relative to using ICD-10 criteria but not relative to DSM-4 and DSM-5 criteria. Diagnosis of CPTSD is likely to be infrequent following single-incident trauma.

ObjectivePeople with vestibular disorders frequently experience psychological distress which can impede daily activities and clinical recovery. Although the need for psychological input is widely acknowledged, there are no clinical guidelines, leading to variation in care received. This study examines how psychological aspects of vestibular disorders are currently addressed highlighting any national variation.MethodAn online survey was completed by 101 UK healthcare professionals who treat vestibular disorders. The survey included open and close-ended questions covering service configurations, respondent characteristics, attitudes towards psychological aspects, and clinical practice for cognitive and mental health problems. Results96% of respondents thought there was a psychological component to vestibular disorders. There was a discrepancy between perceived importance of addressing psychological aspects and confidence to undertake this. Those with more years of experience felt more confident addressing psychological aspects. Mental health problems were addressed more frequently than cognitive problems. History taking and questionnaires containing one or two items about psychological distress were the most common assessment approaches. Discussing symptoms and signposting were the most frequent management approaches. Referrals for psychological support were typically to professionals within another service, via the patient’s GP. Qualitative responses highlighted the interdependence of psychological and vestibular disorders which require identification and timely intervention. Barriers to implementation included limited referral pathways and interdisciplinary expertise.ConclusionClinical practice varies and relates to the confidence, experience and expertise of individual health professionals, resources, and appropriate referral pathways. Although psychological distress is frequently identified, suitable psychological treatment is not routinely offered in the UK.