No Health without Mental Health: European Clinical Psychology Takes Responsibility
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Shortcut: PS-07
Date: Friday, 1 November, 2019, 1:00 p.m.
Room: Foyer
Session type: Poster

Contents

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PS-07-01

Cognitive emotion regulation skills in the framework of school bullying (#33)

I. A. Stylianou1, S. Panayiotis1, M. Ioannou1

1 University of Cyprus, Department of Psychology, Nicosia, Cyprus

Structured Poster Abstract

Introduction: Bullying and victimization have long-term consequences on mental health. Cognitive interventions are among the recommended, but there is limited research investigating the effect of cognitive strategies on bullying and their reciprocal interactions. The aims of the study were to (a) test the extent to which adaptive and maladaptive cognitive emotion regulation strategies (CERS) are used by adolescents who get involved in bullying incidents and (b) examine the bidirectional reciprocal effect between bullying, victimization and CERS using a cross-lagged design.

Methods: 560 adolescents aged 15-18 from Cyprus participated in this longitudinal study with three time points over a year (every 4 months) and completed among other questionnaires, the Bullying Victimization Questionnaire Revised (BVQ-R) and the Cognitive Emotion Regulation Questionnaire (CERQ). The cross-lagged design allowed examination of the long-term reciprocal interactions between bullying and CERS, using Mplus 7.3.

Results: With regard to the frequency of CERS used, significant differences existed only for self-blame and catastrophizing (higher for victims), as well as others-blame (higher for bully/victims). The cross-lagged longitudinal model with continuous variables showed good fit, with χ2 (230)= 885.755, p< .001, CFI= .962, TLI= .916, RMSEA= .062. Long-term victimization was consistently significantly predicted by the use of maladaptive CERS, with emphasis on self-blame, rumination and catastrophizing, whereas the reverse relationship was not supported. Long-term bullying at time 3 was significantly predicted by use of others-blame at time 2, and again no reciprocal effect was detected.

Conclusions: The findings supported the unidirectional effect of maladaptive CERS on long-term victimization and bullying. This supports that training on CERS and CBT informed challenging of cognitive distortions about self-blame could be protective, especially against long-term victimization.

Keywords: Bullying, victimization, longitudinal study
PS-07-02

Insight and psychosis (#63)

K. Opaliński1

1 University of Zielona Góra, Institute of Psychology, Zielona Góra, Poland

Structured Poster Abstract

INTRODUCTION

Aim of my research was to explore how patients diagnosed with schizophrenia construct their illness. 

METHOD

Subject of research are semi-structured interviews with: 1) patients diagnosed with schizophrenia during the hospitalization, 2) psychiatrists about insight into psychosis interviewed patients.All the interviews have been studied based on Critical Discourse Analysis (CDA). CDA explores the connections between use of the language and the social contexts which it occurs. 

RESULTS

Study analysis shows discrepancies between the theory of insight into illness and psychiatrists’ practices. Analysis of qualitative data illustrate that most of the patients diagnosed with schizophrenia are aware of their condition but they don’t describe their condition only in terms of psychopathology. Some of patients are making an individual sense from illness according to their beliefs, individual history and ideas. Interviews with psychiatrists have showed that they require from patients describing their conditions in biomedical (psychiatric) terms. According to them, using the biomedical perspective is a fundamental requirement of having insight. Patients which perspectives on their medical condition do not fit into biomedical view of insight are describe by psychiatrists as having “lack of insight” or “poor insight”. But only in the psychiatrists’ overall declarations, which means – only in the theory.

CONCLUSIONS

Results of research emphasize two major issues that may be applied in further studies: 1) insight into psychosis should be consider not only in terms of psychopathology, 2) qualitative methods enriches scientific data on, so called, well-known issues such as insight into psychosis, 3) applying in researches a Critical Discourse Studies methodology may show social implications of using psychiatric terms such as “lack of insight” or “poor insight”.

Keywords: qualitative research, psychosis, insight
PS-07-03

Nightmares, sleep quality and psychotic experiences in young adults (#92)

M. K. Kammerer1, K. Bub1, T. Lincoln1

1 Universität Hamburg, Klinische Psychologie und Psychotherapie, Hamburg, Germany

Structured Poster Abstract

Introduction: A growing body of evidence supports the notion that frequent nightmares and sleep disturbances present early indicators for psychotic disorders in adolescents and young adults. Yet, what aspects of nightmares contribute to the development of such disorders and the potentially confounding role of a poor overall quality of sleep in that concern are still subject to further investigation. This study examined the relationship between nightmares, quality of sleep, and specific psychotic symptoms in a community sample of young adults. Methods: We used an online survey to assess nightmare frequency (NF), nightmare-related distress (ND), nightmare topics, quality of sleep, paranoid ideation, hallucinations and negative symptoms in young adults between the age of 18 and 27 (n=486). Results: Most frequently experienced nightmare topics were being chased, falling, and losing a close relative. Higher NF was weakly associated with paranoid ideation (rs= 274, p<.001), hallucinations (rs= 293, p<.001), and negative symptoms (rs=.139, p= 001). Higher ND was moderately associated with paranoid ideations (rs=.344, p<.001), hallucinations (rs=.411, p<.001), and weakly with negative symptoms (rs=.166, p<.001). Increased NF and ND significantly added to explaining paranoid ideation and hallucinations, over and above decreased sleep quality, but not to explaining negative symptoms. Conclusions: In young adults we found strong associations particularly between the occurrence of paranoid ideation and hallucinations and frequent and distressing nightmares, in addition to mere poor sleep quality. Longitudinal studies are needed to pin down the potential causal relationship between nightmares and the development of psychotic symptoms. Thorough assessments of nightmares and sleep disturbances may facilitate early detection of those at risk and help to provide preventive interventions.

Keywords: paranoia, hallucinations, nightmares, sleep
PS-07-04

How and why childhood maltreatment and body image are related: a systematic review (#164)

C. Bödicker1, J. Hoyer1

1 Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Dresden, Germany

Structured Poster Abstract

Introduction: Body image distortions have been linked to poor psychological adjustment in nonclinical samples. The body image develops based on interpersonal processes in early childhood and comprises a perceptual, an affective-cognitive and a behavioral component. It has been suggested that severe violations of body boundaries like those caused by childhood maltreatment have persisting effects on the body image. In addition, those alterations in body image have been proposed to mediate the association between childhood maltreatment and a variety of negative mental and physical health outcomes such as PTSD, BPD, eating disorders, depression, poor sexual functioning and obesity.  

Methods: A data-base driven literature research was conducted in May and June 2019. PubMed, PsycINFO, Scope, Web of Science and Google Scholar were searched for studies on the association between childhood maltreatment (defined as sexual, physical or emotional abuse and neglect before the age of 18) and body image (allowing for results on associated keywords like body dissatisfaction and bodily shame). Studies conducted between 1990 and 2019 were included in this review.

Results: The majority of the reviewed studies report a moderate association between childhood maltreatment and cognitive-affective body image. This association is found in community samples as well as in clinical populations. Body image distortions seem to be especially pronounced in individuals with PTSD after childhood abuse and to be closely related to constructs like disgust and shame.

Conclusion: Individuals with a history of childhood maltreatment tend to have a negative body image. To enhance well-being and self-care in patients, trauma-focused psychotherapies should include work on body image.

Keywords: childhood maltreatment, abuse, trauma, body image
PS-07-05

The rights of the mentally retarded persons in Europe (#181)

E. D. Okon1

1 Obong University, Psychology, Etim Ekpo, Nigeria

Structured Poster Abstract

The UN Declaration on the Rights of Persons with Mental Disabilities (CRPD) which European countries are signatories declares that the Mentally Retarded Person has to the maximum degree the same rights as other human beings. The objectives of this study is analyze the rights of People with Mental Illness. The methodology to be used in this study are descriptive and analytical research method. My findings are that there is high level of discrimination and denial of rights against Mentally Retarded Persons. I recommend that EU should ensure that development policies and programs are inclusive to persons with mental disabilities and the adoption of European Disability Strategy (2010-2020) to eliminate barriers.

Keywords: Convention, Human Rights, Persons with Mental Disabilities
PS-07-06

The interplay of 5-HTTLPR and depressive symptomatology on emotional inertia in adolescents. (#211)

T. M. Ollmann1, E. Seidl1, J. Venz1, 2, L. Pieper1, 2, C. Voss1, J. Hoyer1, C. Ziegler3, M. Schiele3, K. Domschke3, K. Beesdo-Baum1, 2

1 Technische Universität Dresden, Behavioral Epidemiology, Institute of Clinial Psychology and Psychotherapy, Dresden, Saxony, Germany
2 Technische Universität Dresden, Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Institute of Clinical Psychology and Psychotherapy, Dresden, Saxony, Germany
3 University of Freiburg, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany

Structured Poster Abstract

Introduction: Not only mean affect was associated with mental disorders previously, also affective dynamics seem to play a crucial role in psychopathology. Measures of affective dynamics, like emotional inertia (EI), defined as resistance of change in affect over time, have been linked to depression, with stronger effects for negative affect dynamics. In a recent study, EI has also been linked to the serotonin transporter polymorphism (5-HTTLPR), whereby carriers of the short allele were characterized by higher EI for negative emotions. The present study uses Ecological Momentary Assessment (EMA) to examine whether EI is associated with 5-HTTLPR as well as depressive symptomatology in adolescents. In addition, an exploratory analysis of the depressive symptomatology*5-HTTLPR interaction on EI will be conducted. Methods: Data of 872 participants from BeMIND, a cross-sectional epidemiological study in a random sample aged 14-21 from Dresden, Germany, are used. Depressive symptomatology was assessed using the Patient Health Questionnaire (PHQ) and adolescents were genotyped for 5-HTTLPR and rs25531. Items of the Patient-Reported Outcomes Measurement Information System (PROMIS; depression, anxiety, anger) were measured in a four day smartphone-based EMA on a scale of 0-100. EI of depression, anxiety and anger will be calculated as autocorrelation coefficient. Multilevel regression models, adjusted for age and sex, will be used to investigate the main effects of depressive symptomatology, 5-HTTLPR and their interaction on EI. Hypotheses: Higher depressive symptomatology is expected to be associated with higher levels of EI in depression, anxiety and anger. Findings could help in revealing the relation of depressive symptomatology, variation in 5-HTTLPR and affective dynamics in adolescent daily life.

Keywords: emotional intertia, 5-HTTLPR, depressive symptomatology, adolescents
PS-07-07

Exploring the Role of Executive Functions in Social Cognition (#221)

M. Kurtz1, J. Stietz1, S. - C. Li2, A. Reiter2, 3, P. Kanske1, 4

1 Clinical Psychology and Behavioural Neuroscience, Faculty of Psychology, Dresden, Saxony, Germany
2 Lifespan Developmental Neuroscience, Faculty of Psycholog, Dresden, Saxony, Germany
3 Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
4 Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Saxony, Germany

Structured Poster Abstract

Introduction

Human social interaction would be inconceivable without the ability to understand the mental states and goals of others (i.e., theory of mind; ToM) as well as the ability to share the feelings of others (i.e., empathy). Impairments of these functions can be found in a large number of mental disorders.

Previous research suggests that empathy and ToM emerge from more basal processes, some of which are summarized under the term executive functions (EF). In terms of ToM and empathy, EF play a role in maintaining one's own perspective and feelings and the feelings and perspectives of others as well as switching between one's own and others' views and feelings.

The relationship between subprocesses of EF and those of social cognition has so far only been investigated in selective, isolated cases. For example, the importance of inhibition (i.e., a sub-process of EF) for overcoming one's own perspective (i.e., a sub-process of ToM) in the false-belief task. A comprehensive assessment of how sub-processes of EF are related to processes of social cognition is still pending. In the present study, we investigate this interaction in a setting that requires both: the ability to empathize as well as ToM.

Methods

Forty young adults were tested with nine tasks that map their abilities in executive functions extensively. Additionally, their abilities in ToM and their empathic capacities were tested in an fMRI session.

Results

First analyses revealed correlations between measures of EF subprocesses and behavioural measures of ToM and empathy. Further analyses will focus on the investigation of relationships between behavioural measures of EF and neuronal processes that underlie empathy and ToM.

Conclusion

This study contributes to a better understanding of mental disorders associated with impairments of social cognition. The investigation of basal processes forms the basis for finding possible targets for therapeutic interventions in these disorders.

 

 

 

Keywords: Theory of mind, Empathy, Mentalizing, Executive Functions
PS-07-08

The neurobiology of paternal involvement, sensitivity, and stress (#278)

K. Preckel1, M. Talovic1, M. Long1, P. Vrticka1

1 Max Planck Institute for Human Cognitive and Brain Sciences, Social Stress and Family Health, Leipzig, Saxony, Germany

Structured Poster Abstract

INTRODUCTION:
Paternal involvement in childcare has increased in the last decades. Consequently, it is relevant to investigate the underlying neurobiological mechanisms of paternal responses to infant’s emotions. Here, we assess paternal neural correlates for own versus unknown infant emotional facial cues and examine how these are modulated by inter-individual differences such as father involvement, paternal sensitivity, and paternal stress.


METHODS:
In an event-related functional MRI study, 47 fathers were shown face images of their own 5-year-old child and a gender-matched unknown child. Six stimulus conditions (happy, neutral, and sad for own versus unknown child) were shown 20 times for 2 seconds each. All faces were rated by fathers post-scanning for emotional valence. Inter-individual difference measures were obtained via online self-reports prior to fMRI scanning.

RESULTS/FUTURE ANALYSES:
Preliminary behavioral ratings revealed that images were perceived as intended: emotional valence ratings decreased from happy > neutral > sad. Imaging data is still being collected. We decided to focus on the following four comparisons: own versus unknown, own happy versus unknown happy, own sad versus unknown sad, and own happy versus own sad. We hypothesize that the comparison of own > unknown child will result in a familiarity effect, which has previously been associated with neural activation in the salience network and especially the insula. For the contrasts own happy > unknown happy, as well as for own happy > own sad we expect increased neural activation in dopaminergic regions such as the substantia nigra and the dorsal putamen. Finally, for the contrast own sad > unknown sad that involves markers of infant’s distress, we predicted higher brain activation in emotion regulation regions and habitual behavioral response systems. Neural activation in the described contrasts will be subsequently associated with inter-individual differences of interest.

Keywords: father-infant relationship, neuroimaging, paternal involvement, paternal sensitivity
PS-07-09

Resting-State Connectivity Differentiates Between Vulnerable and Grandiose Narcissism (#313)

L. Maliske1, M. Lauckner2, K. Lehmann1, E. Jauk1, P. Kanske1, 3

1 Technische Universität Dresden, Clinical Psychology and Behavioral Neuroscience, Dresden, Germany
2 Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
3 Max Planck Institute for Human Cognitive and Brain Sciences, Max Planck Research Group Social Stress and Family Health, Leipzig, Germany

Structured Poster Abstract

Introduction: Research on Narcissism has identified different facets that stand seemingly independent of each other, but root in a common core: narcissistic grandiosity (NG) and vulnerability (NV). While NG describes the stereotypical view that is commonly held of narcissism (exaggerated self-worth, feelings of grandiosity, entitlement, arrogance), NV shares a general self-centeredness, but also goes along with self-consciousness, insecurity, and defensiveness. Distinct patterns of functional organization and connectivity in resting-state functional Magnetic Resonance Imaging (fMRI) characterize both, psychopathology and personality dimensions (e.g., extraversion, neuroticism). However, empirical evidence is still scarce with regard to functional and structural neural organization of the different dimensions of narcissism, with research focusing almost exclusively on NG. The current study aims to fill this gap, by providing a more integrated account of the neuroscience of narcissism.

Methods: resting-state fMRI data of 160 participants ranging on subclinical measures of NG (Narcissistic Personality Inventory) and NV (Hypersensitive Narcissism Scale) is analyzed to determine functional neural organization using seed-based connectivity and Independent Component Analysis.

Results: As was shown in previous research, we expect to find altered functional connectivity patterns between Dorsal Attention and Default Mode Network in NG. Regarding NV, research on related personality constructs leads us to expect altered functional connectivity patterns in regions of the Default Mode, Salience and Dorsal Attention Network, which have previously been linked to social affect and cognition (e.g., insula).

Conclusion: In this study, we use resting-state functional connectivity analysis to elucidate distinct functional neuronal organization in grandiose and vulnerable narcissism. Clinical implications of these results will be discussed.

Keywords: functional connectivity, narcissism, social cognition, resting-state fMRI
PS-07-10

The role of mindful eating in external eating and body mass index in a sample of female university students. (#326)

T. Escrivá-Martínez1, M. Miragall1, A. Cebolla1, T. van Strien2, E. Van der Linden1, R. Baños1

1 University of Valencia, Valencia, Spain
2 Radboud University, Nijmegen, Netherlands

Structured Poster Abstract

Introduction: Mindful Eating (ME) is defined as the awareness at the time of eating, both of the physical signs of hunger and satiety, and the environmental and emotional triggers. Several estudies has shown that mindfulness encourages healthier eating. Nevertheless, to our knowledge, few studies have explored the role of ME in dysfunctional eating styles (e.g., external eating) and Body Mass Index (BMI). The objective of this study was to analyze the relationships between ME (focused eating, hunger and satiety cues, eating with awareness, and eating without distraction), dysfunctional eating styles (emotional, restrained and external eating), and BMI.

Methods: The sample was composed of 31 female college students (age: M= 21.35, SD= 1.70; BMI: M= 23.03, SD= 2.88), who completed self-reported questionnaires to assess ME (Mindful Eating Behavior Scale; Winkens et al., 2018), and dysfunctional eating styles (Dutch Eating Behavior Questionnaire; Van Strien et al., 1986) in a online platform.

Results: Pearson’s correlations showed that there were: (1) a negative significat relationship between the ME dimension “awareness of hunger and satiety cues” and external eating (r= -.38, p= .047); and (2) a positive significant relationship between the external eating and the BMI (r= .43, p= .020). A simple mediation analysis showed that lower levels of awareness of hunger and satiety cues (MEBS) were associated with higher levels of external eating (DEBQ), leading in turn, to a higher BMI, and vice versa, Indirect effect, b= -0.14, 95% CI [- 0.33, -0.01].

Conclusions: This study shows the links between ME, external eating and BMI. Limitations of this study are related to the sample size and the lack of a clinical sample. Future studies should explore the role of enhancing the awareness of hunger and satiety cues to has to promote a healthier eating behavior, preventing dysfunctional eating styles and the gain of weight.

Keywords: mindful eating, external eating, body mass index, female university students
PS-07-11

Resting state salience network interconnectivity as a predictor of social affect and cognition (#352)

K. Lehmann1, M. Lauckner2, L. Puhlmann3, L. Maliske1, K. Preckel3, E. Jauk1, P. Kanske1, 3

1 Technische Universität Dresden, Clinical Psychology and Behavioral Neuroscience, Dresden, Germany
2 Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
3 Max Planck Institute for Human Cognitive and Brain Sciences, Research Group Social Stress and Family Health, Leipzig, Germany

Structured Poster Abstract

Introduction: The salience network (SN) within the human brain (comprising the anterior insula and the anterior cingulate cortex as core hubs) has been implicated to be crucial for experiencing awareness of oneself, others and the environment. Accordingly, atrophy within the SN is associated with symptoms of frontotemporal dementia including loss of social awareness and empathy. A recent study discovered that resting state salience network interconnectivity (SNI) is able to predict trait self-monitoring – denoted as the degree of regulating one’s self-presentation with regard to social situations. However, it remains unclear to which extent SNI is related to the processes required to engage in such a complex social behavior as self-monitoring. We aim at filling this gap by examining whether SNI is able to predict behavioral performance measures of social affect (empathy) and social cognition (Theory of Mind; ToM) and the proneness to engage in ToM and empathy in real-life social interactions. Methods: In a sample of 140 participants, we assessed individual levels in self-monitoring as well as resting state functional connectivity. Furthermore, a subsample of 70 participants executed a well-established behavioral performance measure of empathy and ToM (EmpaToM; Kanske, 2015) during MRI scanning as well as a two-weeks ecological momentary assessment, capturing engagement in empathy and ToM following social interactions. Results: We hypothesize to find positive correlations between SNI and (1) self-reported self-monitoring, (2) empathy following emotional videos, and (3) proneness to engage in real-life ToM and real-life empathy. In contrast, we do not expect to find a positive relationship between SNI and ToM-performance in a behavioral measure. Discussion: Our multi-layered approach might help to elucidate how SNI is related to social-cognitive and -affective performance both in the laboratory and in real-life. Clinical implications are being discussed.

Keywords: Salience network, Self-awareness, Theory of Mind, Empathy
PS-07-12

Neurobiological evidence of physical activity interventions on mental health outcomes and cognition in young people: a systematic review of randomised controlled trials (#392)

K. Heinze1, 2, 3, J. Cumming2, 4, A. Amrita Dosanjh1, S. Palin1, A. P. Bagshaw1, 3, M. R. Broome1, 2, 3

1 University of Birmingham, School of Psychology, Edgbaston, United Kingdom
2 University of Birmingham, Institute for Mental Health, Edgbaston, United Kingdom
3 University of Birmingham, Centre for Human Brain Health, Edgbaston, United Kingdom
4 University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Edgbaston, United Kingdom

Structured Poster Abstract

Introduction. Physical activity appears to be a promising and acceptable intervention to improve mental health and cognition in young people. However, little is known about the neurobiological mechanisms underpinning these effects. With this systematic review, we investigated putative neurobiological mechanisms that link physical activity interventions to mental health and cognition outcomes in children, adolescents and young adults. Methods. A range of medical and psychological science electronic databases were searched (MEDLINE, EMBASE, Scopus, Web of Science, PsychINFO). Research from randomised controlled trials involving physical activity interventions and providing results from at least one measure on mental health and/or cognition and at least one neurobiological measure in clinical and non-clinical populations were included. Studies were selected, data were extracted and quality was appraised. Results. Twenty-five primary papers from 19 different studies were included, using a number of neurobiological measures (e.g. magnetic resonance imaging, electroencephalography, cortisol, brain-derived neurotropic factor) across a variety of age ranges (e.g. kindergarten, middle school, adolescence and young adulthood). Most studies included healthy and community samples (e.g. recruited via schools) and only few included clinical (e.g. attention-deficit hyperactivity disorder, obesity) or subclinical (e.g. mild depression) populations. Conclusions. The majority of studies report improvement in mental health and cognition outcomes following physical activity interventions which coincide with neurobiological alterations from pre- to post-test, e.g. neuroimaging alterations in activation and electrophysiological parameters in frontal areas. Future trials should co-produce interventions with young people and focus on vulnerable young people and those with existing (sub)threshold mental health problems, and generally lower fit individuals. 

Keywords: exercise, BDNF, cortisol, brain imaging
PS-07-13

The Acceptance and Action Questionnaire - II: Exploratory factor analysis of Serbian version (#397)

D. Žuljević1, I. Krnetic2, N. Rakočević3

1 Faculty of Law and Business Studies Dr Lazar Vrkatić, Department of Psychotherapy, Novi Sad, Serbia
2 University of Banja Luka, Department of Psychology, Banja Luka, Bosnia and Herzegovina
3 University of Novi Sad, Department of Psychology, Novi Sad, Serbia

Structured Poster Abstract

Introduction:The increase in psychological flexibility is a central concept and the core mechanism of psychological change in Acceptance and Commitment Therapy (ACT). Psychological flexibility is assessed by the Acceptance and Action Questionnaire – II (AAQ-II). AAQ-II was found to have a unidimensional factor structure with excellent internal consistency and test-retest reliability for 3 and 12 months preiod. The AAQ-II score significantly correlated with different measures of psychopathology, such as depression, anxiety and overall psychological distress, suggesting that psychological inflexibility might be a transdiagnostic process associated with higher risks of many forms of psychopathology. This study aimed to explore the latent structure of Serbian version of AAQ-II by methods of exploratory factor analysis.

Methods:A total of 783 Serbian speaking adults (67.6 % females; Mage = 22.96, SD = 7.05, age range 17-62) from Novi Sad (Serbia) and Banja Luka (Bosnia and Herzegovina) participated in the present study. Participants were recruited via convenience and the snowball sampling method.

Results: The results of principle axis factoring (PAF) of the entire item pool exactly followed the unidimensional latent structure of the scale. Kaiser-Meyer-Olkin measure of sampling adequacy (KMO = 0.89) and significant Bartlett's test of sphericity (Approx. χ2 = 2759.15; p<.01) indicated that correlation matrix was adequate for performing the PAF. A single component met the Guttmann-Kaiser criterion as well as the Scree test criterion, explaining 56% of the total variance. All of the items demonstrated excellent communalities, ranging from .45 to .66 as well as factor loadings ranging from .67 to .81

Conclusions: Based on the presented results, we can recommend Serbian version of AAQ-II as a measure of psychological flexibility which was found to be completely consistent with the original one-factor model structure as was originaly presented by authors.

 

 

 

Keywords: The Acceptance and Action Questionnaire - II, Exploratory factor analysis, Serbian version
PS-07-14

Service user teaching in the training of clinical psychologists: How is the learning different? (#8)

C. E. Wilson1

1 Trinity College Dublin, School of Psychology, Dublin, Ireland

Structured Poster Abstract

Introduction: There are many benefits to including service users in the direct training of mental health professionals, and it is increasingly being included in accreditation criteria for professional training programmes. Depsite this little is known about what this kind of teaching adds to traditional teaching within clinical psychology training programmes.

Methods: Thirty clinical psychology trainees were asked about their experiences of being taught by people with lived experience of mental health difficulties. Their answers were transcribed and analysed using thematic analysis. In addition a systematic review of the literature identified two additional models of learning, and data from 45 papers were used to explore support for these three models.

Results: The qualitative study found that two pre-conditions for learning (valuing the teaching and increased arousal in the teaching context) lead to both cognitive and meta-cognitive processes of learning, and this lead to learning about the self, about client experiences and about services and the wider social context of mental health. It proposes that the meta-cognitive experience of learning something, but not being sure what it is might be crucial for ongoing learning from this kind of teaching.

The systematic review found that there was significant evidence for learning from people with lived experience being different to other kinds of teaching. The differences occurred across three phases; preparation, learning, and consolidation and change.

Conclusion: The process of learning is different when the teacher is a service user and is teaching from lived experience. The experience might not be a comfortable one for all students, but a low level of discomfort may be important in creating conditions for learning. An experience of learning something, but not being sure what it is that you have learned, might be important in understanding how teaching can extend beyond the classroom and beyond training.

Keywords: learning, service users, meta-cognition, training
PS-07-15

Filipino help-seeking for mental health problems and associated barriers and facilitators: A systematic review (#24)

A. B. Martinez1, 2, J. Brown1, M. Co1

1 King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
2 University of the Philippines, Department of Behavioral Science, Manila, Philippines

Structured Poster Abstract

The Philippines now ranks third country in Western Pacific Region with the highest rate of mental health problems, with an estimated 3.3 million Filipinos living with depression and another 3.1 million people having anxiety problems (WHO, 2017).  A barrier to achieving wellbeing and improved mental health among Filipinos is their propensity to not seek psychological help (Ho, et al., 2018; Bernardo & Estrellado, 2017). Yet, there have been a limited number of studies published on Filipino psychological help-seeking (Tuliao, 2014). This is the first systematic review that aims to critically appraise evidence on behavioral and attitudinal patterns of psychological help-seeking among Filipinos and factors that influence the very low help-seeking rates using narrative synthesis approach. Using the PRISMA framework, 15 papers published between 2002-2018 were identified through electronic database searches. Majority of the studies were conducted outside the Philippines, mostly in the United States. Results show that Filipinos across the world have general reluctance to seek help and have unfavorable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking informal help from close family and friends. Filipinos living in the Philippines cited that financial constraints and inaccessibility of mental health services prevent them from seeking formal help, whereas Filipinos in other countries were hampered by their immigration status, lack of health insurance, language barrier, lack of acculturation to their host culture and perceived sense of resilience and self-reliance. Both groups, however, were hindered in their help-seeking by self and social stigma on mental illness, concern for loss of face and sense of shame, and their adherence to Asian values of conformity to norms in which mental illness is considered unacceptable. Filipinos utilize specialty mental health care only as a last resort, or when their problems become severe.

Keywords: psychological help-seeking, mental health, mental health stigma, mental illness
PS-07-16

PS-07-17

Assessing Victimization, Traumatic Stress and Their Correlates in Online Samples: Lessons from a Facebook-Based Study (#82)

O. Bogolyubova1

1 University of Malta, Psychology, Msida, Malta

Structured Poster Abstract

Introduction. The idea that one can gain insight into the workings of the mind by studying language dates back to Freud’s interest in slips of the tongue. The advent of social media granted researchers access to rich linguistic data. Language used online is associated with personality characteristics, health behaviors, and mental health conditions. The goal of this study was to describe violence exposure in a sample of Russian adults and to explore the psychological correlates of such exposure, drawing on self-report and linguistic analysis.

Methods. Data was collected by means of an application, which administered the survey and retrieved public wall posts from the consenting participants’ profiles. Sample included 6,724 Russian Facebook users (Mage = 45; 77.9% female). Linguistic data was available for 1972 individuals. WHO-5 served as an indicator of subjective well-being (SWB) and PC-PTSD as a measure of traumatic stress.

Results. Lifetime physical assault by a stranger, physical assault by someone known to victim, and sexual assault were reported by 56.9%, 64.2%, and 54.1% of respondents, respectively. Participants who were exposed to violence were more likely to experience symptoms of traumatic stress (U = 1,794,250.50, p < .001, d = 0.35). Exposure to multiple forms of violence was associated with more severe traumatic stress symptoms (rs = .257, p < .001). SWB was lower among participants exposed to violence (t = 8.37, p < .001, d = 0.31). Possible linguistic correlates of traumatic stress within the context of online communication were also explored.

Conclusions. This is the largest study on violence victimization in a Russian sample to date. It demonstrates the feasibility of online social media-based psychological research and indicates possible future directions of research into the linguistic markers of trauma-related conditions.

 

Keywords: traumatic stress, violence, social media, language
PS-07-18

Self-Regulation in At-Risk Children: Exploring Factors That Affect Executive Functions in Refugee Children (#107)

B. Coşgun1, N. Yeniad Malkamak1, A. Altan Atalay2, N. Yeniçeri1

1 Boğaziçi University, İstanbul, Turkey
2 Koç University, İstanbul, Turkey

Structured Poster Abstract

The number of refugee children is increasing every year all around the globe along with their suffering from psychological and cognitive problems.Traumatic experiences in the home country, extreme instability during migration and difficulties in adaptation to host country may be related to the self-regulatory skills of children which in turn may affect their psychological well-being. However, there are limited empirical studies examining the effect of refugee experience on self-regulatory skills of children.

The aim of the present study was to define the refugee experience with an emphasis on traumatic and migration-related chaotic components and to explore their effects on the cognitive domain of self-regulation; executive functioning (visual working memory, inhibition, and shifting). 34 Syrian children (7- to 13-year-old) and 40 age-matched locals and their parents participated in the study. Turkish Expressive and Receptive Language Test (TIFALDI) Receptive Vocabulary Subscale, Color Trials Test-2, Heart and Flowers Task and the computerized Backward Corsi Block Tapping Task were administered to participant children. Children’s traumatic experiences and chaotic experiences (e.g. number of residential change, household crowd) were asked to parents.

Turkish receptive vocabulary was the strongest predictor of children’s executive functioning, rather than trauma exposure and chaos. However, after controlling for Turkish language proficiency, Syrian children appeared to be slower on set-shifting and gave fewer accurate responses on visual working memory task compared to their Turkish peers. There was no significant difference on the inhibition and shifting accuracy scores between two groups.

Results provide support for the possibility that the importance of after-migration experiences and adaptation to the host country surpass the effect of war trauma for self-regulation and raise critical questions about clinical interventions for refugee children.

Keywords: self-regulation, executive functioning, refugee experience, trauma
PS-07-19

A comparison of dispositional optimism and general self-efficacy in the prediction of life satisfaction and depression: A prospective study (#119)

V. Jovanović1, M. Lazić1, V. Gavrilov-Jerković1

1 University of Novi Sad, Department of Psychology, Novi Sad, Serbia

Structured Poster Abstract

The present research examined the predictive value of two types of positive expectations: dispositional optimism and general self-efficacy, in predicting two indicators of well-being: life satisfaction and depression. Furthermore, the moderating role of negative life events in the relationships between positive expectations and well-being were examined. We used a prospective design, with a 4 time points over a 18-month period. The final sample included 256 undergraduate students from the University of Novi Sad in Serbia (mean age = 20.96 years, SD = 1.02, age range: 20 to 26 years) who completed the measures of dispositional optimism and general self-efficacy at Time 1 (initial assessment), and measures of life satisfaction and depression at Time 1, Time 2 (6-month follow-up), Time 3 (1-year follow-up), and Time 4 (18-month follow-up). The results of regression analyses showed that dispositional optimism was a robust, unique predictor of both life satisfaction (βs range from .23 to .39, all ps < .01) and depression (βs range from -.22 to -.56, all ps < .01) at each time point. General self-efficacy predicted life satisfaction at three out of four time points (βs range from .09 to .23), but its predictive power was substantially lower when compared with optimism. In contrast to dispositional optimism, general self-efficacy was a rather poor predictor of symptoms of depression (βs range from -.06 to -.13), with statistically significant, but low predictive value in predicting depression only at 6-month follow up. The results of hierarchical regression analyses showed that negative life events did not moderate the relationship between positive expectations and well-being. The present study demonstrated that dispositional optimism is a better predictor of well-being than general self-efficacy, and that the effects of positive expectations on well-being are independent of stress.

Keywords: optimism, self-efficacy, life satisfaction, depression
PS-07-20

Transference in the School Context: An Examination of Self and Object Representations (#128)

D. Acil1, 2, G. Fisek2

1 Istanbul Medipol University, Department of Psychology, Istanbul, Turkey
2 Boğaziçi University, Department of Psychology, Istanbul, Turkey

Structured Poster Abstract

Transference holds a space at the heart of psychotherapy; however, the level of research on the subject falls short of its importance. There are surprisingly few empirical studies on transference. Besides, much less is argued and investigated about transference in non-clinical settings. This study aimed to investigate whether there were parental transferences in the student-teacher relationship at the school, as schools have been considered as fertile grounds for everyday transferences in the literature.

Transference was examined in terms of the object and self-with-other representations of students. By means of a novel design inspired by Ogilvie and Ashmore (1991), university students’ (= 125) representations of their parents, teachers, friends, and acquaintances, as well as their self-with-other representations with these people were obtained. It was hypothesized that the similarity between the representations of the parents and the teachers would be significantly higher than the similarity between any other pairs and that there would be gender congruency in this transference. Similarity rates between specific pairs of representations based on the commonly descriptive adjectives were calculated to test the hypotheses.

The findings indicated that female figures, especially the mother and the female friend resembled both the male and female teachers the most. The central role of representations of the mother in determining those of the teachers was clearly presented by the data, pointing towards maternal transferences in the student-teacher relationship.

This study put forward a series of interesting findings that may challenge our current knowledge in transference relationships in non-clinical settings, e.g. the role of gender or the representational network of university students. It also presents an innovative design that could contribute significantly to the research on transference and mental representations.

Keywords: transference, mental representations, self-with-other, student-teacher relationship
PS-07-21

BEHIND THE CURTAIN OF A GOLDEN AGE: PSYCHOLOGICAL DISTRESS AMONG ITALIAN UNIVERSITY STUDENTS (#156)

I. G. Franzoi1, A. Granieri1

1 Department of Psychology, University of Turin, Turin, Italy

Structured Poster Abstract

Introduction: Emerging adulthood (Arnett, 2000; Arnett et al., 2014) is a phase of development characterized by many transitions and challenging tasks (Furnham, 2004; Miller, 2017). For somebody, this phase coincides with the years of University. Many studies point out high levels of psychological distress in University students (Deb et al., 2016; Schofield et al., 2016; Tang et al., 2018; Tran et al., 2017). However, only a few Italian studies focused on mental health of University students.

Method: One hundred and sixteen students (26.7% males) aged between 18 and 27 (M = 21.38, DS = 1.86) were enrolled. Depression (BDI-II), anxiety (STAI-Y), suicide risk (SHSS) and substance abuse were assessed.

Results: Students show minimal depressive symptoms (M=11.53; DS=9.78), with moderate to severe condition in the 17.2% of cases. SHSS shows a non-at risk mean value (M=1.78; DS=2.66), however, the 4.3% results at risk. Students show both trait and state anxiety (M=49.94; DS=16.61 vs M=46.34; DS=14.90). The 18.1% of the sample reported substance abuse, the 41.4% cannabis abuse. The 55.2% declares to be interested in University psychological services.

Conclusions: Italian data seem in line with international studies, showing significant mental health problems in University students, specifically depression, anxiety and substance abuse (Beiter et al., 2015; Deb et al., 2016; Peltzer et al, 2013; Schofield et al., 2016; Poorolojal et al., 2017). Suicide risk seems to be lower than in previous studies (Chesin & Jelic, 2012; Torres et al., 2017), but still needing attention. Psychological distress can lead to a strong impairment of students’ daily lives (Ivins et al., 2017), as well as to an academic failure (Ishii et al., 2018). It is of the utmost importance to improve University Psychological Services in order to address students’ mental health problems (Ibrahim et al., 2013), as well as to avoid performance decline and drop-out (Lee et al., 2016; Sun et al., 2016).

Keywords: university students, psychological distress, depression, anxiety
PS-07-22

Examining the fear of being laughed at in romantic relationships: An APIM analysis (#157)

K. Brauer1, R. Sendatzki1, R. Proyer1

1 Martin Luther University Halle-Wittenberg, Department of Psychology, Halle, Saxony-Anhalt, Germany

Structured Poster Abstract

Introduction: Gelotophobia describes individual differences in how people experience being laughed at. Those high in gelotophobia (“gelotophobes”) perceive laughter as malicious ridicule, actively directed at them. Although previous studies have shown that gelotophobes are less likely to enter romantic relationships, there is initial evidence that it plays a role in romantic life. This study aims at testing the association of gelotophobia with relationship satisfaction (RS) in romantic couples.

Method: We collected data from 236 adult heterosexual couples who were together for 7.2 years (median = 3.5) and completed measures on gelotophobia (GELOPH-15; Ruch & Proyer, 2008) and different facets of RS (Relationship Quality Questionnaire; Siffert & Bodenmann, 2010) independently from each other. Using the Actor-Partner Interdependence Model (APIM) allowed us to estimate within- (actor) and between- (partner) effects of gelotophobia on facets of RS in the couples.

Results: Preliminary analyses showed the expected associations; namely, gelotophobes experience less satisfaction in their relationship across all tested domains (|rs|≤.26). Moreover, we found that females reported lower optimism and higher constraint when their partner was high in gelotophobia whereas males reported less sexual satisfaction and fascination for their partner when she was high in gelotophobia.

Conclusion: How people deal with being laughed at is associated with couples’ romantic satisfaction. We discuss the differential associations with facets of RS and give an outlook for future research (e.g., the role of similarity and attachment styles).

Keywords: Gelotophobia, Romantic Relationships, Laughter, Relationship satisfaction
PS-07-23

The Map of Cognitive Processes in Boredom, Using Multiple Mediation Models (#304)

I. Milea1, R. A. - I. Cardos1, D. O. David1

1 Babeș-Bolyai University, Clinical Psychology and Psychotherapy, Cluj-Napoca, Romania

Structured Poster Abstract

Introduction: Trait boredom is associated with several internalizing and externalizing problems. Answering existing research gaps in the field, the present study investigated the map of cognitive processes for trait boredom, based on the Rational Emotive-Behavior Therapy model (REBT). The general aim of the study was to investigate the organization of irrational and rational evaluative cognitions related to trait boredom, and the association between trait boredom and the level of depression symptoms and state/trait anxiety.

Methods: The 233 participants (84% women) have completed online scales of evaluative cognitions, trait boredom, trait/state anxiety, and depression. Multiple mediation models via the SPSS extension PROCESS Pearson correlations were employed.

Results: The REBT psychopathology model and the psychological health model are partially confirmed, as the evaluative primary cognitions predicted positively and significantly the secondary ones in both cases. LFT and GE, and FT respectively had significant effects. Moreover, the results indicate a positive significant association between boredom proneness and the negative dis-functional emotions investigated.

Conclusions: Both models offer further support for the hierarchy of cognitions and the distinction between the level of irrationality and rationality in REBT. This is the first attempt to assess a cognitive map of boredom, and it underlines once more the importance of (low) frustration tolerance in relation to boredom after D'Mello & Graesser (2010 – in the educational context). The significance of GE suggests that people might see themselves responsible, or even blame themselves, the others or life itself while bored. The association between anxiety, depression and boredom are both theoretically and practically relevant, as the role of boredom in those contexts is not yet fully understood. The discussions open new theoretical and practical perspectives to study the mechanisms of boredom.

Keywords: trait boredom, anxiety, depression, REBT cognitive map
PS-07-24

Clinical Audit of Electro-Convulsive Therapy (ECT) Outcomes:Using the Clinical Global Impression (CGI) and Hamilton Depression Scale (HAM-D) to evaluate ECT treatment (#306)

P. Jha1

1 Berkshire Healthcare Foundation Trust, Prospect Park Hospital , Reading, United Kingdom

Structured Poster Abstract

Electro-convulsive therapy (ECT) is one of the ways of treating depression, mania, schizophrenia and catatonia (NICE Guidelines, 2009). It is recommended to achieve rapid and short-term improvement of severe symptoms after inadequate trial of other treatment options has proven to be ineffective and/or the mental illness is considered to be potentially life threatening.

Aims & Objectives:

1) To look at the diagnoses of patients who receive ECT treatment and analyse this to see if it meets the guidance adopted from standards set out by NICE

2) To evaluate the response of patients to ECT treatment from the 1st January 2017 to the 31st December 2017 using the Clinical Global Impression (CGI) and the Hamilton Depression Scale (HAM-D) and see if it is in line with the known response rates of ECT as established by the Royal College of Psychiatrists

Methods:

This is a retrospective study analysing the data collected on the 49 patients who received ECT treatment between 1st January 2017 and 31st December 2017. Assessment of the response rate of ECT treatment was done using the Clinical Global Impression (CGI) and the Hamilton Depression Scale (HAM-D).

Results:

  1. Poor post-ECT efficacy index rates were noted this year, with the majority of patients only showing minimal/slight improvement after ECT, which does not alter the status of care for the patient.

  2. Increasing number of patients were noted to be receiving ECT treatment in this year’s audit compared to the previous two years for reasons that are unclear.

Conclusions:

In an attempt to hypothesise the reasons for these findings, collaboration with the ECT department to look at how ECT referrals are accepted and ensure they meet NICE standards is suggested. In addition, proposal of a new audit to evaluate the how appropriate ECT is for patients referred was recommended.

Keywords: Electro-convulsive therapy (ECT), Hamilton Depression Scale (HAM-D), Clinical Global Impression (CGI)
PS-07-25

The Role of Trauma Type in Posttraumatic Stress Disorder, Disordered Eating, and Self-Objectification: Testing a Moderated Mediation Model (#339)

M. Lockett1, 2, T. Pyszczynski1

1 University of Colorado Colorado Springs, Department of Psychology, Colorado Springs, Colorado, United States of America
2 Vrije Universiteit Amsterdam, Department of Clinical Psychology, Amsterdam, Netherlands

Structured Poster Abstract

Posttraumatic Stress Disorder (PTSD) is associated with adverse outcomes, including disordered eating. Self-objectification - that is, the tendency to view oneself as an object - is also associated with disordered eating. Furthermore, some research has hypothesized that self-objectification is an outcome of exposure to traumas involving physical or sexual assault, often referred to as interpersonal traumas which can be differentiated from non-interpersonal traumas (e.g., car accidents, accidental deaths). However, it has not been tested whether self-objectification is specifically related to interpersonal trauma. The present study investigated the associations among self-objectification, trauma type, PTSD symptoms, and disordered eating in a sample of 133 participants recruited from Amazon Turkprime. It was hypothesized that self-objectification would mediate the relationship between PTSD symptoms and disordered eating, but only for those with interpersonal trauma. Results showed that PTSD significantly predicted disordered eating directly (β =.30, CI [.0052, .0172]), as well as indirectly through self-objectification (β = .11, CI [.005, .214]). In the moderated mediation model testing whether the indirect effect of self-objectification differed based on trauma type, the index of moderated mediation did not meet typical standards of significance (CI [-.0021, .0132]). That is, the indirect effect did not significantly differ based on trauma type. This suggests that trauma exposure may be associated with self-objectification regardless of trauma type. This is directly in contrast with existing research in trauma and self-objectification which has suggested that interpersonal trauma specifically contributes to self-objectification. Because self-objectification is associated with adverse outcomes, understanding the role of self-objectification in PTSD may aid the conceptualization and treatment of the disorder.

Keywords: PTSD, Objectification Theory, Trauma type
PS-07-26

Coping with Attention Deficit Hyperactivity Disorder and Developmental Coordination Disorder: An exploratory study (#396)

E. J. Meachon1, A. Schwier1, G. W. Alpers1

1 University of Mannheim, Clinical and Biological Psychology and Psychotherapy , Mannheim, Germany

Structured Poster Abstract

Introduction. Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Coordination Disorder (DCD) each affect about 5% of the population and co-occur in 30-50% of cases. The conditions continue to create difficulties in adulthood, for which affected individuals learn strategies to cope with their symptoms in order to function in school, work, and daily life. While there is literature on personal experiences with ADHD alone, no studies exist to date examining coping in DCD alone or in comorbid populations. With a high comorbidity and symptom overlap between the conditions, this is crucial to examine. The present exploratory study aims to compare and contrast coping strategies between ADHD and DCD groups.

Method. We conducted an online study in English and German with a combined total of N = 150 adults complete respondents with DCD and/or ADHD. Participants completed the Adult Dyspraxia/DCD Checklist, the Brief Cope, and several open-answer format questions about coping with DCD and ADHD symptoms.

Results. A majority of strategies listed by participants in all groups were adaptive forms of coping, and, specifically, adaptive problem-focused in nature. A wide variety of coping mechanisms were reported with some overlap between groups and other mechanisms distinct to the ADHD or DCD groups.

Discussion. Overall the study shows that there are numerous practical and creative ways in which people with ADHD and DCD cope with their symptoms in daily life. Many strategies, such as creating structure, reminders, and limiting distractions, match previous findings for ADHD populations. New insights include that most strategies across groups were reported by only few individuals, indicating that coping may be very individualized even among those with the same condition. It is important for clinicians, educators, and employers to consider the coping mechanisms useful for individuals with ADHD and DCD to make environments more accessible for those with ADHD and DCD.

Keywords: Attention Deficit Hyperactivity Disorder, Developmental Coordination Disorder, Coping, Neurodevelopmental disorders
PS-07-27

Association of Subjective Sleep Quality with Objective Measures of Neurocognitive Impairment in Patients with Depression (#401)

E. Berdzenishvili1

1 Tbilisi State Medical University, Tbilisi, Georgia

Structured Poster Abstract

Introduction:Sleep is essential for cognitive performance.Sleep disturbances are common among patients with Major Depressive Disorder (MDD).Persons with depression show impaired performance on measures of frontotemporally mediated cognitive function.Here we investigate association of sleep quality and neurocognitive dysfunction in patients with MDD.We predicted that poor sleep quality among persons with MDD would be associated with lower scores on objective measures of frontotemporally mediated neurocognitive functions.

Methods:Two groups of patients with MDD were investigated.One group consisted of 15 patients having MDD and poor sleep quality(total score of 5 or greater on PSQI) and second group consisted of 13 patients having MDD and good sleep quality(total score lower than 5 on PSQI).To measure frontotemporally mediated cognitive functioning in patients of these two groups, following tests were administered:Continuous Performance Test (CPT);Wisconsin Card Sorting Test.

Results:Participants with MDD and poor sleep quality performed worse than patients with MDD and good sleep quality. Sleep duration scores on the PSQI were correlated with the CPT Hit Reaction Time Interstimulus Int. Change t-score variable, such that higher scores of sleep duration were related to better performance when stimuli were presented less frequently (r .965, p 0.01).In degraded CPT performance deprim scores(measure of sustained attention) were related to scores of sleep disturbance,such that higher scores no SPQI were associated with better performances (r -.874, p 0.01).Shorter sleep latency was associated with higher scores on correct answers in WCST(r -.879 p 0.01)

Conclusion:Sleep quality,specifically sleep latency,sleep duration and sleep disturbances is related to specific impairments in neurocognitive functioning, namely in sustained attention, processing speed and  mental flexibility.Sleep quality should be assessed before treatment,as they may influence treatment response.

 

Keywords: depression, cognitive impairment, sleep