An exploration of the relationship between use of safety-seeking behaviours and psychosis: A systematic review and meta-analysis

Safety-seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety-seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. This review is, therefore, being conducted in order to synthesize the literature on safety seeking in people with psychosis to increase the understanding of this relationship. A systematic search identified and included 43 studies comprising 2,592 participants, published between 1995 and 2015. The results indicated that people experiencing psychosis commonly respond to their experiences with behavioural and cognitive strategies intended to manage their difficulties. In relation to safety seeking, avoidance, and resistance, there was a pattern that these responses are associated with increased distress and appraisals of threat. The results relating to engagement response styles showed the opposite pattern. These results provide support for cognitive models of safety seeking and psychosis with many of the meta-analyses reported here showing a clear pattern of association between behavioural responses and distress. However, the results reported within individual studies are mixed. This appears to be particularly true with the response style of distraction, with our analyses unable to clarify this relationship. It is possible that the mixed results could reflect the complexities in defining safety seeking and distinguishing it from coping in this population. The clinical implications of this are discussed.

A Pathway to Personalizing Therapy for Metastases Using Liver-on-a-Chip Platforms

Metastasis accounts for most cancer-related deaths. The majority of solid cancers, including those of the breast, colorectum, prostate and skin, metastasize at significant levels to the liver due to its hemodynamic as well as tumor permissive microenvironmental properties. As this occurs prior to detection and treatment of the primary tumor, we need to target liver metastases to improve patients' outcomes. Animal models, while proven to be useful in mechanistic studies, do not represent the heterogeneity of human population especially in drug metabolism lack proper human cell-cell interactions, and this gap between animals and humans results in costly and inefficient drug discovery. This underscores the need to accurately model the human liver for disease studies and drug development. Further, the occurrence of liver metastases is influenced by the primary tumor type, sex and race; thus, modeling these specific settings will facilitate the development of personalized/targeted medicine for each specific group. We have adapted such all-human 3D ex vivo hepatic microphysiological system (MPS) (a.k.a. liver-on-a-chip) to investigate human micrometastases. This review focuses on the sources of liver resident cells, especially the iPS cell-derived hepatocytes, and examines some of the advantages and disadvantages of these sources. In addition, this review also examines other potential challenges and limitations in modeling human liver.

Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial

BACKGROUND

The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and cognitive therapy (CT). Combined treatment is advocated for SAD but has not been evaluated in randomized trials using CT and SSRI. Our aim was to evaluate whether one treatment is more effective than the other and whether combined treatment is more effective than the single treatments.

METHODS

A total of 102 patients were randomly assigned to paroxetine, CT, the combination of CT and paroxetine, or pill placebo. The medication treatment lasted 26 weeks. Of the 102 patients, 54% fulfilled the criteria for an additional diagnosis of avoidant personality disorder. Outcomes were measured at posttreatment and 12-month follow-up assessments.

RESULTS

CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxetine alone, whereas there were no significant differences among combination treatment, paroxetine alone, and placebo. Recovery rates at 12 months were much higher in the CT group (68%) compared to 40% in the combination group, 24% in the paroxetine group, and 4% in the pill placebo group.

CONCLUSIONS

CT was the most effective treatment for SAD at both posttreatment and follow-up compared to paroxetine and better than combined treatment at the 12-month follow-up on the Liebowitz Social Anxiety Scale. Combined treatment provided no advantage over single treatments; rather there was less effect of the combined treatment compared to CT alone.

Cognitive and metacognitive predictors of symptom improvement following treatment for social anxiety disorder: A secondary analysis from a randomized controlled trial

Cognitive therapy for social anxiety disorder (SAD) based on the Clark and Wells model emphasizes negative beliefs about the social self and self-consciousness as central causal factors. However, Wells' metacognitive model proposes that metacognitive beliefs are central to pathology universally. The relative importance of cognitive and metacognitive beliefs in the treatment of SAD is therefore an important research question. This study examined change in negative cognitive and negative metacognitive beliefs as independent correlates of symptom improvement in 46 SAD patients undergoing evidence-based treatments. Both types of beliefs decreased during treatment. However, change in metacognitive belief was the only consistent independent predictor across all outcomes and change in cognitive beliefs did not significantly predict outcomes when change in self-consciousness was controlled. The implication of this finding is that metacognitive change might be more important than cognitive belief change in symptom outcome and recovery in SAD.

KEY PRACTITIONER MESSAGE

Cognitive and metacognitive beliefs decreased during treatment of SAD. Change in self-consciousness predicted symptom improvement. Change in metacognition predicted symptom improvement over change in cognition. Change in metacognition was a more reliable predictor than change in cognition.

Measuring common responses to psychosis: Assessing the psychometric properties of a new measure

Responses to psychotic experiences are central to cognitive models of psychosis. The current study aimed to develop and validate a self-report measure of common responses to the experience of psychosis. This measure is needed as cognitive and behavioural responses are implicated in the maintenance of psychosis, but there is currently no measure that comprehensively assesses these maintaining factors. The Measure of Common Responses to psychosis (MCR) was developed and utilised in a sample of 487 participants who met criteria for treatment-resistant schizophrenia. Principal components analysis using data from 287 participants reduced the initial item pool of 31 items to 15 items with a three component structure. The components represented social control and reassurance seeking, threat monitoring and avoidance and conscious self-regulation attempts. Confirmatory factor analysis using data from the remaining 200 participants generally supported this three factor structure. The three subscales were found to have good internal consistency and convergent validity. The MCR, therefore, appears to be a useful tool to identify and monitor response styles, and could be utilised in further research to increase our understanding of the complex relationships between responses, symptoms and distress. It can also be used in clinical practice to elicit information that will be helpful in the psychological formulation and treatment of psychosis.

Implementation of the Needs Assessment Tool for patients with interstitial lung disease (NAT:ILD): facilitators and barriers

A Needs Assessment Tool (NAT) was developed previously to help clinicians identify the supportive/palliative needs of people with interstitial lung disease (ILD) (NAT:ILD). This letter presents barriers and facilitators to clinical implementation. Data from (1) a focus group of respiratory clinicians and (2) an expert consensus group (respiratory and palliative clinicians, academics, patients, carers) were analysed using Framework Analysis. Barriers related to resources and service reconfiguration, and facilitators to clinical need, structure, objectiveness, flexibility and benefits of an ‘aide-memoire’. Identified training needs included communication skills and local service knowledge. The NAT:ILD was seen as useful, necessary and practical in everyday practice.

Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up

This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression. Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL). The WL-group received 10 sessions of MCT after the waiting period. Two participants dropped out from WL and none dropped out of immediate MCT treatment. Participants receiving MCT improved significantly more than the WL group. Large controlled effect sizes were observed for both depressive (d = 2.51) and anxious symptoms (d = 1.92). Approximately 70–80% could be classified as recovered at post-treatment and 6 months follow-up following immediate MCT, whilst 5% of the WL patients recovered during the waiting period. The results suggest that MCT is a promising treatment for depression. Future controlled studies should compare MCT with other active treatments.

A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis

This meta-analysis investigated whether the five metacognitive beliefs implicated in the Self-Regulatory Executive Function (S-REF) model (Wells and Matthews, 1994; Wells and Matthews, 1996) are elevated in people with clinical psychosis compared to people with emotional disorder and non-psychiatric controls. The review followed guidance set-out in the PRISMA statement. Primary analyses compared summary effect sizes on each sub-scale of the Metacognitions Questionnaire (MCQ) for people with psychosis and non-psychiatric controls; and people with psychosis and people with emotional disorder. Eleven eligible studies were identified comprised of 568 psychosis participants, 212 emotional disorder participants and 776 non-psychiatric controls. Findings indicated that people with psychosis had higher scores on all sub-scales of the MCQ compared to non-psychiatric controls; and higher scores on the positive beliefs about worry sub-scale compared to people with emotional disorder. This suggests metacognitive beliefs may be associated with the presence of psychological disorder and distress in general, rather than specific diagnoses. Implications for models of psychosis and treatment are discussed.

The role of unhelpful metacognitive beliefs in psychosis: Relationships with positive symptoms and negative affect

The Self-Regulatory Executive Function (s-REF) model assumes that a common set of unhelpful metacognitive beliefs have a central role in predisposition to psychological disorder and the maintenance of symptoms and distress. This research aims to test whether the five unhelpful metacognitive beliefs implicated in the model are associated with positive symptoms of psychosis and whether they are a better predictor of negative affect than topological characteristics of positive symptoms. A sample of people with psychosis completed a semi-structured interview about psychotic symptoms and self-report measures of metacognitive beliefs (MCQ-30), anxiety and depression. Hierarchical multiple regression analyses suggested that unhelpful metacognitive beliefs predict negative affect in people with psychosis over and above symptom frequency and other topological characteristics of symptoms captured by the Psychotic Symptoms Rating Scale (PSYRATS). The findings support the application of the metacognitive model to emotional distress in people with psychosis.

A liver microphysiological system of tumor cell dormancy and inflammatory responsiveness is affected by scaffold properties

Distant metastasis is the major cause of breast cancer-related mortality, commonly emerging clinically after 5 or more years of seeming 'cure' of the primary tumor, indicating a quiescent dormancy. The lack of relevant accessible model systems for metastasis that recreate this latent stage has hindered our understanding of the molecular basis and the development of therapies against these lethal outgrowths. We previously reported on the development of an all-human 3D ex vivo hepatic microphysiological system that reproduces several features of liver physiology and enables spontaneous dormancy in a subpopulation of breast cancer cells. However, we observed that the dormant cells were localized primarily within the 3D tissue, while the proliferative cells were in contact with the polystyrene scaffold. As matrix stiffness is known to drive inflammatory and malignant behaviors, we explored the occurrence of spontaneous tumor dormancy and inflammatory phenotype. The microphysiological system was retrofitted with PEGDa-SynKRGD hydrogel scaffolding, which is softer and differs in the interface with the tissue. The microphysiological system incorporated donor-matched primary human hepatocytes and non-parenchymal cells (NPCs), with MDA-MB-231 breast cancer cells. Hepatic tissue in hydrogel scaffolds secreted lower levels of pro-inflammatory analytes, and was more responsive to inflammatory stimuli. The proportion of tumor cells entering dormancy was markedly increased in the hydrogel-supported tissue compared to polystyrene. Interestingly, an unexpected differential response of dormant cells to varying chemotherapeutic doses was identified, which if reflective of patient pathophysiology, has important implications for patient dosing regimens. These findings highlight the metastatic microphysiological system fitted with hydrogel scaffolds as a critical tool in the assessment and development of therapeutic strategies to target dormant metastatic breast cancer.

Abstract P2-05-19: Breast cancer dormancy, re-emergence, and treatment

Breast cancer (BrCa) mortality continues to result predominately from distant metastases that can emerge years after successful treatment of the primary disease. Metastatic resistance to agents that eradicate the primary mass is likely due to protection from the metastatic microenvironment and the quiescent state of dormant BrCa cells. Advancements for the treatment of metastatic tumors have been made, but significant progress has been hampered by the lack of relevant model systems, particularly for dormancy. We address this gap with an innovative all-human 3D liver microphysiological system (MPS). The liver is both a major site for BrCa metastasis (and other solid tumors) and the primary site of drug metabolism and limiting toxicities, an important consideration in evaluating cancer therapy efficacy and availability.

Primary hepatocytes and non-parenchymal cells (NPC) from human liver resections were seeded into the MPS. Following tissue formation on day 3, tagged BrCa cells were seeded and allowed a minimum of 4 days to integrate into the tissue before interventions were initiated. On day 7, chemotherapy treatment of micrometastases was initiated for 72h. Cultures were allowed 3 days to recover before the MPS was challenged with inflammatory factors (LPS/EGF) for 48h. BrCa cells were then re-treated with chemotherapy (either the same or alternate therapy) on day 21 for 72h. Hepatocyte function and injury were measured by urea, AST, ALT, A1AT, fibrinogen and CYP P450 assays. BC proliferation was monitored by quantification, Ki67 staining, and EdU incorporation. Communication networks within the metastatic microenvironment during different stages of metastatic BrCa progression were identified using Luminex assays (55 analytes).

The metastatically aggressive MDA-MB-231 BrCa cells demonstrated growth attenuation after 12d of culture in a subpopulation of cells (Ki67-/EdU-). Treatment of BrCa cells with doxorubicin for 72h eradicates the cycling cells, leaving behind a dormant cell population (Ki67-/EdU-) that can be subsequently stimulated to cycle by addition of inflammatory stimuli. A second dose of doxorubicin or cisplatin reduced the BrCa load but did not eradicate the BrCa. Luminex analysis of culture supernatants identified signaling molecules potentially involved in metastatic progression. In addition, we present the use of adjuvant therapy in the MPS to prevent this outgrowth of the dormant tumor cells.

In parallel, we have piloted hydrogel scaffolds that better support tissue formation and produce signals consistent with a healthier liver physiology. Hydrogels enhanced MDA-MB-231 cell entry into dormancy, resulting in reduced efficacy of doxorubicin treatment with greater persistence of tumor load.

The MPS provides a mechanism to close the gap in understanding metastatic dormancy. We demonstrate spontaneous dormancy for the first time in an all-human system and mimicked the dormancy and outgrowth observed in patients. Namely, that dormant BrCa are resistant to chemotherapy and can be stimulated to reemerge following an inflammatory insult. The completion of these studies will provide insights into the tumor biology of metastatic seeding, dormancy, and re-emergence and provide an accessible tool for testing therapeutics against metastatic BrCa in a metabolically competent system capable of evaluating dose-limiting toxicity.

Citation Format: Beckwitt C, Wheeler SE, Clark AM, Pillai VC, Young CL, Stolz DB, Lauffenburger DA, Venkataramanan R, Griffith LG, Wells A. Breast cancer dormancy, re-emergence, and treatment. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-05-19.

Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study

Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety.

Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA

Metacognitive beliefs have been shown to correlate with emotional disorders and more recently have been implicated in health anxiety. Research exploring these beliefs have tended to use the Metacognition Questionnaire (MCQ), which is a general measure. To facilitate research on the metacognitive model applied to health anxiety the present study reports on the development and initial evaluation of a new specific metacognitive measure of health anxiety, the Metacognitions Questionnaire-Health Anxiety (MCQ-HA). Principal components analysis identified 14 suitable items to be explored. Subsequent exploratory factor analysis of the MCQ-HA identified three factors: "Beliefs that Thoughts can cause Illness", "Beliefs about Biased thinking", and "Beliefs that Thoughts are Uncontrollable". Confirmatory factor analysis supported the three factor model with all selected goodness-of-fit statistics equivalent to or better than recommended values. Preliminary evidence suggests good internal-consistency, incremental, convergent and discriminant validity in relation to associated measures. The MCQ-HA appears to be a potentially useful predictor of health anxiety.

A Metacognitive Perspective on Mindfulness: An Empirical Investigation

Background

The primary aim of this study was to explore how metacognition, as implicated in Wells and Matthews’ metacognitive theory of emotional disorder, might relate to the concept of mindfulness, and whether metacognition or mindfulness best predicted symptoms of emotional disorder.

Methods

Data was collected from 224 community controls on the Five Facet Mindfulness Questionnaire (FFMQ), the Metacognitions Questionnaire-30 (MCQ-30), the Patient Health Questionnaire 9-item (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7), and the Obsessive-Compulsive Inventory Revised (OCI-R).

Results

The MCQ-30 and FFMQ subscales constituted two latent factors which appeared to assess metacognition and mindfulness. The FFMQ subscales nonjudging of inner experience and acting with awareness loaded on metacognition, while observing, nonreacting to inner experience and describing formed a unique mindfulness factor. Metacognition correlated strongly with symptoms of depression, anxiety and obsessive-compulsive disorder. Regression analyses found metacognition to be an important predictor of symptoms explaining between 42 % and 49 % of the variance when controlling for age and gender, while mindfulness was a weaker predictor explaining between 0 % and 2 % of the variance in symptoms.

Conclusions

The structure amongst scales and the pattern of correlations with symptoms were generally consistent with the metacognitive theory which focuses on metacognitive beliefs, enhancing awareness of thoughts and disengaging extended processing.

The Metacognitions about Smoking Questionnaire: development and psychometric properties

OBJECTIVES

Recent research has suggested that metacognitions may play a role in smoking. The goal of the current set of studies was to develop the first self-report instrument of metacognitions about smoking.

METHOD

We conducted three studies with samples of smokers (n = 222, n = 143, n = 25) to test the structure and psychometric properties of the Metacognitions about Smoking Questionnaire and examined its capacity to predict smoking behaviour.

RESULTS

Exploratory and confirmatory factor analyses supported a four-factor solution: positive metacognitions about cognitive regulation, positive metacognitions about emotional regulation, negative metacognitions about uncontrollability, and negative metacognitions about cognitive interference. Internal consistency, predictive and divergent validity, and temporal stability were acceptable. The metacognition factors correlated positively with daily cigarette use and levels of nicotine dependence, and contributed to the prediction of these outcomes over and above smoking outcome expectancies.

CONCLUSIONS

The Metacognitions about Smoking Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested. The metacognition factors explained incremental variance in smoking behaviour above smoking outcome expectancies.

Metacognition in addictive behaviors

BACKGROUND

Over the last twenty years metacognitive theory has provided a novel framework, in the form of the Self-Regulatory Executive Function (S-REF) model, for conceptualizing psychological distress (Wells & Matthews, 1994, 1996). The S-REF model proposes that psychological distress persists because of unhelpful coping styles (e.g. extended thinking and thought suppression) which are activated and maintained as a result of metacognitive beliefs.

OBJECTIVE

This paper describes the S-REF model and its application to addictive behaviors using a triphasic metacognitive formulation.

DISCUSSION

Evidence on the components of the triphasic metacognitive formulation is reviewed and the clinical implications for applying metacognitive therapy to addictive behaviors outlined.

An open trial of group metacognitive therapy for depression in Norway

BACKGROUND

Preliminary data support the implementation of individual metacognitive therapy (MCT) for depression. Given the focus of MCT on transpersonal processes, we hypothesized that this treatment should translate well to a group format. In this study, the effects and feasibility associated with group MCT for depression are reported.

METHODS

Eleven patients who were consecutively referred by general practitioners to a specialist psychiatric practice in Norway participated in an open trial of the effects and feasibility associated with group MCT for depression. All of the patients met the DSM-IV criteria for major depressive disorder (MDD) and were monitored in a baseline period before attending 90-min weekly treatment sessions of group MCT for 10 weeks. The primary symptom outcome measure was severity of depression whilst secondary outcome measures included levels of anxiety, rumination and metacognitive beliefs. We also assessed recovery rates and changes in comorbid Axis I and Axis II diagnoses.

RESULTS

Large clinically significant improvements across all measures were detected at post-treatment and these were maintained at follow-up. Based on objectively defined recovery criteria, all patients were classified as recovered at post-treatment and 91% at 6 months follow-up. The intervention was also associated with significant reductions in comorbid diagnoses.

CONCLUSIONS

These preliminary data indicate that group MCT in the treatment of depression is effective, well accepted and it extends clinical application of MCT for depression to group formats as a potential cost-effective intervention.

Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review

BACKGROUND

Attachment theory has been conceptualised as an emotion regulation theory. Research attributes the occurrence of depressive symptoms to a dysfunction of emotion regulation. Anxious attachment and avoidant attachment, which are two dimensions of insecure attachment, are hypothesised to lead to the development of hyperactivating and deactivating emotion regulation strategies.

METHODS

This systematic review examines the literature on the role of emotion regulation and its relationship with attachment and depressive symptomatology. Furthermore, we examined evidence for hyperactivating and deactivating strategies.

RESULTS

Nineteen papers were identified. Adolescent studies demonstrated associations of varying strength and found unreliable and contradictory results for emotion regulation as a mediator. Conversely, adult studies provided strong evidence for emotion regulation as a mediator. The hypothesis that hyperactivating strategies mediate anxious attachment and depressive symptoms was consistently supported. Mixed evidence was provided for deactivating strategies as mediators to avoidant attachment and depressive symptomatology.

LIMITATIONS

Limitations of methodology and quality of studies are identified with particular attention drawn to problems with conceptual singularity and multicollinearity.

CONCLUSIONS

Despite mixed variable findings, this review indicates that emotion regulation is a mediator between attachment and depression. Hyperactivating strategies, in particular, have been consistently noted as mediators for anxious attachment and depressive symptomatology, whereas evidence for deactivating strategies as mediators between avoidant attachment and depressive symptoms has been mixed. Future research should test the mediators of attachment and symptoms and examine theoretically grounded models of psychopathology, such as metacognitive and cognitive models using clinical samples.

Unique contributions of metacognition and cognition to depressive symptoms

This study attempts to examine the unique contributions of "cognitions" or "metacognitions" to depressive symptoms while controlling for their intercorrelations and comorbid anxiety. Two-hundred-and-fifty-one university students participated in the study. Two complementary hierarchical multiple regression analyses were performed, in which symptoms of depression were regressed on the dysfunctional attitudes (DAS-24 subscales) and metacognition scales (Negative Beliefs about Rumination Scale [NBRS] and Positive Beliefs about Rumination Scale [PBRS]). Results showed that both NBRS and PBRS individually explained a significant amount of variance in depressive symptoms above and beyond dysfunctional schemata while controlling for anxiety. Although dysfunctional attitudes as a set significantly predicted depressive symptoms after anxiety and metacognitions were controlled for, they were weaker than metacognitive variables and none of the DAS-24 subscales contributed individually. Metacognitive beliefs about ruminations appeared to contribute more to depressive symptoms than dysfunctional beliefs in the "cognitive" domain.

Spontaneous dormancy of metastatic breast cancer cells in an all human liver microphysiologic system

Background:

Metastatic outgrowth in breast cancer can occur years after a seeming cure. Existing model systems of dormancy are limited as they do not recapitulate human metastatic dormancy without exogenous manipulations and are unable to query early events of micrometastases.

Methods:

Here, we describe a human ex vivo hepatic microphysiologic system. The system is established with fresh human hepatocytes and non-parenchymal cells (NPCs) creating a microenvironment into which breast cancer cells (MCF7 and MDA-MB-231) are added.

Results:

The hepatic tissue maintains function through 15 days as verified by liver-specific protein production and drug metabolism assays. The NPCs form an integral part of the hepatic niche, demonstrated within the system through their participation in differential signalling cascades and cancer cell outcomes. Breast cancer cells intercalate into the hepatic niche without interfering with hepatocyte function. Examination of cancer cells demonstrated that a significant subset enter a quiescent state of dormancy as shown by lack of cell cycling (EdU⁻ or Ki67⁻). The presence of NPCs altered the cancer cell fraction entering quiescence, and lead to differential cytokine profiles in the microenvironment effluent.

Conclusions:

These findings establish the liver microphysiologic system as a relevant model for the study of breast cancer metastases and entry into dormancy.

Refraining from intrusive thoughts is strategy dependent: a comment on Sugiura, et al. And a preliminary informal test of detached mindfulness, acceptance, and other strategies

The control of cognition is fundamental to psychological well being. One dimension recently explored by Sugiura, Sugiura and Tanno (2013) is the perceived ability to refrain from catastrophic thinking-a construct that could be a marker of several factors. The current paper recommends deeper consideration in terms of metacognitive theory and exemplifies this by testing the effect of a strategy that focuses on abstaining from processes (detached mindfulness) vs. transforming content (acceptance, brief exposure). Fifty-six participants (M age = 21.5 yr., range = 18-42) were randomly assigned to detached mindfulness, acceptance, exposure, or a control group before watching a stressful film that induced intrusive images. Afterwards, they engaged in their respective strategies for 5 min. and the frequency of intrusive images was rated. Detached mindfulness was the only manipulation that was associated with a statistically significant lower frequency of intrusions than the control condition. It is argued that assessment of perceived skills to refrain from thinking should be conceptualized within a metacognitive framework that distinguish process- and content-oriented strategies and address the question: When is a strategy a true refrain?

Modulation of Epidermal Growth Factor Stimulated ERK Phosphorylation and Cell Motility by Inositol Trisphosphate Kinase

Epidermal growth factor [EGF] mediated stimulation of its receptor in endothelial cell [EC] is accompanied by phosphorylation of the EGF-receptor [EGFR] and activation of phospholipase C-γ, resulting in the breakdown of phosphatidylinositol(4,5)-bisphosphate and generating inositol (1,4,5)-trisphosphate [IP₃] and diacylglycerol. IP₃ thus formed can be further converted to inositol (1,3,4,5)-tetrakisphosphate [IP₄] by an enzyme called IP₃-kinase [IP₃K]. In this study we have investigated the effect of modulation of intracellular IP₃K activity by the use of an inhibitor, 2-trifluoromethyl [6-(4-nitrobenzyl)-purine] [IP₃KI] and siRNA against IP₃KB on EGF-induced ERK-phosphorylation and cell motility. EGF stimulated ERK-phosphorylation that has been implicated in EGF-stimulated cell migration was inhibited by both IP₃KI and siRNA against IP₃KB. Inhibition of ERK-phosphorylation was accompanied by decreased cell migration in the presence of IP₃KI.

Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study

BACKGROUND AND OBJECTIVES

Cognitive behaviour therapy (CBT) for psychosis has been shown to be effective, but there are recent suggestions that it is less efficacious than initially thought. Metacognitive therapy (MCT), which focuses on metacognitive mechanisms, has led to positive results in other disorders, but has yet to be evaluated in people with schizophrenia spectrum diagnoses. This study evaluates the feasibility of MCT for people with psychotic disorders.

METHODS

Ten participants with schizophrenia spectrum disorders received up to 12 sessions of MCT in an open trial. Outcomes included psychiatric symptoms measured using the PANSS, at baseline, 9 months (end of treatment) and at 12 months (follow-up), as well as dimensions of hallucinations and delusions, emotional dysfunction, self-rated recovery, social functioning and metacognitive beliefs.

RESULTS

T-tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on several outcomes at end-of-treatment and follow-up. Cohen's d effect sizes were moderate to large (for PANSS total, d = 1.0 at end of treatment; d = 0.95 at follow-up). A response rate analysis found 50% and 40% of participants achieved at least a 25% reduction in PANSS total scores by end of therapy and follow-up, respectively. Exploratory analyses revealed that metacognitive beliefs significantly changed over treatment and follow-up periods.

LIMITATIONS

This study had no control group and was not randomised; therefore, it is likely that effect sizes were inflated.

CONCLUSIONS

This study provides preliminary evidence that MCT is a feasible treatment for people with psychosis. An adequately powered randomised controlled trial is warranted.

Metacognitive beliefs in adolescents with an at-risk mental state for psychosis

AIM

The self-regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at-risk mental state (ARMS) for psychosis is limited.

METHODS

The Metacognitions Questionnaire short form (MCQ-30) was administered to 31 adolescents with an identified ARMS. Scores were subsequently compared to a control group of 76 adolescents drawn from a community population.

RESULTS

As predicted, ARMS patients scored significantly higher on metacognition subscales, with negative beliefs (F = 42.97, P = 0.001), cognitive confidence (F = 17.11, P = 0.001) and need for control (F = 22.48, P = 0.001) subscales of the MCQ-30 distinguishing them from the comparison group.

CONCLUSIONS

The finding that metacognitive beliefs are significantly elevated in comparison to a community sample of adolescents is in keeping with previous adult-orientated research. Possible implications for clinical practice are discussed.

Assessment of the Greek worry-related metacognitions: the Greek version of the Metacognitions Questionnaire (MCQ-30)

The Metacognitions Questionnaire-30 (MCQ-30), developed by Wells and Cartwright-Hatton (2004), represents a multidimensional measure of metacognitive factors considered to be important in the metacognitive model of psychological disorders. The primary aim of the present study was to examine internal consistency, test-retest reliability, convergent validity and the factor structure of the Greek version of the MCQ-30. Moreover, we investigated the associations of the extracted factors with trait anxiety in a Greek sample. The study sample consisted of 547 non-clinical participants (213 males and 334 females). All participants completed the Greek version of the MCQ-30. A subsample of 157 participants also completed the Trait Anxiety subscale of the State -Trait Anxiety Inventory and the Meta-worry subscale of the Anxious Thought Inventory. Thirty participants were retested with the MCQ-30 over a retest interval ranging from three to five weeks. The results confirmed the dimensionality of the MCQ-30 and five factors were extracted consistent with the original English version: (1) positive beliefs about worry, (2) negative beliefs about worry concerning uncontrollability and danger, (3) cognitive confidence, (4) beliefs about the need to control thoughts and the negative consequences of not controlling them, and (5) cognitive selfconsciousness. The MCQ-30 showed high levels of internal consistency and test-retest reliability. The correlation between MCQ-30 total score and AnTI-MW was strong, indicating high level of convergent validity. Moreover, all correlations between MCQ-30 total and subscale scores and STAI-T were significant apart from the correlation between 'cognitive confidence' and trait anxiety. The Greek sample scored higher in the MCQ-30 and its subscales than the English sample in the original study. Women scored significantly higher than men in the overall MCQ-30 and the "uncontrollability and danger" and "need to control thoughts" subscales, whereas no significant differences between genders had been found in the original study. The assumption that the differences in score levels and the gender effect might reflect cultural differences warrants further investigation. The findings of the present study indicate that the Greek version of the MCQ-30 is a comprehensible and psychometrically adequate instrument, as well as a reliable tool in assessing a range of dimensions of worry-related metacognitions in the Greek population. The Greek version of this scale facilitates crosscultural research in metacognition and wider testing of the metacognitive approach to emotional vulnerability, psychological disturbances and mental disorders.

Metacognitive change as a predictor of outcome in cognitive therapy for psychosis

BACKGROUND

There is little known about predictors of response to cognitive therapy (CT) for psychosis. This study tests the hypothesis that metacognitive change at both end of treatment and follow-up is associated with positive outcomes in people with psychosis receiving CT.

METHOD

Patients referred for CT for psychosis were offered CT over a maximum of 30 sessions. Assessments, including interview-based measures of psychotic symptoms and a questionnaire assessing metacognitive worry, were performed at pre-CT, post-CT and one-year follow-up. Data from 32 patients were analyzed.

RESULTS

Significant positive relationships were found between metacognitive worry change scores at one-year follow-up and both positive symptoms of psychosis and particular dimensions of hallucinations. No significant relationships were found between metacognitive change and delusional symptoms.

CONCLUSIONS

These results suggest that metacognitive change is associated with symptom change at followup. In particular, these benefits seem most evident in those people experiencing hallucinations. Methodological limitations and clinical implications are discussed.