Varieties of temporal experience in depression

Transdiagnostic Assessment of Temporal Experience (TATE) in Mental Disorders-Empirical Validation and Adaptation of a Structured Phenomenological Interview

Abnormal experiences of time (ATEs) are an established object of research in phenomenological psychopathology. Objective: The purpose of this study was the first validation of the Transdiagnostic Assessment of Temporal Experience (TATE), a structured phenomenological interview concerning ATEs in individuals with diverse mental health conditions, and its adaptation for the Polish language. Methods: The research employed a mixed-method approach and consisted of several phases including (1) consensual translation; (2) construct and content validation by an expert panel; (3) direct feedback from patients with lived experiences of alcohol addiction, borderline personality, autism, and clinical depression; (4) an auditorium questionnaire with 98 respondents without mental health issues, who were both interviewed and gave qualitative feedback; and (5) a final expert panel and approval. Results: Following multiple stages of modification, the final TATE demonstrates strong internal consistency and validity (Cronbach's α = 0.9), with strong correlations between the frequency, intensity, and impairment of various forms of ATEs as well as their rare occurrence among healthy participants. Conclusions: TATE represents a multidimensional and structured quantitative phenomenological approach to temporal experience for psychiatry and clinical psychology. This article presents the validated version of TATE for Polish alongside updated administration guidelines. It is now the state-of-the-art TATE that may be further adapted to other languages, including English.

Diminished representational momentum for physical states in patients with depressive disorder

The representational momentum for physical state changes refers to the fact that we remember objects as more changed in physical state than they actually were. It has been well documented that depressive disorder is associated with impairment of time perception. Thus, the present work was conducted with the aim to investigate the representational momentum for physical state changes in patients with depressive disorder, firstly. Forty patients with depressive disorder and forty-two healthy controls were administrated with the task of representational momentum for physical state changes and task of time perception. The stimulus comprises 10 videos showing object state changes (e.g., ice melting). During playing, the video would stop and immediately be obscured by mosaics at a specific point. Participants select from three detection images (the exact frame of the video just be masked, the frame after that, and the frame before that) to test representational momentum and estimate the duration of the video in seconds to test time perception. The depressive group showed diminished representational momentum (i.e., lower scores on the task of representational momentum) than normal controls (U = 215.00, Z = -5.83, p < 0.001). In addition, the scores on the task of representational momentum were significantly positively related with the scores on the task of time perception among depressive group (r = 0.446, p = 0.004). The findings indicate that patients with depressive disorder may exhibit diminished representational momentum for physical states, which may be correlated with their impairment of time perception.

A Qualitative Phenomenological Philosophy Analysis of Affectivity and Temporality in Experiences of COVID-19 and Remaining Symptoms after COVID-19 in Sweden

This article explores affectivity, temporality, and their interrelation in patients who contracted COVID-19 during the first wave of the pandemic in Sweden and with symptoms indicative of post-COVID-19 Condition (PCC) that remained one year after the infection. It offers a qualitative phenomenological philosophy analysis, showing how being ill with acute COVID-19 and with symptoms indicative of PCC can entail a radically altered self-world relation. We identify two examples of pre-intentional (existential) feelings: that of listlessness and that of not being able to sense what is real and not real, both of which, in different ways, imply a changed self-world relation. We offer an analysis of intentional feelings: how the fear of not "returning" to one's previous self and the hope of such a return weave together the present and the absent, as well as the past and the future, in ways that make the future appear as constricted, disquieting, or lost. We argue that a phenomenological differentiation among experiences of living with symptoms indicative of PCC-through attention to the way intentional affectivity and pre-intentional affectivity help shape the embodied self's attunement to the world-is apt to yield a better understanding of the variations within these experiences and contribute to clinical practice.

Major Depression as a Disorder of the Narrative Self: A Qualitative Study

INTRODUCTION

Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews.

METHODS

To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method.

RESULTS

Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one's self, and (3) losing control on one's self.

CONCLUSION

Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself - which is the core of depressive experiences - ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.

The role of depressive symptoms in the interplay between aging and temporal processing

Temporal processing, the ability to mentally represent and process the dynamical unfolding of events over time, is a fundamental feature of cognition that evolves with advancing age. Aging has indeed been associated with slower and more variable performance in timing tasks. However, the role of depressive symptoms in age-related changes in temporal processing remains to be investigated. Therefore, the present work aims to shed light on the link between temporal processing and depressive symptoms, which are frequent with advancing age. We relied on the multicentric "Blursday Project" database, providing measures of temporal processing together with questionnaires investigating psychological wellbeing. Results reveal that aging influences several timing abilities, from the reproduction of short time intervals to verbal estimations of longer temporal distances. Furthermore, the slowing down of felt passage of time regarding the last few days with age was fully mediated by the intensity of depressive symptoms. Overall, these findings suggest that depressive symptoms may play a pivotal role in age-related temporal processing changes.

The metacognitive experience of time passing in Chinese college students: scale development, structure verification, and influencing factors

The experience of time passing (ETP) is also the consciousness of the progress of life. ETP contributes to time regulation and life management, which basically conforms to the metacognitive theory. Also, the traditional Chinese cultural approach to time emphasizes ETP. It is an indispensable part of Chinese education and culture to strengthen one's appreciation of time by emphasizing the passage of time. In combination with the above two points, ETP equals metacognitive experience of time passing (METP) to a certain extent. However, we currently know little about the connotations of METP. To better understand traditional Chinese time culture, and referring to the concept of metacognition and model of time experience as proposed by Western scholars, the current study combined the results of open and semi-structured interviews, to explore the structure of METP in Chinese college students and developed a questionnaire with which to measure it. Using convenience sampling, 2,876 college students were recruited, the interview, and the reliability and validity tests were carried out. Five hundred and seventy-nine college students were tested a second time to investigate the correlation validity between METP and Ruminative Responses, time attitude, and meaning in life. The results led to the development of the METP Scale which contains 15 items and assesses two factors: ruminative and emotional experience of time passing. The two-factor model was well fitted, and invariable in measurements across gender, grade, and major. The internal consistency coefficients of the scale and its two factors ranged from 0.82 to 0.89, the half-point reliability between 0.76 and 0.88, and the retest reliability ranged from 0.77 to 0.78. METP Scale has good correlation validity, meanwhile, the results of regression analysis showed that symptom rumination, positive past, negative present, positive future, and searching for meaning in life significantly predict the intensity of METP.

Reward Processing Alters the Time Perception Networks in Patients with Major Depressive Disorder

Behavioral studies revealed that time perception is affected by the presence of a reward. Both the experience of time and the reward processing were shown to be distorted in major depressive disorder (MDD). We aimed to investigate how neural correlates of time perception and reward anticipation interact in patients with MDD. Participants (17 healthy, seven MDD) performed a time perception task during fMRI scanning that requires estimating the speed of a moving rectangle which was briefly occluded. In the control condition, participants attended to the change in color tone of the rectangle. Half of the runs were rewarded with a monetary payment per correctly done trial to evaluate the effect of a reward. The fMRI data were acquired with a 3T scanner and analyzed with repeated-measures analysis of variance (ANOVA) using SPM12. The activations related to the integration of time with reward were different between both groups in the supplementary motor area, intraparietal sulcus, thalamus, frontal eye field and caudate nucleus. Increased coupling between supplementary motor area and caudate/putamen region during timing was found in MDD patients more than in controls. Overall, our findings suggest that functional differences related to the interaction of time perception with reward anticipation in MDD occur via dysfunction of the cortico-striatal-thalamic network.

Adolescents' experiences of acceptance and commitment therapy for depression: An interpretative phenomenological analysis of good-outcome cases

Introduction

Acceptance and commitment therapy (ACT) has been shown to help treat depression. However, little is known about the patient's experiences with ACT. This study aimed to learn how it was used in adolescents with major depressive disorder who have achieved good treatment outcomes.

Methods

Five adolescents with major depressive disorder with good treatment outcomes of ACT were enrolled in the semi-structured qualitative interview and analyzed using systematic textual condensation and interpretative phenomenological analysis.

Results

Four primary themes emerged from the investigation. "Therapist relationships and characteristics" describes the therapist's receptiveness and respect for adolescents with depression and having a trustworthy and sincere therapist. "Spaces to explore and experience" describes the ongoing process and content of acceptance of negative emotions and mindfulness practices in the healing process. "Do important things" refers to values and committed action. The "time settings" include the frequency and duration of treatment.

Conclusion

Adolescents make positive changes with a receptive and respectful therapist by exploring themselves in a genuine and trusting therapeutic relationship. Improvement seems to come from being open to all thoughts and feelings and developing the ability to live in the present moment. Teenagers attach great importance to value-oriented behaviour. Therefore, treatment should target the critical areas of depressed adolescents to guide them towards recovery effectively.

Taking subjectivity seriously: towards a unification of phenomenology, psychiatry, and neuroscience

Nearly all psychiatric diseases involve alterations in subjective, lived experience. The scientific study of the biological basis of mental illness has generally focused on objective measures and observable behaviors, limiting the potential for our understanding of brain mechanisms of disease states and possible treatments. However, applying methods designed principally to interpret objective behavioral measures to the measurement and extrapolation of subjective states presents a number of challenges. In order to help bridge this gap, we draw on the tradition of phenomenology, a philosophical movement concerned with elucidating the structure of lived experience, which emerged in the early 20th century and influenced philosophy of mind, cognitive science, and psychiatry. A number of early phenomenologically-oriented psychiatrists made influential contributions to the field, but this approach retreated to the background as psychiatry moved towards more operationalized disease classifications. Recently, clinical-phenomenological research and viewpoints have re-emerged in the field. We argue that the potential for phenomenological research and methods to generate productive hypotheses about the neurobiological basis of psychiatric diseases has thus far been underappreciated. Using specific examples drawing on the subjective experience of mania and psychosis, we demonstrate that phenomenologically-oriented clinical studies can generate novel and fruitful propositions for neuroscientific investigation. Additionally, we outline a proposal for more rigorously integrating phenomenological investigations of subjective experience with the methods of modern neuroscience research, advocating a cross-species approach with a key role for human subjects research. Collaborative interaction between phenomenology, psychiatry, and neuroscience has the potential to move these fields towards a unified understanding of the biological basis of mental illness.

Erfüllte Gegenwart und Rhythmus des Lebens

Der Zusammenhang von Zeit und gutem Leben wurde bereits für eine Reihe medizinischer Disziplinen und Praktiken herausgearbeitet. Doch welche Rolle spielt die Zeitlichkeit des guten Lebens für die Medizin insgesamt? Das ist die leitende Frage dieses Artikels. Dabei wird das gute Leben als sinnvolles Leben verstanden. In diesem Sinne wird für eine zweifache medizinische Relevanz der Zeitlichkeit des guten Lebens argumentiert: Erstens besteht der Sinn medizinischer Behandlungen in der Ermöglichung erfüllter Gegenwart. Zweitens kann und sollte ebendies u. a. durch die Wahrung und Wiederherstellung der chronobiologischen Rhythmen geschehen.

Issues for a phenomenology of illness - transgressing psychologizations : Author

Phenomenology of illness has grown increasingly popular in recent times. However, the most prominent phenomenologists of illness defend a psychologizing notion of phenomenology, which argues that illness is primarily constituted by embodied experiences, feelings, and emotions of suffering, alienation etc. The article argues that this gives rise to three issues that need to be addressed. (1) How is the theory of embodiment compatible with the strong distinction between disease and illness? (2) What is the difference between problematic embodiment and illness? (3) How is existential edification, that illness can give rise to according to the phenomenologists, to be understood? The article then engages in an analysis of Heidegger's and Waldenfels' phenomenology with the ambition of developing a notion of existence, which can transgress the psychologization of illness. Rather than arguing that illness is constituted by experiences of suffering and alienation, it emphasizes that broaches upon conatively guided activities constitute illness.

Understanding subjective experience in psychedelic-assisted psychotherapy: The need for phenomenology

Psychedelic-assisted psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how psychedelic-assisted psychotherapy alters subjective experience. This research programme aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates.

The temporal experience in depression: from slowing down and delayed help seeking to the emergency setting and length of treatment

The present paper discusses the 'time' dimension in depression, from the phenomenological experience to the diagnostic criteria, from delayed help seeking to the emergency room, from a (non) timely follow-up to (non) adherence to treatment. The temporal experience is fundamentally disturbed in depression and recent neurophenomenological findings help in better understanding this dimension. The duration of symptoms needed to fulfil diagnostic criteria are somewhat arbitrary. Depression dramatically decreases life expectancy mainly through increased non-suicidal mortality. The time from help seeking to getting treatment (between delayed help seeking and the emergency room) is contradictory and the length of treatment (from too short to too long) suggests that taking better account of these phenomena could improve depression treatment.

Psychological Time during the COVID-19 Lockdown: Canadian Data

The COVID-19 pandemic and associated measures have affected routines and mental well-being of people around the world. Research also shows distorted time perception during lockdowns which can partially be explained by compromised well-being. The present study investigates Canadians’ temporal experience and mental well-being at two periods of national lockdown during the COVID-19 pandemic (spring 2020: n = 66; beginning of 2021: n = 100). As results indicate, the only difference between these periods on the investigated variables was the strictness of lockdown measures. Our findings show associations between anxiety, depression, confinement indicators, and time perception (future temporal distance, passage of time judgments). Stepwise regression models indicated that depression and strictness of measures predicted the impression that the next week appeared farther away; one’s loneliness appraisal was associated with a perceived slower time flow. Our findings give a preliminary idea about time perception and mental well-being in the Canadian lockdowns.

Moral Agency, Rules, and Temporality in People Who Are Diagnosed With Mild Forms of Autism: In Defense of a Sentimentalist View

The origin of moral agency is a much-debated issue. While rationalists or Kantians have argued that moral agency is rooted in reason, sentimentalists or Humeans have ascribed its origin to empathic feelings. This debate between rationalists and sentimentalists still stands with respect to persons with mental disorders, such as individuals diagnosed with mild forms of Autism Spectrum Disorder (ASD), without intellectual impairment. Individuals with ASD are typically regarded as moral agents, however their ability for empathy remains debated. The goal of this paper is to investigate the mechanisms of moral actions in people with ASD, by finding arguments for the origin of their moral actions, supporting either the sentimentalist or the rationalist view of the dispute. We propose to revisit the debate using Interpretative Phenomenological Analysis to study the autobiographies of individuals with High-Functioning Autism (HFA) and Asperger Syndrome (AS). While conducting the systematic analysis of 10 autobiographies, we re-examined both the rationalist and the sentimentalist positions, considering the links between empathic feelings and moral agency. The investigation of the temporal dimensions of emotional experiences, an aspect overlooked by previous research, indicated that individuals with ASD empathize with others, but in different ways as compared to neurotypicals. A relationship between emotional experience and the type of moral agency exhibited by individuals with forms of ASD was established. As a consequence, our analyses support the sentimentalist stance on moral action.

AI ethics in computational psychiatry: From the neuroscience of consciousness to the ethics of consciousness

Methods used in artificial intelligence (AI) overlap with methods used in computational psychiatry (CP). Hence, considerations from AI ethics are also relevant to ethical discussions of CP. Ethical issues include, among others, fairness and data ownership and protection. Apart from this, morally relevant issues also include potential transformative effects of applications of AI-for instance, with respect to how we conceive of autonomy and privacy. Similarly, successful applications of CP may have transformative effects on how we categorise and classify mental disorders and mental health. Since many mental disorders go along with disturbed conscious experiences, it is desirable that successful applications of CP improve our understanding of disorders involving disruptions in conscious experience. Here, we discuss prospects and pitfalls of transformative effects that CP may have on our understanding of mental disorders. In particular, we examine the concern that even successful applications of CP may fail to take all aspects of disordered conscious experiences into account.

Time experience in patients with schizophrenia and affective disorders

Background

The experience of time, or the temporal order of external and internal events, is essential for humans. In psychiatric disorders such as depression and schizophrenia, impairment of time processing has been discussed for a long time.

Aims

In this explorative pilot study, therefore, the subjective time feeling as well as objective time perception were determined in patients with depression and schizophrenia, along with possible neurobiological correlates.

Methods

Depressed (n = 34; 32.4 ± 9.8 years; 21 men) and schizophrenic patients (n = 31; 35.1 ± 10.7 years; 22 men) and healthy subjects (n = 33; 32.8 ± 14.3 years; 16 men) were tested using time feeling questionnaires, time perception tasks and critical flicker-fusion frequency (CFF) and loudness dependence of auditory evoked potentials (LDAEP) to determine serotonergic neurotransmission.

Results

There were significant differences between the three groups regarding time feeling and also in time perception tasks (estimation of given time duration) and CFF (the “DOWN” condition). Regarding the LDAEP, patients with schizophrenia showed a significant negative correlation to time experience in terms of a pathologically increased serotonergic neurotransmission with disturbed time feeling.

Conclusions

Impairment of time experience seems to play an important role in depression and schizophrenia, both subjectively and objectively, and novel neurobiological correlates have been uncovered. It is suggested, therefore, that alteration of experience of time should be increasingly included in the current psychopathological findings.

Preexisting Depression and Daytime Sleepiness in Women and Men

BACKGROUND

Sleep problems can persist following the treatment of depression and remission of symptoms. The extent to which having a previous history of depression may be associated with current daytime sleepiness is largely unknown.

METHODS

Data were obtained from the spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey (92 institutions) which assessed self-reported health in U.S. college students (n = 41,670). Among the sample, 93.5% were 18-24 year of age, and 69.6% women. Logistic regression estimated the association between reported prior lifetime diagnosis of depression and daytime sleepiness from the past 7 days, while adjusting for depressive symptoms and antidepressant use from the past year. Unadjusted and adjusted logistic regression models stratified by gender were performed.

RESULTS

Among those who reported problems with sleepiness, 31.6% women and 19.4% men had a preexisting depression diagnosis. Individuals with preexisting depression were more likely than those without this diagnosis to report sleepiness problems (women: OR = 1.4, CI = 1.3-1.6, p < .001; men: OR = 1.2, CI = 1.0-1.4, p < .01). However, this association differed significantly by gender, with women with a preexisting depression diagnosis having a 13.0% greater likelihood of sleepiness compared to men.

CONCLUSIONS

Those with a preexisting depression diagnosis, and specifically women, may be at risk for daytime sleepiness even in the absence of current depressive mood-related symptoms. Given that many individuals are at risk for daytime sleepiness, mental health initiatives, including those on college campuses, should incorporate sleep hygiene within their programming.

Pathology as a phenomenological tool

The phenomenological method (or rather, methods) has been fruitfully used to study the experience of illness in recent years. However, the role of illness is not merely that of a passive object for phenomenological scrutiny. I propose that illness, and pathology more generally, can be developed into a phenomenological method in their own right. I claim that studying cases of pathology, breakdown, and illness offer illumination not only of these experiences, but also of normal function and the tacit background that underpins it. In particular, I claim that the study of embodiment can be greatly enhanced, and indeed would be incomplete, without attending to bodily breakdown and what I term bodily doubt. I offer an analogy between illness and Husserl's epoché, suggesting that both are a source of distancing, and therefore motivate a reflective stance.

Epistemic injustice in psychiatric practice: epistemic duties and the phenomenological approach

Epistemic injustice is a kind of injustice that arises when one's capacity as an epistemic subject (eg, a knower, a reasoner) is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients' first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it.

Integrating clinical staging and phenomenological psychopathology to add depth, nuance, and utility to clinical phenotyping: a heuristic challenge

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the US National Institute of Mental Health's Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, the general psychopathology factor, and a revival of interest in phenomenological psychopathology. The question naturally emerges about what the relationship between these new approaches is. Are they mutually exclusive and competing approaches, or can they be integrated in some way and be used to enrich each other? In this Personal View, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology (eg, selfhood, embodiment, and affectivity) can be overlaid on clinical stages to enrich and deepen the phenotypes captured in clinical staging (creating high-resolution clinical phenotypes). This approach might be useful both ideographically and nomothetically, to complement diagnosis, enrich clinical formulation, inform treatment of individual patients, and help to guide aetiology research, prediction of clinical trajectory and treatment. Overlaying phenomenological domains on clinical stages might require reformulating these domains in dimensional rather than categorial terms. This integrative project requires assessment tools (some of which are already available) that are sufficiently sensitive and thorough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging might be enriched by introducing greater depth to phenotypes; phenomenological psychopathology might be enriched by introducing stages of severity and disorder progression to phenomenological analysis.

Exploration of Everydayness in Schizophrenia: A Phenomenological Approach

This article explores everydayness as a specific form of experience of the world and its alterations in schizophrenia. In the field of phenomenological psychopathology, the transformations of subjective experience in schizophrenia have been the subject of a great deal of work, but the relationship between these alterations of subjective experience and the experience of the everyday remains largely unexplored. A phenomenological point of view leads us to explore everydayness as a constitutive framework of experience, one that may be impeded in schizophrenia. The question of the everyday allows us to bridge the gap between the descriptions of subjective experience proposed by phenomenological psychopathology and what is at stake in therapeutic treatment. It seems to us that the work of constructing an individual narrative of the everyday may be a useful psychotherapeutic approach for helping patients rebuild the framework of everydayness.

Synergistic effect of autonomy and relatedness satisfaction on cognitive deconstruction

We connected self-determination theory (SDT) and escape theory to deepen the understanding of the antecedents of cognitive deconstruction by introducing autonomy and relatedness satisfaction. Based on three laboratory experiments, results showed a limited determining role of autonomy satisfaction (Experiment 1); however, the causal relationship strengthened when autonomy satisfaction was in conjunction with relatedness satisfaction (Experiments 2 and 3). Relatedness satisfaction constantly predicts all symptoms of cognitive deconstruction. Importantly, all independent explanatory powers of the two require satisfactions when explaining that the symptoms of cognitive deconstruction were qualified by their interaction terms. Regardless of relatedness satisfaction, autonomy satisfaction always positively relates to time orientation. The relationship between autonomy satisfaction and meaninglessness is only negative when relatedness satisfaction is low. The relationship between autonomy satisfaction and delayed gratification is only positive when relatedness satisfaction is high.

Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

Neural correlates of temporal updating and reasoning in association with neuropsychiatric disorders

Here we argue how Hoerl & McCormack's dual system proposal may change the current view about the neural correlates underlying temporal information processing. We also consider that the concept of the dual system may help characterize various timing disabilities in neuropsychiatric disorders from the new perspective.

Temporal Preparation, Impulsivity and Short-Term Memory in Depression

Patient suffering of major depressive disorder (MDD) often complain that subjective time seems to "drag" with respect to physical time. This may point toward a generalized dysfunction of temporal processing in MDD. In the present study, we investigated temporal preparation in MDD. "Temporal preparation" refers to an increased readiness to act before an expected event; consequently, reaction time should be reduced. MDD patients and age-matched controls were required to make a saccadic eye movement between a central and an eccentric visual target after a variable duration preparatory period. We found that MDD patients produced a larger number of premature saccades, saccades initiated prior to the appearance of the expected stimulus. These saccades were not temporally controlled; instead, they seemed to reflect reduced inhibitory control causing oculomotor impulsivity. In contrast, the latency of visually guided saccades was strongly influenced by temporal preparation in controls; significantly less so, in MDD patients. This observed reduced temporal preparation in MDD was associated with a faster decay of short-term temporal memory. Moreover, in patients producing a lot of premature responses, temporal preparation to early imperative stimuli was increased. In conclusion, reduced temporal preparation and short-term temporal memory in the oculomotor domain supports the hypothesis that temporal processing was altered in MDD patients. Moreover, oculomotor impulsivity interacted with temporal preparation. These observed deficits could reflect other underlying aspects of abnormal time experience in MDD.

[Hope in tragedy. When action gives meaning to a life]

The experience of illness causes disorientation, a loss of meaning, and a loss of freedom to act. In other words, the entire field of practical possibilities diminishes, resulting in action being viewed as something impossible. In this case, the question is the following: Can the nurse contribute to maintaining hope for a life that is rich in meaning, adjusted to the limits imposed by the patient’s illness? To explore the answer to this question, we propose a humanistic model of accompaniment that enables nurses to restore hope and power to persons in vulnerable situations. In examining the best-case and the worst-case scenarios that a vulnerable person could be faced with, the accompaniment method proposed places emphasis on the exploration of practical interventions that could foster the best-case scenario and reduce the risk and the consequences of the worst-case scenario. By working on certain pragmatic aspects, we find that life becomes meaningful according to the use we can make of it, taking into account what we can actually do.

Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy

Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions.

Time dilation and acceleration in depression

BACKGROUND

A recent meta-analysis left open a significant question regarding altered time perception in depression: Why do depressed people overproduce short durations and under-produce longer durations if their present experience is that time flows slowly? Experience and judgement of time do not seem to accord with one another.

ANALYSIS

By excluding two of the six studies on methodological grounds from a previous meta-analysis of medium-length interval productions, and re-analysing the remaining four studies, the present paper finds that subjective time accelerates from initial dilation within present experience (approximately 1 s duration) to subsequent acceleration within working memory (approximately 30 s duration) when depressed.

PROPOSALS

It is proposed that depressive time dilation and acceleration refer to the default mode and central executive networks, respectively. The acceleration effect is suggested to occur due to mood congruency between long intervals, boredom, and depression. This mood congruency leads to the automatic recall of intrusive, negative, and non-specific autobiographical long-term memories used to judge intervals from previous experience. Acceleration in working memory then occurs according to the contextual change model of duration estimation.

LIMITATIONS

The meta-analysis is limited to four studies only, but provides a potential link between time experience and judgement within the same explanatory model.

CONCLUSIONS

Similarities between psychological time dilation/acceleration and physical time dilation/acceleration are discussed.

Awareness of the passage of time and self-consciousness: What do meditators report?

What do humans mean when they say that time passes quickly or slowly? In this article, we try to respond to this question on the basis of our studies on the judgment of the passage of time and its links with the judgment of physical durations. The awareness of the passage of time when consciousness is altered by meditation is also discussed. A dissociation is then made among the "self-time perspective," the "self-duration" (internal duration), and the "world-duration" (external duration). A link is also established between the self-time perspective and the "narrative self," on one hand, and the self-duration and the "minimal self," on the other hand, that is confirmed in our qualitative analysis of testimonials of four meditators. The awareness of self-duration is thus related to the awareness of the embodied self. When the sense of self is altered and the consciousness of the body is lower, then the subjective experience of internal time changes. However, the mechanisms allowing the disappearance of the self with the feeling of being outside time during meditation remains to be elucidated.

Bad Healthy State Compress Temporal Extension Both in Past and Future Orientations

We examined how different health states and cancer-related depression influence time perception in temporal extension (TE) regarding the past and the future over individuals' entire lives. We used the magnitude estimation method to investigate TE (past and future) and long duration (20 years), and directly measured patients with cancer and their subjective feelings about their lives. In Experiment 1, we investigated whether there were differences in perceptions of TE between patients with cancer (n = 144) compared to a healthy control group (n = 208). Results indicated that the patients with cancer group evaluated longer TE in healthy states (imagination condition) than in unhealthy states (objectivity condition), and the healthy control group evaluated longer TE in healthy states (objectivity condition) than in unhealthy states (imagination condition). Moreover, the patients with cancer group evaluated longer past-oriented TE than future-oriented TE, whereas the healthy control group evaluated longer future-oriented TE than past-oriented TE. Experiment 2 was conducted to further examine the unexplained findings of Experiment 1. Results indicated that because of the impact of depression on the cancer group, their embodied time system slowed down, and explicit behavior indicated an over-evaluation of time, resulting in group differences. In conclusion, TE could be affected by different health states. Moreover, healthy and unhealthy states may be more associated with future and past orientation, respectively. Lastly, individuals' time perception can be influenced by depression.

Disturbed Experience of Time in Depression-Evidence from Content Analysis

Disturbances in the experience of time have been a commonly reported feature of depressive disorders since the beginning of modern psychiatry and psychological research. However, qualitative research approaches to investigate the phenomenon are rarely used. We employed content analysis to investigate disturbances of time experience in Major Depressive Disorder. Our analysis from 25 participants showed that individuals with Major Depressive Disorder subjectively seem to have lost the ability to influence or change the present, resulting in an impersonal and blocked future. The present is rendered meaningless, the past unchangeably negative, and the passage of time turned into a dragging, inexorable, and viscous continuance. The overall,—possibly intersubjective—concept of time experience, remains largely intact, causing or adding to depressive mood and suffering. We elaborate on how these findings reflect previous theories on the experience of time in depression. This study might encourage future inquiries into both the phenomenal and neuroscientific foundation of time experience under psychopathological conditions.

Affectivity and narrativity in depression: a phenomenological study

In this study I explore from a phenomenological perspective the relationship between affectivity and narrative self-understanding in depression. Phenomenological accounts often conceive of the disorder as involving disturbances of the narrative self and suggest that these disturbances are related to the alterations of emotions and moods typical of the illness. In this paper I expand these accounts by advancing two sets of claims. In the first place, I suggest that, due to the loss of feeling characteristic of the illness, the narratives with which the patients identified prior to the onset of depression are altered in various ways, thus leading to the weakening or abandonment of the narratives themselves. I then move to show that these autobiographical narratives are replaced by new stories which possess a distinctive structure and I argue that this is dependent upon specific configurations of affective experience, such as existential feelings of guilt, hopelessness, and isolation, and particular forms of temporal and spatial experience.

Passage of Time Judgments Are Not Duration Judgments: Evidence from a Study Using Experience Sampling Methodology

This study examined relations between passage of time judgments and duration judgments (DJs) in everyday life, in young and elderly people, with an Experience Sampling Method. The DJs were assessed by verbal estimation and interval production measures. The results showed no difference between young and elderly people in judgments of rate of passage of time, a result contrary to the conventional idea that time passes more quickly as we get older. There were also no significant relation between the judgment of passage of time and the judgments of durations. In addition, the significant predictors of individual differences in the judgment of passage of time (emotion states and focus of attention on the current activity) were not predictors of judgment of durations. In sum, passages of time judgments are not related to DJs.

Where am I? Who am I? The Relation Between Spatial Cognition, Social Cognition and Individual Differences in the Built Environment

Knowing who we are, and where we are, are two fundamental aspects of our physical and mental experience. Although the domains of spatial and social cognition are often studied independently, a few recent areas of scholarship have explored the interactions of place and self. This fits in with increasing evidence for embodied theories of cognition, where mental processes are grounded in action and perception. Who we are might be integrated with where we are, and impact how we move through space. Individuals vary in personality, navigational strategies, and numerous cognitive and social competencies. Here we review the relation between social and spatial spheres of existence in the realms of philosophical considerations, neural and psychological representations, and evolutionary context, and how we might use the built environment to suit who we are, or how it creates who we are. In particular we investigate how two spatial reference frames, egocentric and allocentric, might transcend into the social realm. We then speculate on how environments may interact with spatial cognition. Finally, we suggest how a framework encompassing spatial and social cognition might be taken in consideration by architects and urban planners.

Differential Diagnosis of an Elderly Manic-Depressive Patient with Depersonalization and Other Symptoms

The case study of an elderly man having persecutory delusions and bizarre complaints at the first psychiatric interview is reported. The patient complained: “I have no sense of time” and “I have no sense of money.” He refused nursing care. He had delusions centered on himself including that of his own death, which were difficult to diagnose but suggested the possibility of Cotard's syndrome. We assumed that the man was depressed and treated him for depression. However, as a result of this treatment he became temporarily manic but finally recovered completely. After his recovery, we learnt the patient's past history of hospitalization for psychiatric problems, and based on that history he was diagnosed as suffering from a bipolar I disorder. The lack of typical symptoms of depression and the remarkable depersonalization and derealization in this patient made it difficult to infer a depressive state. Nevertheless, being attentive to his strange feelings related to the flow of time would have helped us to make an accurate diagnosis earlier.

Time perception in depression: a meta-analysis

BACKGROUND

Depressive patients frequently report to perceive time as going by very slowly. Potential effects of depression on duration judgments have been investigated mostly by means of four different time perception tasks: verbal time estimation, time production, time reproduction, and duration discrimination. Ratings of the subjective flow of time have also been obtained.

METHODS

By means of a classical random-effects meta-regression model and a robust variance estimation model, this meta-analysis aims at evaluating the inconsistent results from 16 previous studies on time perception in depression, representing data of 433 depressive patients and 485 healthy control subjects.

RESULTS

Depressive patients perceive time as going by less quickly relative to control subjects (g=0.66, p=0.033). However, the analyses showed no significant effects of depression in the four time perception tasks. There was a trend towards inferior time discrimination performance in depression (g=0.38, p=0.079). The meta-regression also showed no significant effects of interval duration. Thus, the lack of effects of depression on timing does not depend on interval duration. However, for time production, there was a tendency towards overproduction of short and underproduction of long durations in depressive patients compared to healthy controls.

LIMITATIONS

Several aspects, such as influences of medication and the dopaminergic neurotransmitter system on time perception in depression, have not been investigated in sufficient detail yet and were therefore not addressed by this meta-analysis.

CONCLUSIONS

Depression has medium effects on the subjective flow of time whereas duration judgments basically remain unaffected.

What is a "sense of foreshortened future?" A phenomenological study of trauma, trust, and time

One of the symptoms of trauma is said to be a "sense of foreshortened future." Without further qualification, it is not clear how to interpret this. In this paper, we offer a phenomenological account of what the experience consists of. To do so, we focus on the effects of torture. We describe how traumatic events, especially those that are deliberately inflicted by other people, can lead to a loss of "trust" or "confidence" in the world. This undermines the intelligibility of one's projects, cares, and commitments, in a way that amounts to a change in the structure of temporal experience. The paper concludes by briefly addressing the implications of this for how we respond to trauma, as well as offering some remarks on the relationship between trauma and psychosis.

What is a "sense of foreshortened future?" A phenomenological study of trauma, trust, and time

One of the symptoms of trauma is said to be a "sense of foreshortened future." Without further qualification, it is not clear how to interpret this. In this paper, we offer a phenomenological account of what the experience consists of. To do so, we focus on the effects of torture. We describe how traumatic events, especially those that are deliberately inflicted by other people, can lead to a loss of "trust" or "confidence" in the world. This undermines the intelligibility of one's projects, cares, and commitments, in a way that amounts to a change in the structure of temporal experience. The paper concludes by briefly addressing the implications of this for how we respond to trauma, as well as offering some remarks on the relationship between trauma and psychosis.

Metacognitive Questionnaire on Time: Feeling of the Passage of Time

The aim of our studies was to design a Metacognitive Questionnaire on Time (MQT) that assesses inter-individual variations in the awareness of factors affecting the experience of the passage of time. In the first study, 532 young adults were asked to reply to an initial questionnaire consisting of 106 questions relating to many different factors (e.g., psychostimulant, body temperature, age, attention) that could affect how time is perceived. Factorial analyses allowed us to extract two discriminant factors, one relating to attention and the other to emotion. The second study sought to validate the final 24-item questionnaire by gathering data from 212 university students. Confirmatory Factorial Analyses (AMOS) showed that the MQT has the same two-factor structure. The third study assessed the construct validity of the MQT by measuring the correlation between the MQT scores and the scores with other questionnaires measuring close or different constructs. In sum, these studies enabled us to develop an easy-to-use questionnaire whereby it is possible to distinguish between individuals according to their subjective feeling of the passage of time. In addition, the participants’ responses on the MQT showed that they were more aware of attention-related factors than of emotion-related factors that might produce time distortions, and that women were more aware of their own temporal distortions than men.

Time perception, emotions and mood disorders

In this review, we describe recent internal clock models accounting for time perception and look at how they try to explain the time distortions produced by emotion. We then discuss the results of studies of patients suffering from affective disorders (depression) who experience the feeling of time slowing down. A distinction is thus made between time perception and explicit awareness of the passage of time. We conclude that the feeling that time is passing slowly is not systematically associated with a disruption in the basic mechanisms underlying time perception.

Capacity, value neutrality and the ability to consider the future

Calls for the adoption of a universal capacity approach to replace dedicated mental health law are motivated by the idea that the measures designed to protect patient autonomy in legislation such as the Mental Capacity Act 2005 should apply to everyone, including people with a psychiatric diagnosis. In this article it is argued that a diachronic perspective on questions of mental capacity is necessary if capacity law is to play this broader role, but that employing this perspective in assessments of capacity undermines central patient autonomy preserving features of the legislation, which presents a moral dilemma.