Publications by authors named "Julia Gillard"

6 Publications

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The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds.

J Child Psychol Psychiatry 2021 Jun 14. Epub 2021 Jun 14.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC.

Method: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC.

Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures.

Conclusions: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.
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http://dx.doi.org/10.1111/jcpp.13460DOI Listing
June 2021

Investigating Emotion in Malay, Australian and Iranian Individuals with and without Depression.

Sci Rep 2019 12 4;9(1):18344. Epub 2019 Dec 4.

Universiti Putra Malaysia, Selangor, Malaysia.

This study investigated the influence of culture and depression on (1) emotion priming reactions, (2) the recall of subjective experience of emotion, and (3) emotion meaning. Members of individualistic culture (Australia, n = 42) and collectivistic culture (Iran, n = 32, Malaysia, n = 74) with and without depression completed a biological motion task, subjective experience questionnaire and emotion meaning questionnaire. Those with depression, regardless of cultural group, provided significantly fewer correct responses on the biological motion task than the control group. Second, the collectivistic control groups reported greater social engaging emotion than the Australian control group. However, the three depressed groups did not differ culturally. The Australian depressed group reported significantly greater interpersonally engaging emotion than the Australian control group. Third, the collectivistic groups reported significantly greater social worth, belief changes and sharing of emotion than the individualistic group. Depression did not influence these cultural effects. Instead we found that those with depression, when compared to controls, considered emotions as subjective phenomena, that were qualifying for relationships with others, and associated with greater agency appraisals. The applicability of the biocultural framework of emotion in depression was considered.
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http://dx.doi.org/10.1038/s41598-019-54775-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892853PMC
December 2019

A randomised controlled trial of memory flexibility training (MemFlex) to enhance memory flexibility and reduce depressive symptomatology in individuals with major depressive disorder.

Behav Res Ther 2018 11 29;110:22-30. Epub 2018 Aug 29.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom.

Successful navigation within the autobiographical memory store is integral to daily cognition. Impairment in the flexibility of memory retrieval can thereby have a detrimental impact on mental health. This randomised controlled phase II exploratory trial (N = 60) evaluated the potential of a novel intervention drawn from basic science - an autobiographical Memory Flexibility (MemFlex) training programme - which sought to ameliorate memory difficulties and improve symptoms of Major Depressive Disorder. MemFlex was compared to Psychoeducation (an evidence-based low-intensity intervention) to determine the likely range of effects on a primary cognitive target of memory flexibility at post-intervention, and co-primary clinical targets of self-reported depressive symptoms and diagnostic status at three-month follow-up. These effect sizes could subsequently be used to estimate sample size for a fully-powered trial. Results demonstrated small-moderate, though as expected statistically non-significant, effect sizes in favour of MemFlex for memory flexibility (d = 0.34, p = .20), and loss of diagnosis (OR = 0.65, p = .48), along with the secondary outcome of depression-free days (d = 0.36, p = .18). A smaller effect size was observed for between-group difference in self-reported depressive symptoms (d = 0.24, p = .35). Effect sizes in favour of MemFlex in this early-stage trial suggest that fully-powered evaluation of MemFlex may be warranted as an avenue to improving low-intensity treatment of depression.

Trial Registration: ClinicalTrials.gov, Identifier NCT02371291.
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http://dx.doi.org/10.1016/j.brat.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173798PMC
November 2018

A cluster randomized controlled platform trial comparing group MEmory specificity training (MEST) to group psychoeducation and supportive counselling (PSC) in the treatment of recurrent depression.

Behav Res Ther 2018 06 15;105:1-9. Epub 2018 Mar 15.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK. Electronic address:

Impaired ability to recall specific autobiographical memories is characteristic of depression, which when reversed, may have therapeutic benefits. This cluster-randomized controlled pilot trial investigated efficacy and aspects of acceptability, and feasibility of MEmory Specificity Training (MEST) relative to Psychoeducation and Supportive Counselling (PSC) for Major Depressive Disorder (N = 62). A key aim of this study was to determine a range of effect size estimates to inform a later phase trial. Assessments were completed at baseline, post-treatment and 3-month follow-up. The cognitive process outcome was memory specificity. The primary clinical outcome was symptoms on the Beck Depression Inventory-II at 3-month follow-up. The MEST group demonstrated greater improvement in memory specificity relative to PSC at post-intervention (d = 0.88) and follow-up (d = 0.74), relative to PSC. Both groups experienced a reduction in depressive symptoms at 3-month follow-up (d = 0.67). However, there was no support for a greater improvement in depressive symptoms at 3 months following MEST relative to PSC (d = -0.04). Although MEST generated changes on memory specificity and improved depressive symptoms, results provide no indication that MEST is superior to PSC in the resolution of self-reported depressive symptoms. Implications for later-phase definitive trials of MEST are discussed.
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http://dx.doi.org/10.1016/j.brat.2018.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937852PMC
June 2018

Study protocol for a randomised, controlled platform trial estimating the effect of autobiographical Memory Flexibility training (MemFlex) on relapse of recurrent major depressive disorder.

BMJ Open 2018 01 29;8(1):e018194. Epub 2018 Jan 29.

Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.

Introduction: Major depressive disorder (MDD) is a chronic condition. Although current treatment approaches are effective in reducing acute depressive symptoms, rates of relapse are high. Chronic and inflexible retrieval of autobiographical memories, and in particular a bias towards negative and overgeneral memories, is a reliable predictor of relapse. This randomised controlled single-blind trial will determine whether a therapist-guided self-help intervention to ameliorate autobiographical memory biases using Memory Flexibility training (MemFlex) will increase the experience of depression-free days, relative to a psychoeducation control condition, in the 12 months following intervention.

Methods And Analysis: Individuals (aged 18 and above) with a diagnosis of recurrent MDD will be recruited when remitted from a major depressive episode. Participants will be randomly allocated to complete 4 weeks of a workbook providing either MemFlex training, or psychoeducation on factors that increase risk of relapse. Assessment of diagnostic status, self-report depressive symptoms, depression-free days and cognitive risk factors for depression will be completed post-intervention, and at 6 and 12 months follow-up. The cognitive target of MemFlex will be change in memory flexibility on the Autobiographical Memory Test- Alternating Instructions. The primary clinical endpoints will be the number of depression-free days in the 12 months following workbook completion, and time to depressive relapse.

Ethics And Dissemination: Ethics approval has been granted by the NHS National Research Ethics Committee (East of England, 11/H0305/1). Results from this study will provide a point-estimate of the effect of MemFlex on depressive relapse, which will be used to inform a fully powered trial evaluating the potential of MemFlex as an effective, low-cost and low-intensity option for reducing relapse of MDD.

Trial Registration Number: NCT02614326.
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http://dx.doi.org/10.1136/bmjopen-2017-018194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829844PMC
January 2018

Experience in judging intent to harm modulates parahippocampal activity: an fMRI study with experienced CCTV operators.

Cortex 2014 Aug 31;57:74-91. Epub 2014 Mar 31.

School of Psychology, University of Glasgow, Glasgow, United Kingdom.

Does visual experience in judging intent to harm change our brain responses? And if it does, what are the mechanisms affected? We addressed these questions by studying the abilities of Closed Circuit Television (CCTV) operators, who must identify the presence of hostile intentions using only visual cues in complex scenes. We used functional magnetic resonance imaging to assess which brain processes are modulated by CCTV experience. To this end we scanned 15 CCTV operators and 15 age and gender matched novices while they watched CCTV videos of 16 sec, and asked them to report whether each clip would end in violence or not. We carried out four separate whole-brain analyses including 3 model-based analyses and one analysis of intersubject correlation to examine differences between the two groups. The three model analyses were based on 1) experimentally pre-defined clip activity labels of fight, confrontation, playful, and neutral behaviour, 2) participants' reports of violent outcomes during the scan, and 3) visual saliency within each clip, as pre-assessed using eye-tracking. The analyses identified greater activation in the right superior frontal gyrus for operators than novices when viewing playful behaviour, and reduced activity for operators in comparison with novices in the occipital and temporal regions, irrespective of the type of clips viewed. However, in the parahippocampal gyrus, all three model-based analyses consistently showed reduced activity for experienced CCTV operators. Activity in the anterior part of the parahippocampal gyrus (uncus) was found to increase with years of CCTV experience. The intersubject correlation analysis revealed a further effect of experience, with CCTV operators showing correlated activity in fewer brain regions (superior and middle temporal gyrus, inferior parietal lobule and the ventral striatum) than novices. Our results indicate that long visual experience in action observation, aimed to predict harmful behaviour, modulates brain mechanisms of intent recognition.
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http://dx.doi.org/10.1016/j.cortex.2014.02.026DOI Listing
August 2014