Applied Neuropsychology

What is neuropsychology?

study of the nr and how changes to it can affect emotions, bv and cognition

Supporting people w/ and ppl inv with those with neurological diagnosis/symptoms to manage and adjust to changes relating to these difficulties

Who do neuropsychologists work with?

ppl with an acquired br injury sa trauma, stroke and a tumour

ppl with a degenerative neurological condition sa dementia or MS,

ppl with a functional neurological disorder and families

What is wrong with research with neurological research?

not good at supporting ppl from racially minoritized backgrounds - data is systematically biased and problematic

What is common following an acquired brain injry?

psychosocial and bv difficulties, ebem a decade later - inc apathy and self isolation

some of these are most common when there are communication difficulties

What are possible biological changes?

changes in mobility, physical changes in brain, hormone imbalances

What are possible social changes?

losing roles/ responsibilities

financial implications and others may not understand how it feels

What is MS?

a neurological condition with no current cure which has progressive effects on mobility, cognition and emotions

What can therapy help with?

working through loss and changes in function and with moves towards adjustment and adaptation

What approaches are becoming common?

transdiagnostic approaches sa ACT but some conditions have quite specific experiences and difficulties

When do older adults experience increasing cog deterioraion?

after age 50

What difficulties do we notice as we age?

memory, attention, slower processing, struggle with EF tasks sa problem solving and planning

What do ppl with visible signs of ageing and illness experience?

distress linked to felt shame and perceived stigma so having cog difficulties are evident to others which may cause similar problems

What do pps in informal pp engagement grps report?

embarrassment at symptoms like forgetfulness or noticing others treat them as less capable which is consonant with findings that ppl with dementia experience shame, avoid potentially embarrassing situations etc

What are current approaches to older adult mental wellbeing like?

inadequate and new models are urgently required

What is it like having a condition from the clients perspective?

You have frightening symptoms which indicate a serious neurological problem, but no one can tell you why

You’re given a diagnosis, often after years of being sent from service to service with no progress, and eventually sent to see a psychologist

By this point, people are often worrying it’s “all in their head”

What is therapy about?

building an understanding of the role of stressors, low mood, anxiety and systemic difficulties in wellbeing, and when they may contribute to “functional” difficulties

What did MacDuffie et al identify?

the need to investigate further about the stigma surrounding neurological conditions and reducing it

What is Huntingtons?

rare. life limiting neurological disease caused by a CAG expansion on the HIT gene

caused by a dominant gene inherited from an affected parent

What is HD onset like?

motor symptoms start around 30-50 years old and inc rigidity and bradykinesia which are used diagnostically but cog, bv and emotional changes which predate physical changes by at least 15 years

What are cog changes in HD?

memory, orientation, speed of processing, EF sa working memory and anosognosia, loss of insight

What do ppl with HD report?

fewer symptoms than their carers do abt them and overestimate their problems and only reports from someone who is close to the person with HD have been shown to have predictive validity abt abilities years into the future

What is the key question abt work with informants in HD?

does it make mental wellbeing assessments more accurate if you have an informant come to appts with a person with HD

for asms in apathy, having a close other present to provide extra info did push scores up compared to self rated scores alone - ppl wth HD may underestimate their apathy lvls but someone who knows them well can adjust that score up - do this bc apathy is visible and observers can see this

What was found abt affect (anxiety, low mood, suicidal thought) for those with HD?

no dfr if alone or with informant

2 possible reasons - dfrs in insight bt domains and affect less observable

What was found abt other scores for those with HD?

scores higher for manifest, pre manifest and genotype neg grps when an informant was present - fits with a relevant past finding; irritablity self-ratings diverse most before cog changes

What is HD about?

not just indvs but its also abt families and systems

What else may cause distress in HD?

changes in narratives and expectations, grief, worries for relatives, financial stressors

What is the heritable component of living with HD?

children of affected parents have a 50% risk of inheriting the disease and predictive genetic testing is available from 18yo but most do not undertake it

What did Maltby et al. (2021)’s factor analysis examine?

what mental health difficulties looked like in these 4 groups

manifest HD - after onset of motor symptoms

premanifest HD - b4 onset

genotype negative - once at risk, but have tested neg

family controls - from HD affected families but never been at genetic risk

What did the factor analysis show?

symptom severity differed less bt grps

Why is understanding mental wellbeing for ppl with HD good?

helps to improve care and open up new therapy options - currently not effective enough

provides confidence to mental health professionals not specialising in HD and highlight psych needs for HD affected families

What does neuropsychologist not do?

challenge bvs but supports with bv management and changes staff attitudes to bvs of concern

models pos engagement/strategies to help person cope differently or reduce risk and enhance life quality

What is ACT?

Third wave intervention, rooted in CBT which grows out of similar understandings about interrelations bt thoughts, feelings, physical sensations, and bv but focuses less on what is “wrong” in the indv, and more on adjusting to difficult situations, promoting valued living,

Why is ACT important for neurological conditions?

bc fixing isnt possible and acceptance of tough realities can be cruical

What is cog defusion?

ability to take a step back from thoughts, emotions and sensations to see them as stories told by our minds which can be compelling but we do not have to accept them, sometimes they are not helpful or accurate but the imp thing is we can choose

What is ACT full of?

metaphors adapted to work with client - typical ones inc ice cream in a shop and the toxic parrot - great way to engage with clients without being too technical

What is acceptance?

ability to make space for distressing thoughts, images, emotions, sensations and that you cannot be got rid of, pain is part of life

Why is being in the present model important?

a skill we support ppl to dvlp through mindfulness practice - focus the attention on specific stimuli like the breath and physical self

What does ACT say we need to see ourselves as?

a container of experiences, not the experiences themselves and can witness our emotional reactions but remain distinct from them

What do you need to find in ACT?

your values, underlying guide to life which helps you make choices that are right for you and show you the way to go - e.g. being a hard worker or taking care of ppl we love

What are values not?

goals - goals can be completed and ticked off whereas values remain - esp helpful for ppl who have experienced a major change in life

What can we do once we have supported a person to identify their values?

they can start finding ways to change their bv and explore new options

can then find new ways to live in line with those values and leader a more meaningful life