Associate Professor Michelle Kelly

Objective: This systematic review and meta-analysis aimed to investigate the effect of mindfulness-based intervention (MBI) on cognitively unimpaired older adults¿ cognitive function and sleep quality. Method: Studies published in English since 2010 were considered for inclusion. Databases searched were PubMed, Embase, Web of Science, and PsycInfo. We included randomized controlled trials (RCTs) with adults over 55 with no known cognitive impairment, that recorded cognitive outcomes and/or sleep quality pre- and post-intervention, and that implemented Mindfulness-Based Stress Reduction (MBSR), or an MBI closely based on MBSR protocol. Results: Seven RCTs fit the inclusion criteria, with 276 participants in MBI groups and 287 in controls. Four studies investigated mindfulness and cognitive function, two investigated mindfulness and sleep quality, and one investigated mindfulness, cognitive function, and sleep quality. Some studies were not reported in sufficient detail to be included in meta-analyses. Results of meta-analyses showed no significant differences between MBI groups vs controls on cognitive measures of executive function, free recall, and delayed recall. Meta-analysis revealed that MBI significantly improved sleep quality compared to controls. Conclusion: Given that poor sleep quality is strongly linked to increased risk of cognitive decline, further research investigating sleep quality¿s role in the mindfulness-cognitive function relationship in cognitively unimpaired older adults is recommended.

Objective: Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning. Method: In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests. Results: In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments. Conclusion: We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.

Background: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). Method: A mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia. Results: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers¿ qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring. Conclusion: START-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services.

In acquired brain injury (ABI), social cognition is a contributing factor to the changes observed in functional outcomes. However, progress in assessing and understanding social cognitive impairments is limited by a lack of consistency in terminology and the proliferation in assessment tools, leading to a lack of consensus on what should be assessed and how. This review aims to examine the domains of social cognition commonly assessed in ABI, the assessment tools used, and the appropriateness of these tools for researchers and clinicians. Using the Arksey and O¿Malley scoping review methodology, 367 articles reporting results from 10,930 people with an ABI met our inclusion criteria. The five most commonly assessed domains of social cognition were emotion perception, theory of mind, social communication, identity recognition and empathy. The most commonly used measure of these domains included: the Ekman and Friesen photo series, Faux Pas Recognition Test, La Trobe Communication Questionnaire, Benton Facial Recognition Test and the Interpersonal Reactivity Index. There are well-validated measures readily available that are underused in favour of non-standardized measures clinically or the development of one¿s own measure in research. The appropriateness of the identified measure for research and clinical use was discussed, including suggestions for future research.

Objective: Empathy is the ability to understand and respond to another person¿s experience and is an important skill for maintaining good relationships across the lifespan. Past research has predominately relied on self-report measures of trait empathy in examining the impact of ageing on empathy, potentially contributing to the very mixed findings in this area. We aimed to examine the effects of age on state empathic ability. Method: Two-hundred and thirty-one adults aged 17¿94 years were administered behavioral measures of cognitive and affective empathy alongside traditional trait measures. We also examined the potential impact of advancing age on inhibition of self-relevant information and the relationship between this and the cognitive, affective and motivational components of empathic ability. Results: Age was not a predictor of either trait cognitive or affective empathy measured using self-report. Further, older adults did not perform worse than younger adults on a state behavioral measure of affective empathy. Older adults did perform less accurately on some behavioral cognitive empathy tasks and also on self-relevant inhibition. Self-relevant inhibition errors and response times were negatively associated with performance on cognitive empathy tasks, though not associated with self-report or behaviorally measured affective empathy scores. Further, mediation analyses suggested the indirect effect from age-inhibitioncognitive empathy was small but significant, implicating inhibition in cognitive empathy ability in older adulthood. Conclusions: The relationship between advancing age and empathic skills is complex, with age possibly conferring both advantages and disadvantages. Inhibition should be examined alongside other general cognitive skills in future studies investigating empathy using behavioural measures.

Background and objectives: Changes in socio-emotional functioning in people living with dementia (PLWD) are common; however, little is known about the broader effects these may have on wellbeing. This study examined socio-emotional functioning over time and associations with the wellbeing of PLWD and their family carers. Method: One hundred and one individuals with a diagnosis of dementia and their respective carers completed the Social Emotional Questionnaire (assessing emotion recognition, empathy, social relationships and social behaviour) alongside measures of dementia severity, cognition, mood, stress, and relationship quality. Sixty-six dyads were reassessed on the same measures at 12 months post-baseline, and 51 dyads again at 20 months post-baseline. Results: When rated by the PLWD, there was no change in socio-emotional functioning over time; however, carers reported a significant decline over time. For both carers and the PLWD, poorer wellbeing measures were indicative of worse socio-emotional functioning at Time 1, though only dementia type, quality of life and relationship quality impacted upon the trajectory of socio-emotional decline over time. Conclusions: Changes in social and emotional functioning are evident early in the course of dementia and worsen within 20 months. Both carer characteristics and those of the PWLD affected reporting of social and emotional functioning. These data are useful for guiding the provision of appropriate education and care.

While research in social and affective neuroscience has a long history, it is only in the last few decades that it has been truly established as an independent field of investigation. In the Australian region, despite having an even shorter history, this field of research is experiencing a dramatic rise. In this review, we present recent findings from a survey conducted on behalf of the Australasian Society for Social and Affective Neuroscience (AS4SAN) and from an analysis of the field to highlight contributions and strengths from our region (with a focus on Australia). Our results demonstrate that researchers in this field draw on a broad range of techniques, with the most common being behavioural experiments and neuropsychological assessment, as well as structural and functional magnetic resonance imaging. The Australian region has a particular strength in clinically driven research, evidenced by the types of populations under investigation, top cited papers from the region, and funding sources. We propose that the Australian region has potential to contribute to cross-cultural research and facilitating data sharing, and that improved links with international leaders will continue to strengthen this burgeoning field.

It is well established that people with a diagnosis of dementia can experience impaired social cognition. This study aimed to develop a new screening test for assessing social cognition impairments in dementia and to examine its convergent and construct validity in normal healthy adults and people with dementia. Materials from established tests with proven sensitivity to social cognition impairments were adapted to create a short screening test that uses pictures and simple text. The Brief Assessment of Social Skills-Dementia (BASS-D) is administrable bedside and examines emotion recognition, face identification, empathy, theory of mind, social disinhibition, social reasoning and memory for faces. The BASS-D was administered to 28 healthy older adults (M age = 76.71, SD = 6.15) and 26 participants with a diagnosis of dementia (M age = 81.38, SD = 9.39). Participants also completed a number of measures of social cognition and the Addenbrooke¿s Cognitive Examination III. Each of the BASS-D domains demonstrated adequate convergent validity (r =.32-.81), with the exception of Face Memory. Significant differences in total BASS-D total scores were observed between the healthy adults and participants with a diagnosis of dementia. BASS-D correlated with some measures of dementia but not others. In conclusion, the BASS-D holds promise as a short screen for assessing social skills in dementia that will assist families and carers in managing social cognition impairments. Further development of normative data in a larger set of healthy older adults along with evidence for test¿retest reliability will advance this tool toward clinical utility.

Social cognition is widely regarded as an essential skill with which to understand the social world. Despite this, the role that social cognition plays in outcome, and whether deficits are remediable after traumatic brain injury (TBI), are not yet well known. The current review examines the construct of social cognition and presents a conceptual biopsychosocial model with which to understand the social cognitive process. This is related to the literature on social cognitive deficits in TBI and we discuss relevant treatment developments to date within this population. We then review social cognition treatment programmes researched in other clinical populations in order to advise and inform approaches for those living with TBI. Whilst treatments have focused on emotion perception skills in the TBI literature, programmes developed for other clinical populations have had broader targets, focusing on Theory of Mind skills and/or modifying interpretational cognitive biases. Moreover, they have largely proven to be efficacious. Programmes that are contextualised, collaborative, and experiential seem optimal in enabling generalisation relevant to individuals¿ everyday social lives. We argue that there is therefore scope to improve the evidence-based social cognitive treatment options available for those with TBI, taking into account specific adaptations necessary for this population.

Whilst some form of ostracism is experienced by most people at some point in their lives, it is experienced far more often in individuals with Autism Spectrum Disorder (ASD). Little is known about how this social exclusion is interpreted, experienced or managed. This study aimed to explore the psychological (mood and social needs) as well as the physiological (arousal) effects of ostracism using a well-established paradigm, Cyberball. Results demonstrated no differences between groups on social needs, however, mood was rated as more negatively by ASDs overall. Arousal was increased in when excluded compared with when excluded for ASDs, but not for controls. Overall, individuals with ASD experienced heightened physiological arousal but whilst these individuals reported overall lower mood, this response to ostracism was not expressed as emotionally significant to these individuals, suggesting possible interoceptive difficulties in this population. This highlights the need for both understanding in non-ASD individuals and intervention of this emotional distress in individuals with ASD.

Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury. Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia. Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation. Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation.

Primary objective: This study aimed to examine the psychological and physiological effects of ostracism in adults with traumatic brain injury (TBI). Research design: A within-subject, counterbalanced design was used. The two conditions, inclusion and ostracism, were examined across two groups (between subjects). Methods and procedures: A group of 21 adults with TBI and 17 matched controls participated in the Cyberball paradigm. This task is a computerised task that exposes participants to a game of catch and throw. In the inclusion condition they are included fairly in the game, while in the ostracism condition they are excluded from the game following the first few throws. Skin conductance levels (SCLs) were measured throughout the game as a proxy for social stress. Main outcomes: Results showed that people with TBI were cognitively aware of when they are being ostracised, but that their self-reported emotional experience to social exclusion was different to that of the control group. Differences in SCLs between groups and between conditions did not reach significance nor did they correlate with behavioural responses. Conclusions: These findings are discussed in terms of the consequences of dissociation between psychological and physiological responses and the implications for motivating behaviours associated with re-inclusion.