# What are you thinking about? Ongoing thought in ASD and BPD --- ### What do we mean by ongoing thought? - Integral part of the "Stream of Consciousness (James,1890)"  ---- ### What do we mean by ongoing thought? - Multidimensional - Heterogeneous (Changes across time, context, people, and has varied outcomes) - ###### See Smallwood & Schooler (2015) --- ## Thought and clinical diagnoses - Different diagnoses associated with differences in ongoing thought ---- ## Autism & Borderline Personality Disorder - borderline personality disorder (Kanske et al., 2016) - autism spectrum disorders (ASD) (Solomon, Ozonoff, Carter, & Caplan, 2008) - How are these differences in thoughts related to context? How do differences in thought relate to different disorder characteristics? --- ## Aim: Map differences in ongoing thought to changing contexts and traits in ASD and BPD ---- # Plan 1. Thoughts during a working memory task in ASD 2. Thoughts during a hallucination-focused context in BPD --- # Study 1 ---- #### Autism Spectrum Disorder is expressed in a wide range of characteristics... - sensory processing (Leekam et al., 2007), - executive function (Craig et al., 2016), - attention (Moriuchi, Klin, & Jones, 2016), - social functioning (Baron-Cohen, 2000, Garfinkel et al., 2016, Tager-Flusberg et al., 2005) ---- ##### Lower level sensory characteristics (e.g. sensory sensitivity) alongside differences in higher-order processing (e.g. "theory-of-mind") ##### Although we have a relatively clear understanding of how autistic traits relate to performance on structured neurological tasks (Kenworthy et al., 2008), we know substantially less about how these traits influence patterns of ongoing thought. --- ## Turnbull (2020) ##### Previous study assessed how autistic traits relate to differences in ongoing thought in a neurotypical sample. ##### Found differences in modality of thought related to ASD traits and performance ##### However, investigation needs extending to clinical population. --- ## Aim ##### To investigate the differences in ongoing thought patterns between nonautistic and autistic individuals ##### To investigate how differences in ongoing thoughts relate to working memory task performance ##### Investigate how differences in thought relate to differences in ASD characteristics --- # Methods --- ## Participants ##### This study recruited a total of 228 participants (N females = 112, N males = 114, N NB = 9) with a mean age of 34 (SD = 13.9). ##### 149 participants (ASD=95, Controls=54, ADIE cohort) completed the 0-back/1-back mind wandering task ---- ## Multidimensional Experience Sampling (MDES) ##### To examine the contents of participants thought we used well established technique referred to as multidimensional experience sampling ##### 13 experience sampling questions on 6 probe instances throughout the n-Back task. ----  ---- ## Principle Components Analysis ##### To identify common patterns of thought, we used a dimension reduction technique called PCA on the z-scored ESQ data  ###### _Turnbull et al (2020)_ ---- ## Behavioural Task (n-back)  ---- ## Task performance ##### Response Time / Accuracy = Inverse Efficiency Score (IES) ##### Averaged for each participant, for each condition (0-back, 1-back) --- ## Linear Mixed Modelling #### How does group membership & condition effect ongoing thought patterns? ###### Thought Pattern Scores ~ Group + Condition + Group:Condition + (1|subject) ---- #### How do (average) ongoing thought patterns, group membership & condition effect task performance? ###### IES ~ Thought Pattern Scores + Group + Condition + Group:Condition + ... (1|subject) ###### Backward fitting fixed effects to find optimal model ---- #### How do AQ subscale scores relate to differences in thought? ###### Thought Pattern Scores ~ AQ_imagination + AQ_attention_to_detail + AQ_social + AQ_attention_switching + AQ_attention_to_detail + Condition + Condition:AQ_subscales [...] --- # Results --- ## ESQ Analysis (PCA) #### 1344 experience sampling observations were collected from 156 subjects Each probe featured 13 questions. ----  --- ## Comparing thoughts between groups and condition ---  --- ## Task performance ##### After removing 18 missing values, and 25 outliers, there were 265 IES scores from 143 participants. ---- ### How do ongoing thoughts, condition and group membership relate to performance (IES)? ###### - Fit full model -> Backwards fit fixed effects -> Reduced model ---- ### How do ongoing thoughts, condition and group membership relate to performance (IES)? ##### Model found: ###### IES ~ Condition + Group ###### + Pattern 1 (Off-Task) + Pattern 3 (Modality) ###### + Group:Pattern 1(Off-task) ###### + (1|subject) --- ## Task Performance Results  ##### Task performance worse in 1-back ##### Task performance worse in ASD participants ---- ## Task Performance Results  ##### Task performance worse when thinking in images ----  ##### Interaction between off-task thought and group (performance decreased as Off-Task thought increased in control participants only) --- ## Relationship between AQ subscales and thought during task  - More imagination difficulties = Less visual thought ---- ## Relationship between AQ subscales and thought during task  - Greater attention to detail = More detailed thought --- # Discussion ---- ## Component Extraction #### Patterns of thought consistent with those extracted from a independent sample of neurotypical individuals (n=199, Turnbull et al 2020)   ---- ## Differences in thought ### Effect of condition ##### During 0-back, thoughts were 1) less task focused 2) more temporally distant 3) more in the form of images and 4) less positively engaged. ### Effect of group ##### ASD participants' thoughts were 1) less variable in their modality between conditions, and 2) less positively engaged during both conditions. ---- ### Difference in Modality  ##### Turnbull et al (2020) found autistic traits in neurotypical individuals associated with thinking more in words in a context unrelated manner ##### Our results extend findings of Turnbull et al (2020) to a sample of individuals with ASD diagnoses, demonstrate a broad similarity in results. ----  ##### Inconsistent with views that autism is linked to excessive use of imagery (Kunda & Goel, 2011) and enhanced visuo-spatial processing (Fugard et al., 2011, Grinter et al., 2009) ##### Bled et al (2021) found the frequency of use of visual mental representation, as well as ratings of their detail, was significantly higher in the ASD group ----  ##### Dance et al (2021) found aphantasia participants reported significantly more autisic traits than the controls ##### ASD reported non-significant differences in the ARSQ imagery scale (Simpraga et al, 2021). Analysis of individual items however, showed significant differences in both word-based narratives (‘I imagined talking to myself’) as well as visual thoughts (‘I pictured places’). ----  ##### Overall, may reflect inflexibility in pattern of cognition to match task-context (Van Eylen et al, 2011) --- ## Differences in Performance  ##### Task performance worse when thinking in images (especially for ASD & 1-back) ----  ##### Turnbull (2020) also found task performance improved with greater word-based thinking (especially in 1-back). ##### Alterations to the modality of thought reflects a successful strategy for maintaining information working memory. ---- ## Differences in Performance  ##### Off-task thought predicted performance in comparison group only. No relationship for ASD participants ##### Represents a decoupling between thought and performance --- ## Relationship between Autism traits and thought  ##### More detailed thought = higher attention to detail ##### Ongoing thoughts in ASD found to be more detailed in the daily-life assessment (Bled et al, 2021) ----  ##### Less visual thought = greater imagination difficulties ##### Ongoing thoughts with visual imagery at rest reduced in ASD individuals with higher scores on the Imagination AQ susbscale (Simpraga et al (2021)) ---- - #### The current study demonstrates that these relationship vary in a context dependent manner. - #### Both of these trait-state relationships were significantly stranger during the 1-back condition, suggesting that autistic traits have greater influence on thought when external task demands are increased. --- ## In summary... ##### ASD linked to inflexibility in the modality of ongoing thought ##### Ongoing thoughts in ASD relate to task performance in ways that significantly differ from controls. ##### AQ trait-thought state relationships change in context dependent manner --- ## Study 2 #### Relationship between thoughts and hallucinations in Borderline Personality Disorder --- ### Background #### “Borderline” - Patients exits in a ‘grey area’ between neurosis and psychosis (Stern, 1939; Kernberg, 1967) #### ICD-10: “Emotionally unstable personality disorder” #### DSM: “Some develop psychotic like symptoms (e.g.hallucinations, body distortions, hypnagogic phenomena) during times of stress” ---- ### Auditory Verbal Hallucinations (AVH) ##### 50-90% of BPD patients report hearing voices that other people don't hear (Kingdon et al, 2010; Yee et al, 2005) ##### ~40% of patients at Sussex Voices Clinic have BPD diagnosis ##### Hearing voices in BPD is sig risk factor for suicide plans, attempts and hospitalisation (Miller et al, 1993; Slotema et al, 2016) --- ### Ongoing thoughts ##### BPD participants have more negative thoughts ##### Compared to controls, BPD participants fluctuated more strongly in the degree to which their thoughts concerned themselves and others and also gave more extreme ratings. (Kanske et al, 2016) --- ### Aim: to understand how ongoing thought relates to phenomenological characteristics of AVH ---  --- # Methods ---- - 32 Participants took part in fMRI study - Participants indicated via button press the presence of hallucinations - At the end of the 4 runs, a thought probe was administered - Thought probe contained 15 ESQs regarding thoughts and 4 questions regarding AVH ---- ### In-scanner experience sampling: #### If answer to 'I heard my voice/s' = Yes: 1. 'How distressing did your voice/s feel?' 2. 'How loud were your voice/s?' 3. 'What proportion of the time were you hearing your voice/s?' [0% / 100%] 4.'Where did your voice/s sound like they were coming from?' [Inside Head / Outside Head] ... 5.'How anxious do you feel?' ---- ## PCA - PCA conducted separately on responses to thought questions and AVH questions. - This identified patterns of thought and patterns of AVH experience ---- ##### To identify common ‘patterns of thought’, 98 responses (from 32 subjects) to 15 experience sampling questions were decomposed using Principal Components Analysis (PCA) ##### To identify ‘patterns of AVH experience’, 53 responses from 18 subjects were decomposed in the same manner ---- ## LMMs Aim: Assess the relationship between patterns of thought and characteristics of AVH experience ###### Thought pattern n ~ AVH pattern 1 + AVH pattern 2 + (1|subject) --- ## Results ---- ## Patterns of experience ##### Ongoing Thought  ##### AVH  ----  ##### More intense hallucinations = More negative memories ----  ##### More externally located hallucinations = more spontaneous intrusive thoughts --- # Discussion ---- ##### The more negative memories the person experienced, the more frequent, loud and prevalent hallucinations were.  ##### Voices found to often be triggered by past memories of trauma and these voices more distressing, negative, controlling and critical than what is typically reported in psychotic disorders (Yee et al.,2005). ##### Voices often identified as the that of a past abuser, and themes associated with posttraumatic experiences (Papadimitriou, 2007). ----  ##### Fits with the aberrant memory model of AVH which identifies a (causal?) link between memories and intense hallucinations (Broome, 2016). ---- #### The more thoughts were rated as spontaneous, abstract, distracting and unwanted, the more 'outside the head' hallucinations were rated as.  ----  ##### This relationship may be reflective of an alienated self experience (Yee, 2005) which is often present in BPD, where by thoughts, feelings and actions are viewed as inconsistent with persons true desires. ##### Spontaneous, unwanted, abstract thought: a pattern of thought that could be characterised as being alienated & dissociated from our ideal goals, desires and self image. ##### Externally located hallucinations: voices which are more likely to be perceived as 'alien' ----  ##### Suggests that thoughts and hallucinations, while phenomenologically distinct, may exist in similar locations in multidimensional space. ---- #### Overall, these results demonstrate the coupling between thoughts and hallucinations. Rather than being some aberrant and random psychological phenomena, hallucinations are influenced by thought in a tangible manner: ---- ##### 1. Recollection of negative past experiences may trigger hallucinations which we know are often past-trauma focussed ##### 2. Spontaneous, abstract unwanted thoughts - could be characterised as more 'alien' than deliberate wanted thoughts - associated with hallucinations that are similarly alien, perceived as coming from outside the head. ---- #### Are hallucinations an extension of our thoughts (Broome et al, 2016)? ---- ##### Previous work which suggests a continuum exists, ranging from hallucinations (a perceptual disorder) to non-psychotic hallucinations (in its most extreme form a thought disorder) and dissociative memory (re-experiences) to normal processes of memory, thought and fantasy. (Van der Zwaard, 2001) ##### AVH exist on a continuum of normal experience (Broome et al, 2016), and are thus effected by other normal experiences like thoughts. ---- ### In summary, we find novel relationships between different phenomenological aspects of hallucinations and ongoing thought, demonstrating a potential shared mechanism behind the two phenomena. --- ## What have we learnt? ---- #### Across BPD and ASD, there are significant relationships between psychological features of the disorder and ongoing thought. ---- ## Why is this important?  #### Studying ongoing thoughts in clinical contexts represents an opportunity to better understand how conscious experience is influenced by a disorder. ----  #### Such clinical conditions have an significant impact on a persons conscious experience. By investigating ongoing thoughts, we can better understand this impact. ---- ## Next steps... ---- ## Thank you for listening #### Any questions? --- ##### Jaspers (1962) said internal voices bear more similarity to thoughts and ideas, which are part of normal mentation than external voices (van der Zwaard and Polak (2001))... but what is 'normal mentation'? Is spontaneous thought not normal? ##### Also consistent with finding that individuals with ASD use verbal strategies to mediate verbal short-term memory (Williams et al, 2012)