Exploring ongoing thoughts in clinical contexts: a multidimensional approach

Whether the mind is wandering or whether it is focussed, our ongoing thoughts are an ever-present feature of the “stream of consciousness”. Thoughts are multidimensional (varying in content and modality across multiple axes) and heterogenous (changing across situations, time and people). Understanding individual differences in ongoing thought, particularly their role in clinical contexts, remains an important research question given the intimate relationship between thoughts and wellbeing. Therefore, in the current thesis, I will outline the application of multidimensional experience sampling in behavioural and neuroimaging environments to explore the role of ongoing thought in clinical contexts.

The first study compares thought patterns in autistic individuals to non-autistic individuals. Using experience sampling during a working memory task, I clinically replicated previous findings in the literature showing differences in the modality of thought. Other novel findings that relate abnormal decoupling of working-memory performance and off-task thought in autism are discussed, as are findings that reveal the comorbidity between autism and anxiety.

The second and third study focuses on hallucinations in borderline personality disorder and their relationship to ongoing thoughts. Using a multimodal approach, I find phenomenological (experience sampling), perceptual (signal detection) and neural (fMRI) correlates of hallucinations. To my knowledge, I am the first to describe this clinically important phenomena in these patients along these dimensions, and how features of hallucinations relate to ongoing thoughts. I show that phenomenological and neural features of hallucinations relate to patterns of thought, highlighting the integrated nature of hallucinations with other features of conscious experience.

In my thesis, I demonstrate how we can capture the multidimensionality and heterogeneity of ongoing thought in clinical contexts. As well as paving the way to an improved mechanistic account of behaviour, I show how this research can aid our understanding how thoughts contribute to wellbeing, informing future treatment interventions.