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Skodzik T, Leopold A, Ehring T. Effects of a training in mental imagery on worry: A proof-of-principle study. J Anxiety Disord 2017; 45:24-33. [PMID: 27915122 DOI: 10.1016/j.janxdis.2016.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/12/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Worry is characterized by a predominance of verbal thinking and relatively little mental imagery. This cognitive bias of verbal and abstract processing has been found to impair emotional processing of worry topics so that worrisome thoughts are maintained. On the other hand, engaging in mental imagery during the worry process fosters emotional processing of worry themes. In the present study, we examined whether training high worriers (n=71) to use more mental imagery in their everyday lives is an effective intervention to reduce pathological worry. Results indicated that our novel training in mental imagery (TMI) led to a significant reduction of worry and impairment, assessed both one and five weeks after the training. Furthermore, in highly anxious participants TMI had beneficial effects on controllability of worry, state anxiety, and positive mood. Theoretical and clinical implications of our findings and methodological limitations of this proof-of-principle study are discussed.
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Affiliation(s)
- Timo Skodzik
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany.
| | - Alexandra Leopold
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany
| | - Thomas Ehring
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany; LMU Munich, Department of Psychology, Leopoldstr. 13, 80802 Munich, Germany
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Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis. Clin Psychol Rev 2016; 52:92-107. [PMID: 28086133 DOI: 10.1016/j.cpr.2016.12.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/28/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
We review evidence for training programmes that manipulate autobiographical processing in order to treat mood, anxiety, and stress-related disorders, using the GRADE criteria to judge evidence quality. We also position the current status of this research within the UK Medical Research Council's (2000, 2008) framework for the development of novel interventions. A literature search according to PRISMA guidelines identified 15 studies that compared an autobiographical episodic memory-based training (AET) programme to a control condition, in samples with a clinician-derived diagnosis. Identified AET programmes included Memory Specificity Training (Raes, Williams, & Hermans, 2009), concreteness training (Watkins, Baeyens, & Read, 2009), Competitive Memory Training (Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009), imagery-based training of future autobiographical episodes (Blackwell & Holmes, 2010), and life review/reminiscence therapy (Arean et al., 1993). Cohen's d was calculated for between-group differences in symptom change from pre- to post-intervention and to follow-up. We also completed meta-analyses for programmes evaluated across multiple studies, and for the overall effect of AET as a treatment approach. Results demonstrated promising evidence for AET in the treatment of depression (d=0.32), however effect sizes varied substantially (from -0.18 to 1.91) across the different training protocols. Currently, research on AET for the treatment of anxiety and stress-related disorders is not yet at a stage to draw firm conclusions regarding efficacy as there were only a very small number of studies which met inclusion criteria. AET offers a potential avenue through which low-intensity treatment for affective disturbance might be offered.
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Watkins E, Newbold A, Tester-Jones M, Javaid M, Cadman J, Collins LM, Graham J, Mostazir M. Implementing multifactorial psychotherapy research in online virtual environments (IMPROVE-2): study protocol for a phase III trial of the MOST randomized component selection method for internet cognitive-behavioural therapy for depression. BMC Psychiatry 2016; 16:345. [PMID: 27716200 PMCID: PMC5054552 DOI: 10.1186/s12888-016-1054-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap is limited understanding of how complex psychological interventions for depression work. Recent reviews have argued that the active ingredients of therapy need to be identified so that therapy can be made briefer, more potent, and to improve scalability. This in turn requires the use of rigorous study designs that test the presence or absence of individual therapeutic elements, rather than standard comparative randomised controlled trials. One such approach is the Multiphase Optimization Strategy, which uses efficient experimentation such as factorial designs to identify active factors in complex interventions. This approach has been successfully applied to behavioural health but not yet to mental health interventions. METHODS/DESIGN A Phase III randomised, single-blind balanced fractional factorial trial, based in England and conducted on the internet, randomized at the level of the patient, will investigate the active ingredients of internet cognitive-behavioural therapy (CBT) for depression. Adults with depression (operationalized as PHQ-9 score ≥ 10), recruited directly from the internet and from an UK National Health Service Improving Access to Psychological Therapies service, will be randomized across seven experimental factors, each reflecting the presence versus absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, self-compassion training) using a 32-condition balanced fractional factorial design (2IV7-2). The primary outcome is symptoms of depression (PHQ-9) at 12 weeks. Secondary outcomes include symptoms of anxiety and process measures related to hypothesized mechanisms. DISCUSSION Better understanding of the active ingredients of efficacious therapies, such as CBT, is necessary in order to improve and further disseminate these interventions. This study is the first application of a component selection experiment to psychological interventions in depression and will enable us to determine the main effect of each treatment component and its relative efficacy, and cast light on underlying mechanisms, so that we can systematically enhance internet CBT. TRIAL REGISTRATION Current Controlled Trials ISRCTN24117387 . Registered 26 August 2014.
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Affiliation(s)
- Edward Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG, UK.
| | - Alexandra Newbold
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG UK
| | - Michelle Tester-Jones
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG UK
| | - Mahmood Javaid
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG UK
| | - Jennifer Cadman
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG UK
| | - Linda M. Collins
- The Methodology Center and Department of Human Development and Family Studies, The Pennsylvania State University, Health and Human Development Building, University Park, PA 16802 USA
| | - John Graham
- The Methodology Center and Department of Human Development and Family Studies, The Pennsylvania State University, Health and Human Development Building, University Park, PA 16802 USA
| | - Mohammod Mostazir
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG UK
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Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: A meta-analysis. J Affect Disord 2016; 202:67-86. [PMID: 27253219 DOI: 10.1016/j.jad.2016.03.063] [Citation(s) in RCA: 432] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND This meta-analysis of randomized controlled trials (RCTs) examines the efficacy of physical exercise as treatment for unipolar depression, both as an independent intervention and as an adjunct intervention to antidepressant medication. METHODS We searched PsycINFO, EMBASE, MEDLINE, CENTRAL, and Sports Discus for articles published until November 2014. Effect sizes were computed with random effects models. The main outcome was reduction in depressive symptoms or remission. RESULTS A total of 23 RCTs and 977 participants were included. Physical exercise had a moderate to large significant effect on depression compared to control conditions (g=-0.68), but the effect was small and not significant at follow-up (g=-0.22). Exercise compared to no intervention yielded a large and significant effect size (g=-1.24), and exercise had a moderate and significant effect compared to usual care (g=-0.48). The effects of exercise when compared to psychological treatments or antidepressant medication were small and not significant (g=-0.22 and g=-0.08, respectively). Exercise as an adjunct to antidepressant medication yielded a moderate effect (g=-0.50) that trended toward significance. LIMITATIONS Use of the arms with the largest clinical effect instead of largest dose may have overestimated the effect of exercise. CONCLUSIONS Physical exercise is an effective intervention for depression. It also could be a viable adjunct treatment in combination with antidepressants.
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Affiliation(s)
- Siri Kvam
- Sogndal Child and Adolescent Psychiatric Outpatient Clinic, Division of Medicine, District General Hospital of Førde, postboks 1000, 6807 Førde, Norway.
| | | | | | - Anders Hovland
- Department of Clinical Psychology, University of Bergen, Norway; Solli District Psychiatric Centre (DPS), Norway
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Marchetti I, Koster EH, Klinger E, Alloy LB. Spontaneous Thought and Vulnerability to Mood Disorders: The Dark Side of the Wandering Mind. Clin Psychol Sci 2016; 4:835-857. [PMID: 28785510 PMCID: PMC5544025 DOI: 10.1177/2167702615622383] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is increasing interest in spontaneous thought, namely task-unrelated or rest-related mental activity. Spontaneous thought is an umbrella term for processes like mindwandering, involuntary autobiographical memory, and daydreaming, with evidence elucidating adaptive and maladaptive consequences. In this theoretical framework, we propose that, apart from its positive functions, spontaneous thought is a precursor for cognitive vulnerability in individuals who are at-risk for mood disorders. Importantly, spontaneous thought mostly focuses on unattained goals and evaluates the discrepancy between current and desired status (Klinger, 1971, 2013a). In individuals who stably (i.e., trait negative affectivity) or transitorily (i.e., stress) experience negative emotions in reaction to goal-discrepancy, spontaneous thought fosters major cognitive vulnerabilities (e.g., rumination, hopelessness, low self-esteem, and cognitive reactivity) which, in turn, enhance depression. Furthermore, we also highlight preliminary links between spontaneous thought and bipolar disorder. The evidence for this framework is reviewed and we discuss theoretical and clinical implications of our proposal.
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Affiliation(s)
- Igor Marchetti
- Ghent University, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, Ghent, B-9000, Belgium
| | - Ernst H.W. Koster
- Ghent University, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, Ghent, B-9000, Belgium
| | - Eric Klinger
- University of Minnesota, Morris, Psychology Discipline, Division of Social Sciences, Morris, MN 56267, USA
| | - Lauren B. Alloy
- Temple University, Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA 19122, USA
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Hitchcock C, Mueller V, Hammond E, Rees C, Werner-Seidler A, Dalgleish T. The effects of autobiographical memory flexibility (MemFlex) training: An uncontrolled trial in individuals in remission from depression. J Behav Ther Exp Psychiatry 2016; 52:92-98. [PMID: 27058165 DOI: 10.1016/j.jbtep.2016.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/11/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Impaired cognitive processing is a key feature of depression. Biases in autobiographical memory retrieval (in favour of negative and over-general memories) directly impact depression symptoms, but also influence downstream cognitive factors implicated in the onset and maintenance of the disorder. We introduce a novel cognitive intervention, MemFlex, which aims to correct these biases in memory retrieval and thereby modify key downstream cognitive risk and maintenance factors: rumination, impaired problem solving, and cognitive avoidance. METHOD Thirty eight adults with remitted Major Depressive Disorder completed MemFlex in an uncontrolled clinical trial. This involved an orientation session, followed by self-guided completion of six workbook-based sessions over one-month. Assessments of cognitive performance and depression symptoms were completed at pre- and post-intervention. RESULTS Results demonstrated medium-sized effects of MemFlex in improving memory specificity and problem solving, and decreasing rumination, and a small effect in reducing cognitive avoidance. No significant change was observed in residual symptoms of depression. LIMITATIONS This study was an uncontrolled trial, and has provided initial evidence to support a larger-scale, randomized controlled trial. CONCLUSIONS These findings provide promising evidence for MemFlex as a cost-effective, low-intensity option for reducing cognitive risk associated with depression.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
| | - Viola Mueller
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Emily Hammond
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Catrin Rees
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom; The Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
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Grynberg D, de Timary P, Philippot P, D'Hondt F, Briane Y, Devynck F, Douilliez C, Billieux J, Heeren A, Maurage P. Abstract and concrete repetitive thinking modes in alcohol-dependence. J Addict Dis 2016; 35:238-243. [DOI: 10.1080/10550887.2016.1207970] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bastin M, Mezulis AH, Ahles J, Raes F, Bijttebier P. Moderating effects of brooding and co-rumination on the relationship between stress and depressive symptoms in early adolescence: a multi-wave study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:607-18. [PMID: 25034958 DOI: 10.1007/s10802-014-9912-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The current study investigated brooding and co-rumination as moderators of the relationship between interpersonal and noninterpersonal stress and depressive symptom trajectories. The sample consisted of 368 early adolescents ages 9 to 15 (M = 11.72, 63 % female) who completed self-report measures of brooding, co-rumination, stress, and depressive symptoms at baseline with follow-up assessments of stress and depressive symptoms at 3, 8, and 12 months post-baseline. Data were analyzed using multi-level modeling. Results showed that the association between interpersonal stress and depressive symptoms was stronger for adolescents high on brooding, compared to adolescents low on brooding. Sex moderated a co-rumination × stress interaction, with girls high on co-rumination and boys low on co-rumination reporting the highest levels of depressive symptoms when faced with interpersonal stress across the 1-year study period. These findings shed light on pathways to depressive symptoms in early adolescence and suggest that adolescent boys and girls may differ in these pathways.
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Affiliation(s)
- Margot Bastin
- School Psychology and Child and Adolescent Development, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium,
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Kornacka M, Buczny J, Layton RL. Assessing Repetitive Negative Thinking Using Categorical and Transdiagnostic Approaches: A Comparison and Validation of Three Polish Language Adaptations of Self-Report Questionnaires. Front Psychol 2016; 7:322. [PMID: 27014134 PMCID: PMC4783414 DOI: 10.3389/fpsyg.2016.00322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/21/2016] [Indexed: 11/29/2022] Open
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic process involved in the risk, maintenance, and relapse of serious conditions including mood disorders, anxiety, eating disorders, and addictions. Processing mode theory provides a theoretical model to assess, research, and treat RNT using a transdiagnostic approach. Clinical researchers also often employ categorical approaches to RNT, including a focus on depressive rumination or worry, for similar purposes. Three widely used self-report questionnaires have been developed to assess these related constructs: the Ruminative Response Scale (RRS), the Perseverative Thinking Questionnaire (PTQ), and the Mini-Cambridge Exeter Repetitive Thought Scale (Mini-CERTS). Yet these scales have not previously been used in conjunction, despite useful theoretical distinctions only available in Mini-CERTS. The present validation of the methods in a Polish speaking population provides psychometric parameters estimates that contribute to current efforts to increase reliable replication of theoretical outcomes. Moreover, the following study aims to present particular characteristics and a comparison of the three methods. Although there has been some exploration of a categorical approach, the comparison of transdiagnostic methods is still lacking. These methods are particularly relevant for developing and evaluating theoretically based interventions like concreteness training, an emerging field of increasing interest, which can be used to address the maladaptive processing mode in RNT that can lead to depression and other disorders. Furthermore, the translation of these measures enables the examination of possible cross-cultural structural differences that may lead to important theoretical progress in the measurement and classification of RNT. The results support the theoretical hypothesis. As expected, the dimensions of brooding, general repetitive negative thinking, as well as abstract analytical thinking, can all be classified as unconstructive repetitive thinking. The particular characteristics of each scale and potential practical applications in clinical and research are discussed.
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Affiliation(s)
| | - Jacek Buczny
- SWPS University of Social Sciences and Humanities Sopot, Poland
| | - Rebekah L Layton
- University of North Carolina at Chapel Hill Chapel Hill, NC, USA
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Abstract
Instead of converging to one, all-embracing resilience mechanism - that is, positive appraisal style - we encourage complementary research strategies, exploring both vulnerabilities and resilience factors, much like the biomedical sciences combine insights from pathophysiology and immunology. Furthermore, we argue that research with a strong focus on one central resilience mechanism may overlook or undervalue other processes that can aid in maintaining mental health.
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Addis DR, Hach S, Tippett LJ. Do strategic processes contribute to the specificity of future simulation in depression? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:167-86. [DOI: 10.1111/bjc.12103] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 11/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Donna Rose Addis
- School of Psychology & Centre for Brain Research; The University of Auckland; New Zealand
| | - Sylvia Hach
- School of Psychology & Centre for Brain Research; The University of Auckland; New Zealand
| | - Lynette J. Tippett
- School of Psychology & Centre for Brain Research; The University of Auckland; New Zealand
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Holmes EA, Blackwell SE, Burnett Heyes S, Renner F, Raes F. Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications. Annu Rev Clin Psychol 2016; 12:249-80. [PMID: 26772205 DOI: 10.1146/annurev-clinpsy-021815-092925] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.
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Affiliation(s)
- Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , , .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Simon E Blackwell
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, West Midlands B15 2TT, United Kingdom; .,Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, United Kingdom
| | - Fritz Renner
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 7EF, United Kingdom; , ,
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, University of Leuven, 3000 Leuven, Belgium;
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Cook L, Watkins E. Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression trial (RESPOND): study protocol for a phase III randomised controlled trial. Trials 2016; 17:1. [PMID: 26725476 PMCID: PMC4698823 DOI: 10.1186/s13063-015-1128-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control. Methods/Design A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Framework will extend a Dutch trial to the United Kingdom, with the addition of diagnostic interviews, primarily to test whether guided internet-RFCBT reduces the onset of depression relative to a no-intervention control. High-risk young adults (aged 18 to 24 years), selected with elevated worry/rumination and recruited through university and internet advertisement, will be randomised to receive either guided internet-RFCBT, supported by clinical psychologists or mental health paraprofessionals, or a no-intervention control. As an adjunct arm, participants are also randomised to unguided internet-RFCBT self-help to provide an initial test of the feasibility and effect size of this intervention. While participants are also randomised to unguided internet-RFCBT, the trial was designed and powered as a phase III trial comparing guided internet-RFCBT versus a no-intervention control. In the comparison between these two arms, the primary outcomes are as follows: a) onset of major depressive episode over a 12-month period, assessed with a Structured Clinical Interview for Diagnosis at 3 months (post-intervention), 6 months and 15 months after randomisation. The following secondary outcomes will be recorded: the incidence of generalized anxiety disorder, symptoms of depression and anxiety, and levels of worry and rumination, measured at baseline and at the same follow-up intervals. In relation to the pilot investigation of unguided internet-RFCBT (the adjunct intervention arm), we will assess the feasibility and acceptability of the data-collection procedures, levels of attrition, effect size and acceptability of the unguided internet-RFCBT intervention. Discussion Widespread implementation is necessary for effective prevention, suggesting that the internet may be a valuable mode of delivery. Previous research suggests that guided internet-RFCBT reduces incidence rates relative to controls. We are also interested in developing and evaluating an unguided version to potentially increase the availability and reduce the costs. Trial Registration Current Controlled Trials ISRCTN12683436. Date of registration: 27 October 2014 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Cook
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4QG, UK.
| | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4QG, UK.
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Hitchcock C, Hammond E, Rees C, Panesar I, Watson P, Werner-Seidler A, Dalgleish T. Memory Flexibility training (MemFlex) to reduce depressive symptomatology in individuals with major depressive disorder: study protocol for a randomised controlled trial. Trials 2015; 16:494. [PMID: 26531124 PMCID: PMC4632349 DOI: 10.1186/s13063-015-1029-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Major depressive disorder (MDD) is associated with chronic biases in the allocation of attention and recollection of personal memories. Impaired flexibility in attention and autobiographical memory retrieval is seen to both maintain current symptoms and predict future depression. Development of innovative interventions to reduce maladaptive cognitive patterns and improve cognitive flexibility in the domain of memory may therefore advance current treatment approaches for depression. Memory specificity training and cognitive bias modification techniques have both shown some promise in improving cognitive flexibility. Here we outline plans for a trial of an innovative memory flexibility training programme, MemFlex, which advances current training techniques with the aim of improving flexibility of autobiographical memory retrieval. This trial seeks to estimate the efficacy of MemFlex, provide data on feasibility, and begin to explore mechanisms of change. Methods/design We plan a single-blind, randomised, controlled, patient-level trial in which 50 individuals with MDD will complete either psychoeducation (n = 25) or MemFlex (n = 25). After completing pre-treatment measures and an orientation session, participants complete eight workbook-based sessions at home. Participants will then be assessed at post-treatment and at 3 month follow-up. The co-primary outcomes are depressive symptoms and diagnostic status at 3 month follow-up. The secondary outcomes are memory flexibility at post-treatment and number of depression free days at 3 month follow-up. Other process outcomes and mediators of any treatment effects will also be explored. Discussion This trial will establish the efficacy of MemFlex in improving memory flexibility, and reducing depressive symptoms. Any effects on process measures related to relapse may also indicate whether MemFlex may be helpful in reducing vulnerability to future depressive episodes. The low-intensity and workbook-based format of the programme may improve access to psychological therapies, and, if encouraging, the results of this study will provide a platform for later-phase trials. Trial registration NCT02371291 (ClinicalTrials.gov), registered 9 February 2015.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. .,Cambridgeshire and Peterborough National Health Service Foundation Trust (CPFT), Cambridge, UK.
| | - Emily Hammond
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. .,University of Exeter, Exeter, Devon, UK.
| | - Catrin Rees
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
| | - Inderpal Panesar
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. .,Cambridgeshire and Peterborough National Health Service Foundation Trust (CPFT), Cambridge, UK.
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
| | - Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. .,The Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. .,Cambridgeshire and Peterborough National Health Service Foundation Trust (CPFT), Cambridge, UK.
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Dillon DG. The neuroscience of positive memory deficits in depression. Front Psychol 2015; 6:1295. [PMID: 26441703 PMCID: PMC4561348 DOI: 10.3389/fpsyg.2015.01295] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 12/17/2022] Open
Abstract
Adults with unipolar depression typically show poor episodic memory for positive material, but the neuroscientific mechanisms responsible for this deficit have not been characterized. I suggest a simple hypothesis: weak memory for positive material in depression reflects disrupted communication between the mesolimbic dopamine pathway and medial temporal lobe (MTL) memory systems during encoding. This proposal draws on basic research showing that dopamine release in the hippocampus is critical for the transition from early- to late-phase long-term potentiation (LTP) that marks the conversion of labile, short-term memories into stable, long-term memories. Neuroimaging and pharmacological data from healthy humans paint a similar picture: activation of the mesolimbic reward circuit enhances encoding and boosts retention. Unipolar depression is characterized by anhedonia-loss of pleasure-and reward circuit dysfunction, which is believed to reflect negative effects of stress on the mesolimbic dopamine pathway. Thus, I propose that the MTL is deprived of strengthening reward signals in depressed adults and memory for positive events suffers accordingly. Although other mechanisms are important, this hypothesis holds promise as an explanation for positive memory deficits in depression.
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Affiliation(s)
- Daniel G Dillon
- Motivated Learning and Memory Laboratory, Center for Depression, Anxiety and Stress Research, McLean Hospital, Harvard Medical School , Belmont, MA, USA
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66
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Hvenegaard M, Watkins ER, Poulsen S, Rosenberg NK, Gondan M, Grafton B, Austin SF, Howard H, Moeller SB. Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial. Trials 2015; 16:344. [PMID: 26260780 PMCID: PMC4532251 DOI: 10.1186/s13063-015-0875-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30–50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy. Method/design This study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse. Discussion The clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services. Trial registration ClinicalTrials.gov Identifier: NCT02278224, registered 28 Oct. 2014.
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Affiliation(s)
- Morten Hvenegaard
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Ed R Watkins
- School of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Streatham Campus, Perry Road, Exeter, EX4 4QG, UK.
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Nicole K Rosenberg
- Psychiatric Outpatient Clinic of Copenhagen, Psychiatric Hospital of The Capital Region, Nannasgade 28, 2200, Copenhagen N, Denmark.
| | - Matthias Gondan
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Ben Grafton
- Centre for the Advancement of Research in Emotion, School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Stephen F Austin
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University, Dyrehavehavevej 48, 3400, Hillerød, Denmark.
| | - Henriette Howard
- Mental Health Centre for Child and Adolescent Psychiatry, Bispebjerg Bakke 30, 2400, Copenhagen, NV, Denmark.
| | - Stine B Moeller
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University, Dyrehavehavevej 48, 3400, Hillerød, Denmark.
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Spinhoven P, Penninx BW, Krempeniou A, van Hemert AM, Elzinga B. Trait rumination predicts onset of Post-Traumatic Stress Disorder through trauma-related cognitive appraisals: A 4-year longitudinal study. Behav Res Ther 2015; 71:101-9. [DOI: 10.1016/j.brat.2015.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
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Van Lier J, Vervliet B, Boddez Y, Raes F. "Why is everyone always angry with me?!": When thinking 'why' leads to generalization. J Behav Ther Exp Psychiatry 2015; 47:34-41. [PMID: 25479926 DOI: 10.1016/j.jbtep.2014.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/11/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The degree of (over)generalization (to the self, over situations) is an important characteristic of depression and anxiety disorders. Little is known about cognitive mechanisms underlying this (over)generalization. In this context, the present study examined the effect of an abstract processing style (compared to a more concrete processing style) on generalization of angry faces to the self. An abstract processing style refers to thoughts about the meaning, causes and consequences of events or situations ('Why'-thinking). METHODS To test the impact of an abstract processing experimentally, images of angry faces were paired with the name of the participant and happy faces were paired with another person's name while participants adopted either an abstract ('Why') or a concrete ('How') processing style. A surprise recognition task, where participants were asked to indicate whether they had seen the faces before, served as a test of generalization of angry faces to the self. RESULTS Results indicated that participants who adopted an abstract processing style showed more generalization of angry faces to the self and a trend towards more generalization of happy faces to the other person, relative to participants who adopted a concrete processing style. LIMITATIONS Our sample was a non-clinical student sample and thus conclusions about the generalizability to clinical samples should be done with caution. CONCLUSIONS These results suggest that abstract thought may underlie the generalization of bad/failure/angry feelings toward the self ('Everyone is always angry with me') and of good feelings towards other people ('Everyone is always nicer to other people') that is often seen in depression and social anxiety disorder.
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Repetitive negative thinking predicts depression and anxiety symptom improvement during brief cognitive behavioral therapy. Behav Res Ther 2015; 68:54-63. [DOI: 10.1016/j.brat.2015.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/18/2014] [Accepted: 03/13/2015] [Indexed: 11/18/2022]
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Watkins E. An Alternative Transdiagnostic Mechanistic Approach to Affective Disorders Illustrated With Research From Clinical Psychology. EMOTION REVIEW 2015. [DOI: 10.1177/1754073915575400] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current psychiatric classification adopts a disorder-focused diagnostic approach, as exemplified within ICD-11 and DSM-V. Although this approach has improved reliability of categorization, its validity and utility has been questioned (Harvey, Watkins, Mansell, & Shafran, 2004; Insel et al., 2009; Sanislow et al., 2010). Limitations include high comorbidity between supposedly distinct disorders; heterogeneity within diagnoses; limited treatment efficacy; and similarities across disorders in aetiology, latent symptom structure, and underlying biology. There is also evidence of transdiagnostic cognitive-behavioural processes (Harvey et al., 2004). An alternative approach is therefore to focus on fundamental underlying mechanisms of psychopathology rather than observed symptom clusters. This article considers the possible benefits, hurdles, and steps towards implementation of this transdiagnostic mechanistic approach, using the example of repetitive negative thought.
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Affiliation(s)
- Edward Watkins
- School of Psychology, University of Exeter, UK
- School of Psychology, University of Western Australia, Australia
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Lyubomirsky S, Layous K, Chancellor J, Nelson SK. Thinking about rumination: the scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema. Annu Rev Clin Psychol 2015; 11:1-22. [PMID: 25581241 DOI: 10.1146/annurev-clinpsy-032814-112733] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Our article reviews and celebrates Susan Nolen-Hoeksema's remarkable contributions to psychological and clinical science, focusing on her vast body of theoretical and empirical work and her influence on colleagues and students. Susan spent her career trying to understand how and why a style of regulating emotions called rumination increases vulnerability to depression and exacerbates and perpetuates negative moods. More broadly, we describe research by Susan and her colleagues on the predictors of depression in childhood and adolescence; gender differences in depression and rumination in adolescence and adulthood; roots, correlates, and adverse consequences of ruminative response styles; and rumination as a transdiagnostic risk factor for not only depression but also a host of psychological disorders, including anxiety, substance abuse, and eating disorders. Susan's intellectual legacy is evident in her impressive publication and citation record, the clinical applications of her work, and the flourishing careers of the students she mentored.
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Affiliation(s)
- Sonja Lyubomirsky
- Department of Psychology, University of California, Riverside, California 92521;
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Cristea IA, Kok RN, Cuijpers P. Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis. Br J Psychiatry 2015; 206:7-16. [PMID: 25561486 DOI: 10.1192/bjp.bp.114.146761] [Citation(s) in RCA: 328] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive bias modification (CBM) interventions are strongly advocated in research and clinical practice. AIMS To examine the efficiency of CBM for clinically relevant outcomes, along with study quality, publication bias and potential moderators. METHOD We included randomised controlled trials (RCTs) of CBM interventions that reported clinically relevant outcomes assessed with standardised instruments. RESULTS We identified 49 trials and grouped outcomes into anxiety and depression. Effect sizes were small considering all the samples, and mostly non-significant for patient samples. Effect sizes became non-significant when outliers were excluded and after adjustment for publication bias. The quality of the RCTs was suboptimal. CONCLUSIONS CBM may have small effects on mental health problems, but it is also very well possible that there are no significant clinically relevant effects. Research in this field is hampered by small and low-quality trials, and by risk of publication bias. Many positive outcomes are driven by extreme outliers.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Robin N Kok
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Pim Cuijpers
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
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Reductions in negative repetitive thinking and metacognitive beliefs during transdiagnostic internet cognitive behavioural therapy (iCBT) for mixed anxiety and depression. Behav Res Ther 2014; 59:52-60. [DOI: 10.1016/j.brat.2014.05.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/25/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022]
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Dalgleish T, Werner-Seidler A. Disruptions in autobiographical memory processing in depression and the emergence of memory therapeutics. Trends Cogn Sci 2014; 18:596-604. [PMID: 25060510 DOI: 10.1016/j.tics.2014.06.010] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/05/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
Depression is characterized by distinct profiles of disturbance in ways autobiographical memories are represented, recalled, and maintained. We review four core domains of difficulty: systematic biases in favor of negative material; impoverished access and responses to positive memories; reduced access to the specific details of the personal past; and dysfunctional processes of rumination and avoidance around personal autobiographical material. These difficulties drive the onset and maintenance of depression; consequently, interventions targeted at these maladaptive processes have clinical potential. Memory therapeutics is the development of novel clinical techniques, translated from basic research, that target memory difficulties in those with emotional disorders. We discuss prototypical examples from this clinical domain including MEmory Specificity Training, positive memory elaboration, memory rescripting, and the method-of-loci (MoL).
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Affiliation(s)
- Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
| | - Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Malhotra S, Chakrabarti S, Gupta A, Mehta A, Shah R, Kumar V, Sharma M. A self-guided relaxation module for telepsychiatric services: development, usefulness, and feasibility. Int J Psychiatry Med 2014; 46:325-37. [PMID: 24922985 DOI: 10.2190/pm.46.4.a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A modified form of the standard autogenic relaxation exercise was developed as part of a telepsychiatry project, which aims to deliver mental healthcare to remote areas through the net, and through the agency of non-specialists. This study describes the development and evaluation of a brief and simpler form of a relaxation technique, the Self-Guided Relaxation (SGR). METHOD SGR is a systematic technique to focus on muscle groups and feel the heaviness and relaxation through suggestions to induce relaxation in the body. The SGR was taught to 37 patients with different psychiatric disorders over two sessions a week apart. Measures of change used were scores on the Hamilton Anxiety Rating Scale (HAM-A) and a visual analog scale. Its usefulness and feasibility was examined over a follow-up period of one month. Additionally a group of non-specialists was trained in SGR supplemented by audiovisual aids and printed instructions. These therapists rated the ease in learning and administering SGR in patients. RESULTS There was a consistent reduction in the HAM-A scores over the follow-up period among patients. Improvements were also noted in positive experiences, adherence, depth of relaxation achieved, perceived benefit, and patient satisfaction. Majority of the patients, relatives, and therapists reported that they could administer or practice SGR after having learned the technique in a single session lasting about 30 minutes. The use of audio-video aids and manual was helpful in making the process of learning easy. CONCLUSIONS Preliminary findings of usefulness, feasibility, and acceptance of the SGR were encouraging. These findings pave way for larger, randomized controlled study and for testing applicability of the SGR as a net-based psychological intervention.
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Affiliation(s)
- Savita Malhotra
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Subho Chakrabarti
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Aarzoo Gupta
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Anurati Mehta
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Ruchita Shah
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Vineet Kumar
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
| | - Minali Sharma
- Postgraduate Institute of Medical Education and, Research (PGIMER), Chandigarh, India
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Pasyugina I, Koval P, De Leersnyder J, Mesquita B, Kuppens P. Distinguishing between level and impact of rumination as predictors of depressive symptoms: an experience sampling study. Cogn Emot 2014; 29:736-46. [PMID: 24979309 DOI: 10.1080/02699931.2014.932755] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Rumination--repetitively thinking about one's emotional state, its causes and consequences--exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person's negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students' (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.
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Affiliation(s)
- Irina Pasyugina
- a Faculty of Psychology and Educational Sciences , KU Leuven , Leuven , Belgium
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79
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Effects of Specific Positive Events Training on Autobiographical Memories in People with Schizophrenia. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9610-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Feldman G, Dunn E, Stemke C, Bell K, Greeson J. Mindfulness and rumination as predictors of persistence with a distress tolerance task. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014; 56. [PMID: 24298196 DOI: 10.1016/j.paid.2013.08.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Distress tolerance (DT) is a proposed transdiagnostic factor in psychopathology, yet sources of individual differences in DT are largely unknown. The present study examined mindfulness and rumination facets as predictors of persistence on a standardized DT task (mirror tracing). Acting with awareness (a facet of mindfulness) and reflection (a potentially adaptive form of rumination) predicted increased DT. Increased task-induced skin conductance reactivity predicted decreased DT. These results held after controlling for task skill and subjective and heart rate reactivity. Together, these results suggest that teaching skills to promote mindful awareness and reflection hold promise as interventions to enhance DT.
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Schaich A, Watkins ER, Ehring T. Can concreteness training buffer against the negative effects of rumination on PTSD? An experimental analogue study. J Behav Ther Exp Psychiatry 2013; 44:396-403. [PMID: 23659920 DOI: 10.1016/j.jbtep.2013.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/21/2013] [Accepted: 03/27/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Trauma-related rumination has been found to be an important maintaining factor for PTSD. On the background of the processing mode account of ruminative thinking, this study tested whether the relationship between rumination and analogue PTSD symptoms can be modified by training participants in a concrete mode of processing. METHODS Healthy participants were trained in either an abstract or a concrete style of processing. Afterwards, they watched a stressful film. The interactive effect of training condition and trait rumination on intrusive memories of the film was examined. RESULTS Following abstract training, a positive relationship between trait rumination and intrusive memories of the film emerged. As hypothesized, this relationship disappeared following concrete training. LIMITATIONS include the lack of a no-training control group and the analogue paradigm used. CONCLUSIONS The study provides preliminary evidence that the relationship between trait rumination and analogue PTSD symptoms can be modified. If replicated in future studies, it may be promising to examine the value of concreteness training for prevention and/or treatment of PTSD.
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Affiliation(s)
- Anja Schaich
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, The Netherlands
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Querstret D, Cropley M. Assessing treatments used to reduce rumination and/or worry: a systematic review. Clin Psychol Rev 2013; 33:996-1009. [PMID: 24036088 DOI: 10.1016/j.cpr.2013.08.004] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/03/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
Perseverative cognitions such as rumination and worry are key components of mental illnesses such as depression and anxiety. Given the frequent comorbidity of conditions in which rumination and worry are present, it is possible that they are underpinned by the same cognitive process. Furthermore, rumination and worry appear to be part of a causal chain that can lead to long-term health consequences, including cardiovascular disease and other chronic conditions. It is important therefore to understand what interventions may be useful in reducing their incidence. This systematic review aimed to assess treatments used to reduce worry and/or rumination. As we were interested in understanding the current treatment landscape, we limited our search from 2002 to 2012. Nineteen studies were included in the review and were assessed for methodological quality and treatment integrity. Results suggested that mindfulness-based and cognitive behavioural interventions may be effective in the reduction of both rumination and worry; with both Internet-delivered and face-to-face delivered formats useful. More broadly, it appears that treatments in which participants are encouraged to change their thinking style, or to disengage from emotional response to rumination and/or worry (e.g., through mindful techniques), could be helpful. Implications for treatment and avenues for future research are discussed.
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Affiliation(s)
- Dawn Querstret
- School of Psychology, University of Surrey, Guildford GU2 7XH, United Kingdom.
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Training Ruminators to Inhibit Negative Information: A Preliminary Report. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9585-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Merino H, Ferreiro F, Senra C. Cognitive Vulnerability to Emotional Symptoms: Reconsidering the Role of Worry and Rumination. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9374-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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85
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The use of cognitive bias modification and imagery in the understanding and treatment of depression. Curr Top Behav Neurosci 2013; 14:243-60. [PMID: 22566082 DOI: 10.1007/7854_2012_212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cognitive models of depression form the natural link between neurobiological and social accounts of the illness. Interest in the role of cognition in depression has recently been stimulated by the advent of simple, computer-based "cognitive bias modification" (CBM) techniques which are able to experimentally alter cognitive habits in clinical and non-clinical populations. In this chapter, we review recent work which has used CBM techniques to address questions of aetiology and treatment in depression with a particular focus on the interface with neurobiological and social processes relevant to the illness. We find that there are early signs that CBM may be a useful tool in exploring the aetiology of depression, particularly in regard to the neural and genetic factors which influence susceptibility to the illness and response to treatment. There is also early evidence suggesting that CBM has promise in the treatment and prevention of depression. This work suggests that the beneficial effects of CBM are mediated by the interaction between cognitive functioning and environmental and social information. In summary, by providing a method for altering habitual cognitive function in experimental and clinical settings CBM techniques have begun to further the understanding of and the treatment for depression.
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Why are Depressive Individuals Indecisive? Different Modes of Rumination Account for Indecision in Non-clinical Depression. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-012-9517-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Can Concreteness Training Alone Reduce Depressive Symptoms? A Randomized Pilot Study Using an Internet-Delivered Protocol. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-012-9514-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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