Information processing and cognitive organization in unipolar depression: Specificity and comorbidity issues

Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

CONTEXT

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.

OBJECTIVES

Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.

METHODS

Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.

RESULTS

Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.

CONCLUSION

Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

Decoding of Processing Preferences from Language Paradigms by Means of EEG-ERP Methodology: Risk Markers of Cognitive Vulnerability for Depression and Protective Indicators of Well-Being? Cerebral Correlates and Mechanisms

Depression is a frequent mental affective disorder. Cognitive vulnerability models propose two major cognitive risk factors that favor the onset and severity of depressive symptoms. These include a pronounced self-focus, as well as a negative emotional processing bias. According to two-process models of cognitive vulnerability, these two risk factors are not independent from each other, but affect information processing already at an early perceptual processing level. Simultaneously, a processing advantage for self-related positive information including better memory for positive than negative information has been associated with mental health and well-being. This perspective paper introduces a research framework that discusses how EEG-ERP methodology can serve as a standardized tool for the decoding of negative and positive processing biases and their potential use as risk markers of cognitive vulnerability for depression, on the one hand, and as protective indicators of well-being, on the other hand. Previous results from EEG-ERP studies investigating the time-course of self-referential emotional processing are introduced, summarized, and discussed with respect to the specificity of depression-related processing and the importance of EEG-ERP-based experimental testing for well-being and the prevention and treatment of depressive disorders.

Visual Attention and Lexical Involvement in L1 and L2 Word Processing: Emotional Stroop Effect

Given the fact that the process of engaging and interacting with the text is not only the function of a reader but also the text itself, the current study attempts to examine the role of the type of the word in the attentional engagement. More specifically, the present investigation aims to verify the interplay of sensorimotor information, emotions, and the linguistic information in the word processing. In so doing, for the scale validation, a sample of 220 Iranian English as a Foreign Language (EFL) learners from different language institutes were requested to complete the newly designed Persian and English lexical involvement scales. The results of Structural Equation Modeling (SEM) supported the factor structure and the reliability of the measures. Moreover, using Emotional Stroop task in the experimental set up, the results revealed that there is a strong positive relationship between lexical involvement and visual attentional engagement in L1(Persian). The association was conversely negative in L2 (English). Finally, the statistical analysis indicates that the lexical stimuli differ regarding their magnitude of lexical involvement in L1 and L2.

The Relational Self-Schema Measure: Assessing Psychological Needs in Multiple Self-with-Other Representations

Modern self-schema theory posits multiple representations in memory of the self, with each individual self-schema possessing associative connections to relational contexts (i.e., self-with-other). However, existing self-schema measures typically assess a generalized self unmoored from context. In two studies, we present a new instrument-the Relational Self-Schema Measure (RSSM)-designed to represent the self-schema construct with greater content validity. In Study 1, 512 adults completed an initial version of the RSSM that was subjected to exploratory factor analyses. Support emerged for a reduced four-factor model that included relatedness satisfaction, control satisfaction, self-esteem/status frustration, and autonomy frustration psychological need themes. In Study 2, 516 adults completed a revised RSSM along with measures of self-esteem, attachment, and mood and anxiety symptoms. A separate sample of 191 college students completed the revised RSSM and a measure of dysfunctional attitudes. Confirmatory factor analyses supported the same four-factor model. Moreover, the RSSM exhibited good convergent and discriminant validity as well as incremental validity in predicting positive affect, distress, and anxiety symptoms. Finally, significant within-person variability was apparent across relational schemata that accounted for additional variance in positive affect, distress, and anxiety symptoms.

Is a Negative Attentional Bias in Individuals with Autism Spectrum Disorder Explained by Comorbid Depression? An Eye-Tracking Study

Heightened attention towards negative information is characteristic of depression. Evidence is emerging for a negative attentional bias in Autism spectrum disorder (ASD), perhaps driven by the high comorbidity between ASD and depression. We investigated whether ASD is characterised by a negative attentional bias and whether this can be explained by comorbid (sub) clinical depression. Participants (n = 116) with current (CD) or remitted depression (RD) and/or ASD, and 64 controls viewed positively and negatively valenced (non-)social pictures. Groups were compared on three components of visual attention using linear mixed models. Both CD individuals with and without ASD, but not remitted depressed and never-depressed ASD individuals showed a negative bias, suggesting that negative attentional bias might be a depressive state-specific marker for depression in ASD.

Affective compatibility with the self modulates the self-prioritisation effect

The "self" shapes the way in which we process the world around us. It makes sense then, that self-related information is reliably prioritised over non self-related information in cognition. How might other factors such as self-compatibility shape the way self-relevant information is prioritised? The present work asks whether affective consistency between the self and arbitrarily self-associated stimuli influences the degree to which self-prioritisation can be observed. To this end, participants were asked to associate themselves with either a positive or a negative concept and to then indicate if a given stimulus (Experiment 1: Emotional faces; Experiment 2: Luminance cues) and an identity label matched. If affective consistency is key to self-prioritisation, negative constructs should dampen self-prioritisation and positive constructs should boost self-prioritisation because the self is universally construed as positive. Indeed, the results of the two experiments indicate that participants who made the negative association had more difficulty confirming whether the stimulus and the label matched than those who made the positive association. The implications of this finding are discussed in terms of "self" theories that span various levels of information processing. The data reveal that self-referential information processing goes beyond a default elevation of priority to the self.

Fractured Pasts: The Structure of the Life Story in Sexual-Trauma Survivors With Posttraumatic Stress Disorder

We examined the organization of past and future affective autobiographical knowledge in sexual-trauma survivors compared with control participants. Participants (N = 113) divided their past (and future) life into chapters (e.g., “college,” “marriage”), then characterized each chapter using positive or negative attributes. Sexual-trauma survivors (n = 27) endorsed a greater proportion of negative attributes, demonstrated greater affective compartmentalization (separation of positive and negative attributes into different chapters), and showed reduced redundancy (consistent endorsement across chapters) of positive attributes relative to control participants (n = 23). Groups did not differ on negative redundancy for past life structure or any metrics for future life structure. In a secondary analysis, we compared life structures for the sexual-trauma group and for individuals with chronic depression but no sexual-trauma history (n = 30) and matched control participants (n = 56), which revealed significantly greater negative redundancy in the depressed group. The distinct life structure presented by sexual-trauma survivors may reflect efforts to constrain the impact of trauma on an individual’s self-identity.

Compartmentalization of self-representations in female survivors of sexual abuse and assault, with posttraumatic stress disorder (PTSD)

BACKGROUND

This study examined the structure of the self-concept in a sample of sexual trauma survivors with posttraumatic stress disorder (PTSD) compared to healthy controls using a self-descriptive card-sorting task. We explored whether individuals with PTSD possess a highly affectively-compartmentalized self-structure, whereby positive and negative self-attributes are sectioned off into separate components of self-concept (e.g. self as an employee, lover, mother). We also examined redundancy (i.e. overlap) of positive and negative self-attributes across the different components of self-concept.

METHOD

Participants generated a set of self-aspects that reflected their own life (e.g. 'self at work'). They were then asked to describe their self-aspects using list of positive or negative attributes.

RESULTS

Results revealed that, relative to the control group, the PTSD group used a greater proportion of negative attributes and had a more compartmentalized self-structure. However, there were no significant differences between the PTSD and control groups in positive or negative redundancy. Sensitivity analyses demonstrated that the key findings were not accounted for by comorbid diagnosis of depression.

CONCLUSION

Findings indicated that the self-structure is organized differently in those with PTSD, relative to those with depression or good mental health.

Sack A, Fecteau S. Characterizing emotional Stroop interference in posttraumatic stress disorder, major depression and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Posttraumatic stress disorder is a debilitating psychiatric disorder characterized by symptoms of intrusive re-experiencing of trauma, avoidance and hyper-arousal. Diagnosis and treatment of PTSD is further complicated by concurrently occurring disorders, the most frequent being major depressive disorder and anxiety disorders. Previous research highlights that attentional processing in posttraumatic stress disorder is associated with substantial interference by emotional stimuli, a phenomenon also observed in these concurrently occurring psychiatric disorders. However, the diagnosis-relevance of this interference remains elusive. Here, we investigated the emotional Stroop interference for diagnosis-related stimuli, generally negative stimuli, and generally positive stimuli in posttraumatic stress disorder, major depressive disorder and anxiety disorders.

METHODS

We performed a systematic database search in PubMed (Medline), Cochrane Library and PsycINFO on emotional Stroop performance in individuals with a diagnosis of posttraumatic stress disorder, major depressive disorder or anxiety disorders separately. Mean effect sizes, standard errors and confidence intervals were estimated for each clinical group and healthy control group comparison using random effect models.

RESULTS

As compared to healthy control group, the posttraumatic stress disorder group displayed greater interference by diagnosis-related stimuli and positive stimuli but not for generally negative stimuli. The major depressive disorder and anxiety disorders groups showed greater interference by diagnosis-related and negative stimuli, but not by positive stimuli. The age and sex had no significant impact on interference.

CONCLUSIONS

These findings highlight the importance of diagnosis-relevant information on attentional processing in all three clinical populations, posttraumatic stress disorder, major depressive disorder and anxiety disorders. Further, the impact of generally negative stimuli but not generally positive stimuli in major depressive disorder and anxiety disorders indicate impaired attentional bias for mood-congruent stimuli but not for general stimuli. Finally, it remains to be studied whether the influence of generally positive stimuli in posttraumatic stress disorder indicate that positive stimuli are perceived as PTSD related.

Association between negative cognitive bias and depression: A symptom-level approach

Cognitive models of depression posit that negatively biased self-referent processing and attention have important roles in the disorder. However, depression is a heterogeneous collection of symptoms and all symptoms are unlikely to be associated with these negative cognitive biases. The current study involved 218 community adults whose depression ranged from no symptoms to clinical levels of depression. Random forest machine learning was used to identify the most important depression symptom predictors of each negative cognitive bias. Depression symptoms were measured with the Beck Depression Inventory-II. Model performance was evaluated using predictive R-squared (Rpred2), the expected variance explained in data not used to train the algorithm, estimated by 10 repetitions of 10-fold cross-validation. Using the self-referent encoding task (SRET), depression symptoms explained 34% to 45% of the variance in negative self-referent processing. The symptoms of sadness, self-dislike, pessimism, feelings of punishment, and indecision were most important. Notably, many depression symptoms made virtually no contribution to this prediction. In contrast, for attention bias for sad stimuli, measured with the dot-probe task using behavioral reaction time (RT) and eye gaze metrics, no reliable symptom predictors were identified. Findings indicate that a symptom-level approach may provide new insights into which symptoms, if any, are associated with negative cognitive biases in depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Linguistic analysis of the autobiographical memories of individuals with major depressive disorder

Background

Major depressive disorder (MDD) is characterized by biases in memory, attention, and cognition. The present study utilized the Linguistic Inquiry and Word Count (LIWC) to examine the content of specific autobiographical memories (AMs) recalled by individuals with MDD during an autobiographical memory task.

Methods

We examined various features of the text (including use of affective, cognitive, and self-referential terms), as well as their associations with clinical and cognitive features of MDD (depression severity, autobiographical memory specificity, amygdala activity), in 45 unmedicated adults with MDD compared to 61 healthy controls.

Results

When recalling positive memories MDD individuals used the word “I” less, fewer positive words, more words indicating present focus (present tense verbs), and fewer words overall to describe memories compared to controls. When recalling negative memories, MDD individuals used “I” more, more words indicating present focus, and more words overall to describe memories relative to controls. Depression severity was correlated with word count, the use of “I”, and words indicating present focus in negative memories and inversely correlated with word count and the use of “I” in positive memories. Autobiographical memory specificity was correlated with word count, the use of “I”, and words indicating present focus for positive memories and inversely correlated with the use of “I” and words indicating present focus for negative memories.

Limitations

Due to the nature of AM recall, we could not control for the number of memories which participants recalled in each mnemonic category.

Conclusions

Results align with literature implicating rumination and intensive self-focus in depression and suggest that interventions targeting specific word use may be therapeutically beneficial in the treatment of MDD.

Cognitive load and emotional processing in psoriasis: a thermal imaging study

Psoriasis is a chronic dermatologic disease which is frequently associated with psychological distress. Although studies suggest a relationship between this condition and difficulties in emotion regulation, behavioral and physiological evidence about this link is scarce. We measured implicit emotion regulation abilities of psoriasis patients and a healthy control group by examining the impact of distracting emotional (positive, negative or neutral) images on a working memory task ("Emotional N-Back") which could present high (2-back) or low (1-back) cognitive workload. Moreover, we used Functional Infrared Thermal Imaging to record participants' facial temperature and obtain a measure of the activation of the autonomic system. Rising of temperature over the peri-orbital areas and the nose tip are believed to reflect the activation and the de-activation of the sympathetic system, respectively. Patients scored higher than controls on the "Lack of emotional clarity" sub-scale of the Difficulties in Emotion Regulation Scale. Compared to controls, who performed much better in the low vs. high cognitive load condition, patients showed a smaller accuracy difference between the two conditions. Moreover, patients showed less sympathetic (lower peri-orbital and higher nasal tip temperature) activity (especially in the negative and neutral blocks) during the high vs. low cognitive load condition, suggesting that the former condition might be less emotionally demanding for them. Patients benefit more than controls from the load-dependent interference effect when dealing with emotional information; thus, therapeutic techniques aiming at teaching how to use cognitive strategies to downregulate emotions might be particularly appropriated for them.

It's Not Me, It's You: Self- and Partner-Schemas, Depressive Symptoms, and Relationship Quality

Depression is associated with a host of interpersonal difficulties, particularly within intimate relationships. Although a significant body of literature has supported the presence of a highly consolidated negative self-representation or self-schema, no studies have examined whether depression is also associated with a highly organized negative “partner-schema”, and whether this represents a risk factor for relationship distress. Given the high degree of similarity between cognitive representations of self and close others, it was predicted that depression would be associated with a partner-schema structure mirroring that of the self-schema: an organized cognitive structure characterized by tightly interconnected negative information, and loosely dispersed positive information. In a sample of 291 undergraduate students, results supported this hypothesis. The findings also revealed that partner-schema structure was associated with relationship quality and attributions about a partner's behaviors over and above self-schema structure. These findings have important implications for understanding the link between cognitive risk factors, relational dysfunction, and depressive symptoms.

Impact of culture on autobiographical life structure in depression

OBJECTIVES

Distortions in autobiographical memory have been implicated in major depressive disorder (MDD). Those with MDD demonstrate a 'depressogenic' autobiographical life structure. Research has not examined how culture influences this process. We investigated whether Malay individuals (members of an interdependent culture) with MDD demonstrated a 'depressogenic' autobiographical life structure similar to that of British individuals (members of an independent culture) with MDD.

DESIGN

A 2 (Culture; Malay, British) × 2 (Mood; depressed, control) cross-sectional design using a card sort task and self-report measures was used.

METHODS

Malay individuals with MDD or no history of MDD completed the life-structure card-sorting task, which provided a novel method for investigating organizational structure of the life narrative. These data were compared to previously collected data in which British individuals with MDD or without MDD had completed the same task within the same experimental protocol.

RESULTS

Pan-culturally those with MDD had greater negativity (i.e., used more negative attributes), negative redundancy (i.e., used the same negative attributes repeatedly across life chapters) and negative emodiversity (i.e., had greater variety and relative abundance of negative attributes), and reduced positive redundancy (i.e., used the same positive attributes repeatedly across chapters) in their structuring relative to controls. While the British MDD group had greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters) than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls.

CONCLUSIONS

The findings suggest culture may shape aspects of the autobiographical life structure in MDD.

PRACTITIONER POINTS

The majority of the literature investigating depression pertains to individuals from European Western cultures, despite recognition that depression ranks as one of the most debilitating diseases worldwide. This raises questions as to whether current depression models and interventions can be applied universally or whether they are limited to European Western groups. The current study found that pan-culturally those with MDD had similar structuring of their life story relative to controls. However, there were some cultural differences that need to be considered (e.g., Malay individuals provided less detailed, less elaborate and less emotionally diverse life stories and while the British MDD group had greater compartmentalization than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls). Limitations of the study included group differences in gender and mood at the time of testing. Cultural differences in the number of attributes used may have influenced findings. Only the Malay group completed the individualism-collectivism measure.

The Measurement of Cognitive Schemas: Validation of the Psychological Distance Scaling Task in a Community Mental Health Sample

Objective

The purpose of this study was to examine the validity of the Psychological Distance Scaling Task (PDST), a measure of cognitive schema organization, in a community mental health setting. We also compared validity among African Americans and Caucasians.

Method

In order to accommodate participants with low education levels, 26 out of 80 PDST word stimuli were replaced with similar words at a lower reading level. A sample of 466 (42% African American; 50% Caucasian; 8% other) community patients with major depressive disorder completed the PDST and a variety of depressive symptom measures.

Results

The modified PDST demonstrated acceptable validity within all subscales. Validity coefficients resembled those reported in prior studies and were similar within minority and non-minority subsamples.

Conclusions

The modified PDST appears to be a valid measure of schema organization in a low-income, racially diverse population seeking treatment for depression at community clinics.

Neural Response After a Single ECT Session During Retrieval of Emotional Self-Referent Words in Depression: A Randomized, Sham-Controlled fMRI Study

BACKGROUND

Negative neurocognitive bias is a core feature of depression that is reversed by antidepressant drug treatment. However, it is unclear whether modulation of neurocognitive bias is a common mechanism of distinct biological treatments. This randomized controlled functional magnetic resonance imaging study explored the effects of a single electroconvulsive therapy session on self-referent emotional processing.

METHODS

Twenty-nine patients with treatment-resistant major depressive disorder were randomized to one active or sham electroconvulsive therapy session at the beginning of their electroconvulsive therapy course in a double-blind, between-groups design. The following day, patients were given a self-referential emotional word categorization test and a free recall test. This was followed by an incidental word recognition task during whole-brain functional magnetic resonance imaging at 3T. Mood was assessed at baseline, on the functional magnetic resonance imaging day, and after 6 electroconvulsive therapy sessions. Data were complete and analyzed for 25 patients (electroconvulsive therapy: n = 14, sham: n = 11). The functional magnetic resonance imaging data were analyzed using the FMRIB Software Library randomize algorithm, and the Threshold-Free Cluster Enhancement method was used to identify significant clusters (corrected at P < .05).

RESULTS

A single electroconvulsive therapy session had no effect on hippocampal activity during retrieval of emotional words. However, electroconvulsive therapy reduced the retrieval-specific neural response for positive words in the left frontopolar cortex. This effect occurred in the absence of differences between groups in behavioral performance or mood symptoms.

CONCLUSIONS

The observed effect of electroconvulsive therapy on prefrontal response may reflect early facilitation of memory for positive self-referent information, which could contribute to improvements in depressive symptoms including feelings of self-worth with repeated treatments.

Matching Message Design and Depressed Cognition: An Exploration of Attention Patterns for Gain- and Loss-Framed Depression Help-Seeking Messages

Although disproportionally affected by depression, most depressed college students do not seek the help they need. Research has recently uncovered the potential negative effects of depression help-seeking messages if depressed cognition is not considered in the health message design process. It is unclear if depression determines whether and how individuals pay attention to gain- and loss-framed depression help-seeking messages-a mechanism that has significant implications for the strategic planning of health communication interventions. In order to enable the effective matching of message design and audience features, this study investigated attention patterns for gain (n = 75)- and loss (n = 78)-framed depression help-seeking messages using eye-tracking technology and self-report measures. The results confirmed that depression is a characteristic of risk avoidance and negative cognition. Depressed participants tended to pay more attention to disease information that was placed in a loss-framed rather than a gain-framed depression help-seeking message. Using negative message framing strategies for health messages seeking to educate about depression symptoms might therefore be a useful persuasive strategy-particularly when disseminated to vulnerable populations affected by depression. Furthermore, the present study emphasizes the effective use of eye-tracking technology in communication research.

Depression and Identity: Are Self-Constructions Negative or Conflictual?

Negative self-views have proved to be a consistent marker of vulnerability for depression. However, recent research has shown that a particular kind of cognitive conflict, implicative dilemma, is highly prevalent in depression. In this study, the relevance of these conflicts is assessed as compared to the cognitive model of depression of a negative view of the self. In so doing, 161 patients with major depression and 110 controls were assessed to explore negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas), as well as severity of symptoms. Results showed specificity for the clinical group indicating a pattern of mixed positive and negative self-descriptions with a high rate of conflict. Regression analysis lent support to the conflict hypothesis in relation to clinically relevant indicators such as symptom severity, global functioning. However, self-ideal discrepancy was a stronger predictor of group membership. The findings showed the relevance of cognitive conflicts to compliment the well-consolidated theory of negative self-views. Clinical implications for designing interventions are discussed.

Childhood trauma and negative memory bias as shared risk factors for psychopathology and comorbidity in a naturalistic psychiatric patient sample

BACKGROUND

Both childhood trauma and negative memory bias are associated with the onset and severity level of several psychiatric disorders, such as depression and anxiety disorders. Studies on these risk factors, however, generally use homogeneous noncomorbid samples. Hence, studies in naturalistic psychiatric samples are lacking. Moreover, we know little about the quantitative relationship between the frequency of traumatic childhood events, strength of memory bias and number of comorbid psychiatric disorders; the latter being an index of severity. The current study examined the association of childhood trauma and negative memory bias with psychopathology in a large naturalistic psychiatric patient sample.

METHODS

Frequency of traumatic childhood events (emotional neglect, psychological-, physical- and sexual abuse) was assessed using a questionnaire in a sample of 252 adult psychiatric patients with no psychotic or bipolar-I disorder and no cognitive disorder as main diagnosis. Patients were diagnosed for DSM-IV Axis-I and Axis-II disorders using a structured clinical interview. This allowed for the assessment of comorbidity between disorders. Negative memory bias for verbal stimuli was measured using a computer task.

RESULTS

Linear regression models revealed that the frequency of childhood trauma as well as negative memory bias was positively associated with psychiatric comorbidity, separately and above and beyond each other (all p < .01).

CONCLUSIONS

The results indicate that childhood trauma and negative memory bias may be of importance for a broader spectrum of psychiatric diagnoses, besides the frequently studied affective disorders. Importantly, frequently experiencing traumatic events during childhood increases the risk of comorbid psychiatric disorders.

Referential focus moderates depression-linked attentional avoidance of positive information

While there is consensus that depression is associated with a memory bias characterized by reduced retrieval of positive information that is restricted to information that had been self-referentially processed, there is less agreement concerning whether depression is characterized by an attention bias involving reduced attention to positive information. However, unlike memory research, previous attention research has not systematically examined the potential role of referential processing focus. The present study tested the hypothesis that evidence of depression-linked attentional avoidance of positive information would be more readily obtained following the self-referential processing of such information. We assessed attentional responding to positive information (and also to negative information) using a dot-probe procedure, after this information had been processed either in a self-referential or other-referential manner. The findings lend support to the hypothesis under scrutiny. Participants scoring high in depression score exhibited reduced attention to positive information compared to those scoring low in depression score, but only when this information had been processed in a self-referential manner. These findings may shed light on the mechanisms that underpin attentional selectivity in depression, while potentially also helping to account for inconsistencies in previous literature.

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First systematic investigation of the role of referential processing focus in moderating depression-linked attentional bias.

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Reduced attention to self-referential positive information was exhibited by high relative to low depression individuals.

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No evidence of a depression-linked reduction in attention to other-referential positive information was found.

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Findings shed light on the mechanisms that underpin attentional selectivity in depression.

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Findings also help to account for inconsistencies in previous literature.

A self-report version of the Ways of Responding: Reliability and validity in a clinical sample

OBJECTIVE

The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects' open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N = 467).

METHOD

Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points.

RESULTS

An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach's alphas = .91) and moderate convergent validity with other measures.

CONCLUSION

The WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers.

Examining the impact of thought substitution on intentional forgetting in induced and naturally occurring dysphoria

Two experiments were conducted to determine if natural and induced dysphoria is associated with impaired forgetting and, whether a thought-substitution strategy would ameliorate any observed deficits. Study 1: 36 dysphoric & 36 non-dysphoric participants learnt a series of emotional word pairs. Participants were subsequently presented with some of the cues and were asked to recall the targets or prevent the targets from coming to mind. Half of the participants were provided with substitute words to recall instead of the original targets (aided suppression). At final memory testing, participants were asked to recall the targets to all cues. Dysphoric participants exhibited impaired forgetting, even when using a thought substitution strategy. Non-dysphoric participants, however, were able to use substitutes to suppress words. Study 2: 50 healthy participants initially completed the aided condition of the forgetting task. Participants were then given a positive or negative mood-induction, followed by another version of the forgetting task. Although all participants showed a forgetting effect prior to the mood-induction, only the positive group was successful at forgetting after the mood induction. Taken together, these findings do not support the utility of thought-substitution as an aid to forgetting in individuals in a naturally or induced dysphoric mood.

Bad Roots to Grow: Deficient Implicit Self-Evaluations in Chronic Depression With an Early Onset

OBJECTIVE

Implicit self-esteem, which is based on associative learning processes, is considered to be constituted earlier in life than explicit, verbalized self-esteem. While depressed individuals report negative explicit self-esteem, research has predominantly demonstrated equivalent levels of implicit self-esteem of depressed and healthy individuals. We further illuminate this finding by theorizing and empirically demonstrating that chronically depressed individuals show particularly low levels of implicit self-esteem when depression had an early onset.

METHOD

We applied measures of implicit (name-letter test) and explicit (Rosenberg Self-Esteem Scale) self-esteem in chronically depressed patients with an early onset (N = 17), a late onset (N = 13), and an episodic depression (N = 29).

RESULTS

As expected, patients with an early onset showed lower implicit self-esteem than the 2 other groups.

CONCLUSION

Implicit self-esteem may function as a marker of how deeply negative self-views are internalized. Furthermore, the distinction between early and late onset of chronic depression seems to be valuable for classification and potentially treatment of unipolar depression.

Processing of Emotional Information in Major Depressive Disorder: Toward a Dimensional Understanding

Several decades of research converge on the formulation that individuals diagnosed with major depressive disorder (MDD) exhibit negative biases in their processing of emotional information. It is becoming increasingly clear, however, that traditional between-group comparisons have obscured the substantial heterogeneity of cognitive and affective dysfunction that is associated with depressive symptomatology. In this article, we review the findings of research examining attention to and memory for negative emotional information using a more dimensional perspective on depression. Specifically, we explore studies that assess cognitive biases along a continuum of depressive symptom severity and consider the influence of co-occurring dimensions of functioning, in particular the severity of anxiety symptoms. Finally, we identify critical empirical questions and issues in this growing literature.

Information processing biases concurrently and prospectively predict depressive symptoms in adolescents: Evidence from a self-referent encoding task

Negative information processing biases have been hypothesised to serve as precursors for the development of depression. The current study examined negative self-referent information processing and depressive symptoms in a community sample of adolescents (N = 291, Mage at baseline = 12.34 ± 0.61, 53% female, 47.4% African-American, 49.5% Caucasian and 3.1% Biracial). Participants completed a computerised self-referent encoding task (SRET) and a measure of depressive symptoms at baseline and completed an additional measure of depressive symptoms nine months later. Several negative information processing biases on the SRET were associated with concurrent depressive symptoms and predicted increases in depressive symptoms at follow-up. Findings partially support the hypothesis that negative information processing biases are associated with depressive symptoms in a nonclinical sample of adolescents, and provide preliminary evidence that these biases prospectively predict increases in depressive symptoms.

Investigating biases of attention and memory for alcohol-related and negative words in alcohol-dependents with and without major depression after day-clinic treatment

This study aimed to investigate attentional and memory biases in alcohol-dependents with and without major depression compared to healthy controls. We assumed that both groups of alcohol-dependents would show attentional and memory biases for alcohol-related words. For the alcohol-dependents with depression, we additionally expected both types of biases for negative words. Alcohol-dependents without co-morbidity (Alc) and alcohol-dependents with major depression (D-Alc) as well as control participants with a moderate consumption of alcohol (Con) completed an alcohol Stroop task and a directed forgetting paradigm using word stimuli from three categories: neutral, negative, and alcohol-related. Stroop effects showed that not only alcohol-dependents but also control participants were more distracted by alcohol-related than by negative words. In the directed forgetting procedure, all participants showed a significant effect for each word-category, including alcohol-related and negative words. The D-Alc-group memorized more alcohol-related than negative to-be-remembered words. The results do not corroborate the hypothesis of more pronounced attentional and memory biases in alcohol-dependents. However, in alcohol-dependents with depression a memory bias for alcohol-related material was found, suggesting that this group may be more pre-occupied with alcohol than patients without such co-morbidity.

Quality of life in children with narcolepsy

AIMS

To evaluate the health-related quality of life (HRQL) and its correlates in children and adolescents with narcolepsy.

METHODS

We compared the clinical characteristics of control subjects and patients with primary narcolepsy from data collected at the National Reference Centers for Narcolepsy.

RESULTS

The cohort included 69 control subjects (29 boys) and 117 patients (65 boys; 59 de novo patients). Cataplexy was present in 81% and DQB1*0602 was positive in 91%. The control children were older (13.5±3.2 vs. 11.6±3.1 years, P<0.001) and less obese (1.4% vs. 60%, P<0.001). Twenty-five percent of the patients and 15.6% of the control subjects had clinically significant depressive feelings on Children's Depression Inventory (CDI≥16) (NS). Fifty-three narcoleptic and 43 control adolescents, 31 narcoleptic children and 23 control children filled out the HRQL questionnaires as well as 83 parents of patients and 60 parents of control subjects. Narcolepsy seriously impacts HRQL in terms of vitality, physical well-being, relations with friends and leisure activities, especially in adolescents. Depression was the factor that most affected HRQL in both narcoleptic and control subjects. For the control subjects and the narcoleptic patients, when the CDI score was entered into the multivariable regression model adjusted for gender and age, no other continuous independent variable could significantly increase the likelihood of the model. When the CDI score increased by 1, the mean HRQL score decreased by 1.7 for narcoleptic patients and 1.5 for control subjects. Apnea-hypopnoea index, diagnosis delay, disease duration, obesity, the presence of cataplexy or treatment had no effects on HRQL.

CONCLUSIONS

Narcoleptic children and adolescents were at high risk for poor HRQL. Depressive symptoms had a major impact on HRQL. We recommend a more thorough assessment and management of psychological health in this population.

Why are anxiety and depressive symptoms comorbid in youth? A multi-wave, longitudinal examination of competing etiological models

BACKGROUND

The present study sought to clarify the development of comorbid emotional distress by comparing different explanations for how youth develop anxiety and depressive symptoms. Specifically, we introduced the diathesis-anxiety approach (whether cognitive vulnerabilities interact with anxiety symptoms), and compared it to a causal model (anxiety symptoms predicting depressive symptoms), and a correlated liabilities model (whether cognitive vulnerabilities interacted with stressors to predict both anxiety and depressive symptoms) to examine which model best explained the relation between depressive and anxiety symptoms in youth.

METHODS

678 3rd (n=208), 6th (n=245), and 9th (n=225) grade girls (n=380) and boys (n=298) completed self-report measures at baseline assessing cognitive vulnerabilities (rumination and self-criticism), stressors, depressive and anxiety symptoms. Every 3 months over the next 18 months, youth completed follow-up measures of symptoms and stressors.

RESULTS

While limited support was found for a causal (p>0.10) or correlated-liability model (p>0.05) for comorbidity, findings did support a diathesis-anxiety approach for both self-criticism (t(2494)=3.36, p<0.001) and rumination (t(2505)=2.40, p<0.05).

LIMITATIONS

The present study׳s findings are based on self-report measure and makes inferences concerning comorbidity with a community sample.

CONCLUSIONS

These results may help clarify past research concerning comorbidity by introducing a diathesis-anxiety approach as a viable model to understand which youth are most at-risk for developing comorbid emotional distress.

Depressive feelings in children with narcolepsy

OBJECTIVES

We aimed to evaluate depressive feelings and their correlations in children and adolescents with narcolepsy collected in national reference centers for narcolepsy.

METHODS

We compared clinical and sleep characteristics of patients with and without depressive symptoms evaluated on the Children's Depression Inventory (CDI).

RESULTS

Our study sample included 88 children (44 boys; 44 de novo patients) with a mean age of 11.9 ± 3.1 years at diagnosis (37.5% were aged ⩽ 10 years). Obesity was found in 59% of the sample and cataplexy was present in 80.7%. The DQB1*0602 allele was positive in 93.5% of our sample. There were 25% of children who had clinically depressive feelings (CDI>16), especially girls older than the age of 10 years. Bivariate associations indicated that depressive feelings were associated with fatigue (48%), hyperactivity (31%), insomnia (16%), and excessive daytime sleepiness (EDS) (14-24%). In the multivariate model adjusted for gender and age, only fatigue explained the variability of the depression score.

CONCLUSION

In our large cohort, high levels of depressive symptoms essentially expressed by fatigue affected 25% of children with narcolepsy. The girls older than 10 years of age were especially vulnerable. The similar prevalence of depressive feelings in treated vs never-treated patients suggests a specific need for diagnosing and managing this symptom in young patients with narcolepsy.

Persuading people with depression to seek help: respect the boomerang

People with depression are likely to process information with a negative bias when confronted with self-relevant information. Accordingly, we feared exposing depressed people to a public service announcement (PSA) addressing the stigma of depression would possibly boomerang and result in less intention to seek help and in increased self-stigma. College students (N = 271; Mage  = 22.51, SD = 4.71; 63.1% female; 37.3% White, 31.9% Hispanic, 12.9% Asian, 6.8% multiethnic, 3.4% Black, 7.6% other) were randomly assigned to receive a print ad focused on depression or a nonrelevant comparison ad. A paper-and-pencil survey consisting of the Beck Depression Inventory-II, Self-Stigma of Seeking Help scale, help-seeking intentions, and demographics followed. Regression analysis indicated that viewing a depression ad caused people with greater depressive symptoms to experience greater levels of self-stigma than depressed people exposed to a nonrelevant comparison ad. Bootstrap mediation analysis showed that for individuals who viewed a depression PSA, self-stigma mediated the relationship between depressive symptoms and professional help-seeking intentions. While this current study offers no direct evidence in regard to the utility of current and past depression campaigns, results indicate a definite need for caution when developing materials targeting people with depression to seek help.

The combined effects of self-referent information processing and ruminative responses on adolescent depression

Adolescents who develop depression have worse interpersonal and affective experiences and are more likely to develop substance problems and/or suicidal ideation compared to adolescents who do not develop depression. This study examined the combined effects of negative self-referent information processing and rumination (i.e., brooding and reflection) on adolescent depressive symptoms. It was hypothesized that the interaction of negative self-referent information processing and brooding would significantly predict depressive symptoms, while the interaction of negative self-referent information processing and reflection would not predict depressive symptoms. Adolescents (n = 92; 13-15 years; 34.7% female) participated in a 6-month longitudinal study. Self-report instruments measured depressive symptoms and rumination; a cognitive task measured information processing. Path modelling in Amos 19.0 analyzed the data. The interaction of negative information processing and brooding significantly predicted an increase in depressive symptoms 6 months later. The interaction of negative information processing and reflection did not significantly predict depression, however, the model not meet a priori standards to accept the null hypothesis. Results suggest clinicians working with adolescents at-risk for depression should consider focusing on the reduction of brooding and negative information processing to reduce long-term depressive symptoms.

Automaticity in anxiety disorders and major depressive disorder

In this paper we examine the nature of automatic cognitive processing in anxiety disorders and Major Depressive Disorder (MDD). Rather than viewing automaticity as a unitary construct, we follow a social cognition perspective (Bargh, 1994) that argues for four theoretically independent features of automaticity: unconscious (processing of emotional stimuli occurs outside awareness), efficient (processing emotional meaning uses minimal attentional resources), unintentional (no goal is needed to engage in processing emotional meaning), and uncontrollable (limited ability to avoid, alter or terminate processing emotional stimuli). Our review of the literature suggests that most anxiety disorders are characterized by uncontrollable, and likely also unconscious and unintentional, biased processing of threat-relevant information. In contrast, MDD is most clearly typified by uncontrollable, but not unconscious or unintentional, processing of negative information. For the anxiety disorders and for MDD, there is no sufficient evidence to draw firm conclusions about efficiency of processing, though early indications are that neither anxiety disorders nor MDD are characterized by this feature. Clinical and theoretical implications of these findings are discussed and directions for future research are offered. In particular, it is clear that paradigms that more directly delineate the different features of automaticity are required to gain a more comprehensive and systematic understanding of the importance of automatic processing in emotion dysregulation.

Depression reduces perceptual sensitivity for positive words and pictures

There is evidence of maladaptive attentional biases for lexical information (e.g., Atchley, Ilardi, & Enloe, 2003; Atchley, Stringer, Mathias, Ilardi, & Minatrea, 2007) and for pictographic stimuli (e.g., Gotlib, Krasnoperova, Yue, & Joormann, 2004) among patients with depression. The current research looks for depressotypic processing biases among depressed out-patients and non-clinical controls, using both verbal and pictorial stimuli. A d' measure (sensitivity index) was used to examine each participant's perceptual sensitivity threshold. Never-depressed controls evidenced a detection bias for positive picture stimuli, while depressed participants had no such bias. With verbal stimuli, depressed individuals showed specific decrements in the detection of positive person-referent words (WINNER), but not with positive non-person-referent words (SUNSHINE) or with negative words. Never-depressed participants showed no such differences across word types. In the current study, depression is characterised both by an absence of the normal positivistic biases seen in individuals without mood disorders (consistent with McCabe & Gotlib, 1995), and by a specific reduction in sensitivity for person-referent positive information that might be inconsistent with depressotypic self-schemas.

Evaluating the Mood State Dependence of Automatic Thoughts and Dysfunctional Attitudes in Remitted Versus Never-Depressed Individuals

The cognitive model of depression specifies the role of schema-driven negative processing biases in the onset and maintenance of depression. Research has shown that cognitive reactivity, or the ease with which negative thinking patterns are activated by mild changes in negative mood, is related to relapse and recurrence. The goal of this study was to examine cognitive reactivity following a mood prime in individuals vulnerable to depression. Formerly (n = 28) and never (n = 36) depressed individuals were assessed on two measures of negative cognition, the Automatic Thoughts Questionnaire (ATQ) and Dysfunctional Attitudes Scale (DAS), before and after participating in a sad or neutral mood induction procedure (MIP). The negative mood induction resulted in increased belief in negative automatic thoughts across groups; however, only the formerly depressed participants assigned to this condition demonstrated increased DAS scores. Importantly, individuals who completed the neutral mood induction did not exhibit increases in negative cognition, providing evidence against the possibility that the MIP itself may lead to increases in negative cognition. These findings are discussed in relation to understanding the role of negative cognition and vulnerability to depression.

Relapse and recurrence prevention in depression: current research and future prospects

There is a growing body of literature which indicates that acute phases of psychotherapy are often ineffective in preventing relapse and recurrence in major depression. As a result, there is a need to develop and evaluate therapeutic approaches which aim to reduce the risk of relapse. This article provides a review of the empirical studies which have tested the prophylactic effects of therapy (cognitive-behavioral, mindfulness-based, and interpersonal psychotherapy) targeting relapse and recurrence in major depression. For definitional clarity, relapse is defined here as a return to full depressive symptomatology before an individual has reached a full recovery, whereas recurrence in defined as the onset of a new depressive episode after a full recovery has been achieved. Psychotherapeutic efforts to prevent relapse and recurrence in depression have been effective to varying degrees, and a number of variables appear to moderate the success of these approaches. A consistent finding has been that preventive cognitive-behavioral and mindfulness-based therapies are most effective for patients with three or more previous depressive episodes, and alternative explanations for this finding are discussed. It is noted, however, that a number of methodological limitations exist within this field of research, and so a set of hypotheses that may guide future studies in this area is provided.

Selective attention in depression: influence of emotionality and personal relevance

Selective attention to negative stimuli has been discussed as being an essential characteristic of depressive disorder. Theories and empirical data, however, are contradictory. The present study addressed the question of whether depressive patients selectively attend to negatively valenced and personally relevant or irrelevant stimuli and whether they habituate to these stimuli. Thirty-one inpatients with major depressive disorder and 37 healthy controls participated in the study. They underwent a modification of the emotional Stroop paradigm. The results indicated that personally relevant stimuli evoked more pronounced Stroop interference than did stimuli without personal relevance in all subjects. Furthermore, habituation to personally relevant negative stimuli was seen in both depressive patients and control subjects. The present findings question a generally negative attentional bias as being a specific characteristic of depressive disorder. Furthermore, as depressed patients habituated to personally relevant negative stimuli, exposure therapy might be suitable for the treatment of depressive disorder.