Treating major depression by creating positive expectations for the future: a pilot study for the effectiveness of future-directed therapy (FDT) on symptom severity and quality of life

'Who will I become?': possible selves and depression symptoms in adolescents

BACKGROUND

Adolescence is an important period for the development of the possible self. It is also a time when depression is prevalent. The cognitive theory of depression proposes that a negative view of the future is a key feature of depression. Targeting these negative thoughts about the future during cognitive behavioural therapy may be helpful in depression. However, little is known about how adolescents envisage their future (i.e. possible) self, or if the content is associated with affect. The aim of this quantitative study is to describe how adolescents describe their 'possible self' and examine the relationship between the valence of the possible self and depression in adolescents.

METHOD

Adolescents (n = 584) aged 13-18 years were recruited via opportunity sampling via their schools and completed measures of depression symptoms (the Mood and Feelings Questionnaire) and the 'possible self' (a variant of the 'I Will Be' task). Possible selves were coded for content and valence.

RESULTS

Despite depression severity, the most common possible selves generated by adolescents were positive and described interpersonal roles. The valence of the possible self was associated with depression severity but only accounted for 3.4% of the variance in severity.

CONCLUSION

The results support the cognitive model of depression. However, adolescents with elevated symptoms of depression were able to generate positive, possible selves and therefore may remain somewhat 'hopeful' about their future despite clinically significant depression symptoms. Future-oriented treatment approaches such as cognitive behavioural therapy that focus on changing unhelpful negative future thinking may not be appropriate for this population.

Depression Accompanied by Hopelessness Is Associated with More Negative Future Thinking

BACKGROUND

This study aimed to delineate the interplay between depression, hopelessness, and episodic future thinking (EFT), focusing on cognitive biases towards negative future thinking that are central to depressive symptomatically.

METHODS

A Japanese university student was utilized to scrutinize divergences in EFT across groups stratified by varying degrees of depression and hopelessness. The research leveraged a modified future thinking task (FTT), the Beck Hopelessness Scale, and the Beck Depression Inventory-II to gauge participants' levels of hopelessness and depressive symptoms.

RESULTS

Consistent with prior research, the non-depressed group showed a reduction in positive EFT, reinforcing the idea that diminished positive future thinking is a hallmark of depressive conditions, even in the absence of a clinical diagnosis. Moreover, individuals with comorbid depression and elevated hopelessness demonstrated a significant decrease in positive EFT and an increase in negative EFT, substantiating a distinctive cognitive profile for this subgroup. This finding suggests that the presence of hopelessness exacerbates the negative cognitive biases associated with depression.

CONCLUSIONS

The study emphasizes the importance of considering hopelessness as an independent construct when assessing EFT in clinical contexts. The pronounced impact of hopelessness on future thinking in those with depression suggests that targeted interventions, such as future-directed therapy (FDT), may be particularly effective for individuals with hopelessness depression by focusing on modifying negative future thinking patterns and enhancing life quality.

Hypnotically enhancing behavioral activation in the treatment of depression

Depressive disorders are common conditions associated with high personal and economic burdens. The best treatment outcomes occur in patients receiving both psychotherapy and antidepressant medications. Behavioral activation is one approach within the most widely available and studied psychotherapy frameworks (cognitive behavioral therapy, CBT) utilized for depression, and is effective in treating depression even in isolation from the rest of the CBT approach. Many hypnosis treatments for depression have been developed to incorporate various CBT techniques, including behavioral activation. However, research regarding the applications of hypnosis to facilitate behavioral activation has been slow to emerge. Addressing this relative gap in the literature may be possible through a broader review of the relevant literature. There is quality evidence speaking to the efficacy of diverse clinician-guided visualization or imagery exercises in the treatment of depression by means of behavioral activation. While not explicitly hypnosis, the similarities of these interventions to more typical hypnosis interventions are highly salient. Clinicians and researchers interested in hypnosis's applications to treating depression would benefit from adopting a more comprehensive consideration of the relevant literature.

Future focused strategies in treating depression

Depression commonly features the experience of hopelessness and a loss of the ability to imagine and believe in one's positive future. This article considers this important feature of depression and how effective recovery from depression includes the restoration of hope and a belief in actualizing a positive future. It provides in detail a treatment strategy that is focused on cocreating with the patient a positive therapeutic outcome in the patient's future and encourages patients to internalize a representation of the future experience of recovery and restoration of hope. This approach is described in detail and begins by guiding the client suffering from depression to experience a positive therapeutic outcome during hypnosis. This is followed by having the client internalize this positive resolution and recovery and integrate this experience on conscious and subconscious levels. As the client "returns from the future" to the present, bringing back with them this experience of having achieved a resolution and recovery from depression, this corrective emotional experience can affect their daily behavior in the present arising from a significant change in thoughts, feelings, and actions. Case examples that illustrate the use of the future focused strategy in clinical practice are included.

Affective forecasting and psychopathology: A scoping review

Affective forecasting - estimations of future emotional reactions - is an important aspect of future thinking that informs judgement and decision making. Biases in affective forecasting have been noted generally and with people with emotional disturbances specifically. Still, the role of affective forecasting within models of psychopathology has received little attention. Given the state of the literature, a scoping review method was adopted to summarize and synthesize the methodological approaches used in measuring affective forecasting within the context of psychopathology and the scope of the evidence on this association. Three databases were searched for research published on or before November 13th, 2023. Original quantitative research that examined affective forecasting and its association with psychopathology was reviewed. Data were charted using a form designed for this study. Overall, the review highlights the heterogeneity in operationalization of affective forecasting. The majority of the evidence supports an association between severity of psychopathology and intensity of affective forecasts, with notable exceptions, which are discussed within the scope of methodology and operationalization of affective forecasting. This remains an important process to investigate in information processing models of psychopathology to elucidate its role in the development and maintenance of psychopathology and potential as a target for intervention.

Links between mental health problems and future thinking from the perspective of adolescents with experience of depression and anxiety: a qualitative study

BACKGROUND

Depression and anxiety are common during adolescence and could have detrimental impacts on young people's ability to make and implement plans for their future. However, to the best of our knowledge, no other study has adopted a qualitative approach in investigating these effects from the perspective of adolescents with lived experiences of depression and anxiety. We sought to understand how young people perceive and interpret the impact of mental health conditions on their thinking about the future.

METHODS

We conducted semi-structured interviews with 19 adolescents aged 16-19 years in the UK (median age = 19, IQR = 1.5), who had a history of protracted periods of clinical or subclinical depression and/or anxiety. They were asked to reflect on how their ability to think about the future and the content of the future-related thinking was impacted during periods of poor mental health, compared with periods of feeling well. Interviews were transcribed verbatim and subjected to thematic content analysis.

RESULTS

Five domains were identified. First, the impact of mood on future thinking capability focuses on reduced ability and motivation to engage in future thinking. Second, the impact of mood on images, thoughts, and feelings about the future includes the emotional valence of future-related thoughts, their vividness, structure, and the extent to which they intimated subjective feelings of control (i.e., agency). Third, social influences focuses on social factors that might ameliorate or exacerbate future thinking. Fourth, reflections on personal worries and expectations about the future captures personal interpretations of past worries and hopes and how future thinking affected mood. Finally, personal coping refers to how young people cope with the negative emotions that come with future thinking.

CONCLUSIONS

This study provided a nuanced and granular account of how depression and anxiety impacted young people's future thinking based on their lived experiences. By highlighting the different ways that variations in future thinking were experienced as a function of depression and anxiety, our analysis highlighted new factors that should be considered in studies of adolescent mental health risk, which could inform the development of new therapeutic approaches.

Induced optimism to lessen hopelessness-related cognitions among young adults at risk for suicidal thoughts and behavior

Background

Hopelessness is one of the best-studied cognitive predictors of depression and suicide. Previous research suggests that hopelessness may develop through repetitive thinking about the occurrence of positive and negative future outcomes. The present study sought to investigate whether mental rehearsal in making optimistic future-event predictions, or induced optimism, would lead to reductions in hopelessness, particularly among individuals with a history of suicide ideation or suicide attempts.

Methods

Participants with (n = 58) and without (n = 76) a history of suicide ideation or attempts were randomly assigned to either practice making optimistic future-event predictions or to a control condition in which they practiced making a lexical decision (using the same stimuli) over three study sessions, each separated by one week.

Results

Findings offered modest support for the hypothesis that induced optimism would decrease hopelessness but not improve mood; this was regardless of history of suicide ideation or attempts.

Limitations

The sample was predominantly female, and assessment of suicide ideation and attempt history was not confirmed by clinical interview, which may limit generalizability.

Conclusion

Practice in making optimistic future-event predictions over time may be one way to reduce the hopelessness-related cognitions that confer vulnerability to suicide ideation and behavior.

The Effect of Perceived Tinnitus Disturbance on Hope

BACKGROUND

Although there are systematic reviews of the effects of tinnitus on quality of life, the relationship of tinnitus to hopefulness has not been examined.

PURPOSE

The purpose of this study was to determine the relationship between tinnitus distress and hope by comparing the severity of tinnitus to measures of hopefulness. This was done by comparing the Tinnitus Reaction Questionnaire (TRQ) to the following hope scales: the Herth Hope Scale (HHS) and the Herth Hope Index (HHI).

METHOD

Patients seen for a tinnitus evaluation in the University of Tennessee audiology clinic completed the TRQ, HHS, and HHI scales. Investigation of relationships between tinnitus assessment using the TRQ and measurements of hope (HHS and HHI) was performed via correlation analyses using Pearson coefficients and linear regression.

RESULTS

Significant correlations were found between overall scores on the TRQ and HHS, and TRQ and HHI, indicating that greater tinnitus distress was associated with lower levels of hope. Further analyses showed the HHS and HHI Domain 1, regarding temporality and future, as significantly related to tinnitus distress.

CONCLUSION

Significant correlations between tinnitus disturbance and hope suggest that potential interventions based on hopefulness may be of benefit for individuals suffering from tinnitus.

Moderating Impact of Dispositional Mindfulness in the Relationship Between Future Expectancies and Psychological Well-Being

OBJECTIVES

Mindfulness has been studied under cultivated or dispositional divisions where the latter has strong implications for psychological well-being in meditators and non-meditators alike. In addition, future expectations, or prospections, regarding the occurrence of important events in a person's future have recently been hypothesized to be the main cause behind symptoms of major depression. There is, however, a lack of empirical research looking at possible links between dispositional mindfulness, as understood in its facet structure, and future expectations as understood via perceived risk of occurrence and vividness of mental imagery when prompted to imagine a given list of positive and negative prospective event item lists. Therefore, this research aimed at examining how dispositional mindfulness may be related to probabilistic risk assessments of positive and negative future events (Stage I); and how mental imagery vividness may be moderated by mindfulness facets (Stage II).

METHODS

Both stages included healthy participants and incorporated the PROCESS macro for moderated regression analysis done with the SPSS software. Stage I included 204 voluntary college students, and Stage II was conducted online with a public sample of 110 adults.

RESULTS

Although no interaction effect was found in Stage I, nonreactivity to inner experience facet of dispositional mindfulness moderated the relationship between negative imagery vividness and psychological distress in Stage II (F_(1,103) = 4.00, R² change=.018, p <.05).

CONCLUSIONS

This is a novel finding that could inform a future line of research looking into the relationship between prospection and mindfulness, holding a potential for informing research on mindfulness-based interventions.

The Mediating Role of Time Perspective in the Relationship between Chronotype and Suicide in Bipolar Disorder

(1) Background: Suicide in patients with bipolar disorder (BD) is related to the chronotype of the person from a biological perspective. However, it is not known whether there is a relationship between suicide and psychological time in BD. The aim of our study was to evaluate the relationship between time perspective (TP) and suicide and the effect of TP on the relationship between suicide and chronotype in euthymic patients with BD. (2) Methods: We included 150 BD patients and 84 healthy controls in this cross-sectional study. We administered the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Beck Scale for Suicidal Ideation (BSSI), Zimbardo Time Perspective Inventory (ZTPI), and Morning−Evening Questionnaire (MEQ). (3) Results: There was a statistically significant difference between the median scores of past negative TP, present fatalistic TP, future TP, and MEQ total score (p < 0.001, p < 0.001, p = 0.010, and p = 0.020, respectively). There was a significant correlation between past negative TP, future TP, MEQ scores, and BSSI scores in the patient group (p < 0.001, p = 0.018, and p = 0.028, respectively). An inverse and significant relationship between the MEQ total score and BSSI score and TP types had a mediator role in this relationship. (4) Conclusions: Our study shows that TP, which evaluates time from a psychological perspective, has a direct relationship with suicidal ideation and a mediating role in the relationship between chronotype and suicide. According to our results, we can conclude that ZTPI can also be used to evaluate the risk of suicidality in patients with BD. Appropriate therapy methods for TP may help to prevent some suicide attempts.

Future projection therapy: Techniques and case examples

As noted by some recent authors, psychotherapy has traditionally focused primarily on how the past affects present functioning. For example, in the hypnosis literature, there is much written about age regression and more recently there has been a focus on the future. In the 1950's there was discussions about embodying expectancy and pseudo-orientation-in-time, but there was not much in the literature again until the 1980's and thereafter about the importance of future focus. Some authors refer to future work as age progression. This article summarizes a "future projection" approach including why this terminology appears more suited for the approach. Techniques and strategies are described. Six case examples are presented covering varied clinical issues in which there was evidence of positive change.

Aberrant social feedback processing and its impact on memory, social evaluation, and decision-making among individuals with depressive symptoms

BACKGROUND

Depression is associated with aberrant social feedback processing. However, little is known about the impact of these deficits on individuals' memory, social evaluation, and social decision-making.

METHODS

We examined event-related potentials (ERPs) during the processing of social feedback with different emotional valences and intensities, among individuals with high and low depressive symptoms. After three days, participants performed a recall test, along with social evaluation and money allocation.

RESULTS

Compared with the control group, participants with depressive symptoms showed larger occipital P1 and parietal P3 amplitudes to negative social feedback, as well as larger frontal feedback-related negativity toward highly positive social feedback; this indicates toward altered attentional allocation, encoding, and anticipation in social feedback processing. After three days of social feedback processing, individuals in the depressive symptom group recalled negative social feedback better and gave less positive evaluations and allocated less money to the senders of highly negative social feedback compared with control group participants. Notably, ERPs predicted subsequent memory, social evaluation, and decision-making, suggesting a significant impact of aberrant social feedback processing on social cognition and behaviors in depression.

LIMITATIONS

Individuals with depressive symptoms rather than patients with depressive disorders were recruited and therefore caution is needed in applying the findings to clinical populations.

CONCLUSIONS

Individuals with depressive symptoms exhibit negative bias in anticipation, attentional allocation, and encoding processes during social feedback processing, which further influences their memory, social evaluation, and social decision-making in the long run. These aberrant biases should be targeted to prevent the development of major depressive disorders.

COVID-19 associated psychological symptoms in Turkish population: A path model

We investigated the mediator roles of risk factors (intolerance of uncertainty, negative metacognition, and negative prospections) and protective factors (positive prospections and psychological resilience) together on the link between COVID-19-related feelings and behaviors, thoughts, and precautions taken and psychological symptoms with an integrative approach in Turkey. The online sample consisted of Turkish adults. The results of path analyses indicated that feelings and behaviors related to COVID-19, thoughts about COVID-19, and precautions taken related to COVID-19 are significantly associated with intolerance of uncertainty. Intolerance of uncertainty is significantly associated with negative metacognition, negative and positive prospections, psychological symptoms, and psychological resilience. Negative metacognition, negative and positive prospections, and psychological resilience are significantly associated with psychological symptoms. Mediation analysis demonstrated that intolerance of uncertainty significantly mediated the relationship between feelings and behaviors related to COVID-19, thoughts about COVID-19, and precautions taken related to COVID-19 and negative metacognition, psychological resilience, positive and negative prospections, and psychological symptoms. Lastly, negative metacognition, psychological resilience, positive and negative prospections significantly mediated the relationship between intolerance of uncertainty and psychological symptoms. Implications for mental health providers are discussed.

Distorted Cognitive Processes in Major Depression: A Predictive Processing Perspective

The cognitive model of depression has significantly influenced the understanding of distorted cognitive processes in major depression; however, this model's conception of cognition has recently been criticized as possibly too broad and unspecific. In this review, we connect insights from cognitive neuroscience and psychiatry to suggest that the traditional cognitive model may benefit from a reformulation that takes current Bayesian models of the brain into account. Appealing to a predictive processing account, we explain that healthy human learning is normally based on making predictions and experiencing discrepancies between predicted and actual events or experiences. We present evidence suggesting that this learning mechanism is distorted in depression: current research indicates that people with depression tend to negatively reappraise or disregard positive information that disconfirms negative expectations, thus resulting in sustained negative predictions and biased learning. We also review the neurophysiological correlates of such deficits in processing prediction errors in people with depression. Synthesizing these findings, we propose a novel mechanistic model of depression suggesting that people with depression have the tendency to predominantly expect negative events or experiences, which they subjectively feel confirmed due to reappraisal of disconfirming evidence, thus creating a self-reinforcing negative feedback loop. Computationally, we consider too much precision afforded to negative prior beliefs as the main candidate of pathology, accompanied by an attenuation of positive prediction errors. We conclude by outlining some directions for future research into the understanding of the behavioral and neurophysiological underpinnings of this model and point to clinical implications of it.

Further Specifying the Cognitive Model of Depression: Situational Expectations and Global Cognitions as Predictors of Depressive Symptoms

The cognitive model of depression assumes that depressive symptoms are influenced by dysfunctional cognitions. To further specify this model, the present study aimed to examine the influence of different types of cognitions on depressive symptoms, i.e., situational expectations and global cognitions. It was hypothesized that situational expectations predict depressive symptoms beyond global cognitions.

The present study examined a clinical (N = 91) and a healthy sample (N = 80) using longitudinal data with a baseline assessment and a follow-up five months later. Although the study was not designed as an interventional trial, participants from the clinical study received non-manualized cognitive-behavioral treatment after the baseline assessment.

We examined situational expectations, intermediate beliefs, dispositional optimism, and generalized expectancies for negative mood regulation as predictors of depressive symptoms. Hypotheses were tested using multiple hierarchical linear regression analyses.

Results indicate that, although there were significant correlations between the cognitive factors and depressive symptoms, in both samples neither global cognitions, nor situational expectations significantly predicted depressive symptoms at the five-month follow-up.

The present study could, contrary to the hypotheses, not provide evidence for a significant impact of cognitive vulnerabilities on depressive symptoms, presumably due to high drop-out rates at follow-up. Limitations of the study and directions for future research are critically discussed.

Situational and global cognitions were examined as predictors of depressive symptoms.

In a healthy and a clinical sample, cognitive factors were correlated with depressive symptoms.

However, in both samples depressive symptoms at follow-up were not predicted by cognitive factors.

The Predictive Value of Emotional Intelligence for Internet Gaming Disorder: A 1-Year Longitudinal Study

This one-year longitudinal study examined trait emotional intelligence as a predictor of Internet gaming disorder (IGD). To date, only cross-sectional research has been conducted to test the protective effects of emotional intelligence against IGD tendency. Based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study aimed to address the research gap by examining not only the direct effects of trait emotional intelligence, but also its indirect effects (via depressive symptoms and coping flexibility) on IGD, with both a cross-sectional and longitudinal design. The participants were 282 Chinese university students (mean age = 20.47; 39.4% males) who voluntarily completed an anonymous questionnaire at both baseline (W1) and one-year follow-up (W2). Path analysis results revealed that trait emotional intelligence had a protective but indirect effect on IGD tendency in both our cross-sectional and longitudinal data. Depression was found to have a significant, full mediating effect on the relationship between: (i) trait emotional intelligence and IGD tendency (W2) and (ii) coping flexibility and IGD tendency (W2), after adjusting for IGD tendency at the baseline (W1). Gender invariance of the path coefficient was also observed in the prospective model. This study provided longitudinal evidence to support the I-PACE model. Interventions should address both IGD and depressive symptoms, and school-based workshops to increase emotional intelligence and coping flexibility are also recommended.

Why dysfunctional expectations in depression persist - Results from two experimental studies investigating cognitive immunization

BACKGROUND

Research has revealed that negative expectations impact depressive symptoms. However, research on the change of dysfunctional expectations in depression is lacking so far. Therefore, the present research aimed to fill this gap by testing the hypothesis that people with the major depressive disorder (MDD), contrary to healthy individuals, maintain their expectations despite experiences that positively disconfirm expectations. Further, it was hypothesized that cognitive immunization (a cognitive reappraisal of the disconfirming evidence) is a mechanism underlying the persistence of expectations.

METHOD

In Study 1, we compared individuals with MDD (N = 58) to healthy individuals (N = 59). Participants worked on the same performance test and received standardized feedback that either confirmed or disconfirmed their initial performance expectations. In Study 2, we investigated the effects of cognitive immunization on expectation change among 59 individuals reporting elevated levels of depression by varying the appraisal of expectation-disconfirming feedback.

RESULTS

Results from Study 1 show that in the expectation-disconfirming condition, healthy individuals changed their expectations, whereas individuals with MDD did not. No such difference between the two groups was found for expectation-confirming feedback. Results from Study 2 indicated that varying cognitive immunization impacted expectation change, thus suggesting a crucial role of cognitive immunization in expectation change.

CONCLUSIONS

These two studies indicated that individuals suffering from depression have more difficulties in changing their expectations after disconfirming experiences than do healthy individuals, and cognitive immunization might be a core mechanism underlying expectation persistence. Therefore, psychotherapeutic interventions should aim to inhibit cognitive immunization processes to enhance expectation change.

Future orientation buffers depression in daily and specific stress

Future orientation has been regarded as a protective factor that helps prevent problem behaviors, such as drug and alcohol use, smoking, and unprotected sex. Recently, many studies have focused on the relationship between a person's orientation towards the future and his or her depression symptoms; however, relatively few studies have explored the effect of future orientation on depressive responses to ordinary stress. The present study aimed to test whether future orientation could be a protective factor against depression in ordinary stress contexts. We conducted two studies to test this hypothesis and recruited 369 participants. Study 1 was a cross-sectional study that involved 217 employees from a food-processing company and examined the effect of future orientation in a daily stress context. Study 2 tested a hierarchical linear model in which 152 college students from an examination training institution in Beijing completed a five-wave assessment with 3-week intervals before taking the national entrance examination for postgraduate studies. The results showed that future orientation moderated the stress-depression relationship in the two samples. The present study provides evidence supporting the hypothesis that future orientation helps individuals cope with stress and protects people from depression, suggesting that future orientation plays a protective role in the stress-depression relationship.

A review on future episodic thinking in mood and anxiety disorders

Future episodic thinking refers to the ability to imagine oneself in the future and project oneself into specific future events. This cognitive process is related to decision making and planning for the future. Although healthy populations commonly project themselves into the future (e.g. while planning a trip or career), patients with mood disorders show impairment in this ability. In this review article, we discuss the similarities and differences in future thinking among the following populations: major depressive disorder, dysphoria, anxiety, and post-traumatic stress disorder (PTSD). Importantly, we highlight the methodological variations in future episodic memory tasks in the literature that may explain the differences in the existing results.

The Functions of Prospection - Variations in Health and Disease

Much of human life revolves around anticipating and planning for the future. It has become increasingly clear that this capacity for prospective cognition is a core adaptive function of the mind. Here, we review the role of prospection in two key functional domains: goal-directed behavior and flexible decision-making. We then survey and categorize variations in prospection, with a particular focus on functional impact in clinical psychological conditions and neurological disorders. Finally, we suggest avenues for future research into the functions of prospection and the manner in which these functions can shift toward maladaptive outcomes. In doing so, we consider the conceptualization and measurement of prospection, as well as novel approaches to its augmentation in healthy people and managing its alterations in a clinical context.

Situational expectations mediate the effect of global beliefs on depressive symptoms: a 1-year prospective study using a student sample

PURPOSE OF REVIEW

Recent research suggests that expectations might be a particularly important subgroup of cognitions in major depression. The present study aimed to further specify the role of situation-specific dysfunctional expectations (SDEs) in the development of depressive symptoms. It was hypothesized that the effects of intermediate beliefs and dispositional optimism on depressive symptoms would be mediated via SDEs.

RECENT FINDINGS

We examined 125 students (age M = 22.05, SD = 4.00, 74.6% women) using a longitudinal design with a 1-year follow-up. Questionnaires used in the study included the Depressive Expectations Scale, Dysfunctional Attitudes Scale, Life Orientation Test and Beck's Depression Inventory. When considering SDEs at baseline as mediator variable, neither intermediate beliefs nor dispositional optimism had significant direct effects on depressive symptoms. Instead, their effects were fully mediated via SDEs. When considering SDEs at the follow-up as the mediator variable, SDEs partly mediated the effects of intermediate beliefs and dispositional optimism on depressive symptoms.

SUMMARY

The study provides further evidence for a cognitive mediational model, suggesting that SDEs mediate the effects of rather global beliefs (such as intermediate beliefs and dispositional optimism) on depressive symptoms. Due to their high level of situational specificity, SDEs might be an effective target for cognitive-behavioural interventions.

Introducing an EXperimental Paradigm to investigate Expectation Change (EXPEC)

BACKGROUND AND OBJECTIVES

Dysfunctional expectations are considered to be core features of various mental disorders. Clinical observations suggest that people suffering from mental disorders such as major depression tend to maintain dysfunctional expectations despite expectation-disconfirming evidence. Surprisingly, this clinically relevant phenomenon has not yet sufficiently been investigated in empirical studies. Therefore, we developed an experimental paradigm to investigate expectation change vs. maintenance, and the first step to test its validity is to apply it in healthy individuals.

METHODS

After conducting two pilot studies (n = 28; n = 37), the present study systematically examined whether it is possible to change healthy individuals' (n = 102) task-specific and generalized performance expectations through expectation-disconfirming experiences. Using a standardized instruction, we initially induced non-positive expectations regarding participants' ability to successfully work on an unknown test. Then, participants received standardized performance feedback that either confirmed or disconfirmed their expectations before assessing participants' expectations again after completing the Test for the Measure of Emotional Intelligence.

RESULTS

Results indicate that expectation-disconfirming feedback led to a significant change of both task-specific and generalized performance expectations. There was no expectation change in the expectation-confirming condition.

LIMITATIONS

As the present study examined expectation change among healthy individuals, the next step is to apply this paradigm in a clinical sample and to examine whether expectation change is less likely among people suffering from depression or other mental disorders characterized by dysfunctional expectations.

CONCLUSIONS

Focusing more rigorously on expectation maintenance among people with mental disorders could enable therapists to develop expectation-focused interventions aiming at enhancing expectation change.

Integrating situation-specific dysfunctional expectations and dispositional optimism into the cognitive model of depression - A path-analytic approach

BACKGROUND

Dysfunctional expectations are considered to be core features of mental disorders and, in particular, major depression. The aim of the present study was to integrate two important types of expectations into the cognitive model of depression: situation-specific dysfunctional expectations (SDE) and dispositional optimism (DO). It was hypothesized that the influence of both DO and intermediate beliefs (IB) on depressive symptoms would be mediated via SDE.

METHODS

We examined 95 individuals (age M = 40.7, 68.1% female) with a diagnosed major depressive disorder from two inpatient clinics and one outpatient clinic. Measurements used in the study included the Depressive Expectations Scale, Dysfunctional Attitudes Scale, Life Orientation Test Revised, and Beck's Depression Inventory-II. Relationships between the constructs were analyzed using path-analytic models with bias-corrected bootstrapping confidence intervals.

RESULTS

Results indicate that the effect of IB on depressive symptoms was fully mediated via SDE, while the effect of DO on depressive symptoms was partly mediated via SDE. IB and DO moderately correlated with each other.

LIMITATIONS

Due to the cross-sectional design of the study, it is not possible to draw unambiguous conclusions regarding the causality of the suggested relationships.

CONCLUSIONS

The present study stresses the crucial role of dysfunctional expectations for major depression. Moreover, it reveals that SDEs as expectations with a high level of situational specificity may pose an important link between global cognitions and depressive symptoms. Given this situational specificity, SDEs are amenable to disconfirmation through behavioral experiments and may therefore be a promising target for cognitive-behavioral interventions.

Focusing on situation-specific expectations in major depression as basis for behavioural experiments - Development of the Depressive Expectations Scale

OBJECTIVES

Dysfunctional expectations are considered to be core features of various mental disorders. The aim of the study was to develop the Depressive Expectations Scale (DES) as a depression-specific measure for the assessment of dysfunctional expectations. Whereas previous research primarily focused on general cognitions and attitudes, the DES assesses 25 future-directed expectations (originally 75 items) which are situation-specific and falsifiable.

DESIGN AND METHODS

To evaluate the psychometric properties of the DES, the scale was completed by 175 participants with and without severe depressive symptoms in an online survey. Participants additionally completed the Patient Health Questionnaire modules for depression (PHQ-9) and anxiety (GAD-7). People experiencing depressive symptoms were informed about the study with the help of self-help organizations.

RESULTS

Reliability analyses indicated excellent internal consistency of the scale. An exploratory factor analyses revealed four factors: social rejection, social support, mood regulation, and ability to perform. The DES sum score strongly correlated with the severity of depressive symptoms. The DES sum score also significantly correlated with symptoms of generalized anxiety.

CONCLUSION

The DES was shown to have excellent reliability; validity analyses were promising. As the DES items are situation-specific and falsifiable, they can be tested by the individual using behavioural experiments and may therefore facilitate cognitive restructuring. Thus, a structured assessment of patients' expectation with help of the DES can provide a basis for interventions within cognitive-behavioural treatment of depression.

PRACTITIONER POINTS

Assessing situation-specific expectations in patients experiencing depressive symptoms can provide a basis for the conduction of behavioural experiments to test patients' expectations. For the use of behavioural experiments, therapists should choose those dysfunctional expectations which a patient strongly agrees on. To modify patients' expectations, they should be exposed to situations where the discrepancy between patients' expectations and actual situational outcomes can be maximized. The Depressive Expectations Scale can be completed repeatedly to monitor a patient's progress within cognitive-behavioural treatment.

Reward Processing, Neuroeconomics, and Psychopathology

Abnormal reward processing is a prominent transdiagnostic feature of psychopathology. The present review provides a framework for considering the different aspects of reward processing and their assessment, and highlights recent insights from the field of neuroeconomics that may aid in understanding these processes. Although altered reward processing in psychopathology has often been treated as a general hypo- or hyperresponsivity to reward, increasing data indicate that a comprehensive understanding of reward dysfunction requires characterization within more specific reward-processing domains, including subjective valuation, discounting, hedonics, reward anticipation and facilitation, and reinforcement learning. As such, more nuanced models of the nature of these abnormalities are needed. We describe several processing abnormalities capable of producing the types of selective alterations in reward-related behavior observed in different forms of psychopathology, including (mal)adaptive scaling and anchoring, dysfunctional weighting of reward and cost variables, competition between valuation systems, and reward prediction error signaling.

On the Maintenance of Expectations in Major Depression - Investigating a Neglected Phenomenon

In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.

Unveiling the Structure of Cognitive Vulnerability for Depression: Specificity and Overlap

There is extensive literature establishing the influence of rumination, hopelessness, and dysfunctional attitudes on depressive symptoms. However, it is unclear whether these vulnerability factors are distinctly related to depressive symptoms or show substantial overlap. In two large samples of undergraduates (Study #1, n = 304; Study #2, n = 491) and two samples of clinically depressed individuals (Study #3, n = 141; Study #4, n = 109, from published studies), questionnaire data were used to examine the relationship between cognitive vulnerability factors and depressive symptoms, along with additional measures of anxiety and stress symptoms. To decompose model fit into its specific and common partitions, we relied on commonality analysis (CA). CA showed that there is substantial overlap in cognitive risk factors for depression. Moreover, we found strong evidence that hopelessness provides a unique statistical contribution to depression. This pattern of findings was stable in healthy as well as clinical samples. Symptom-levels analysis revealed that a specific subset of depressive symptoms are associated with hopelessness. In closing, we showed that CA provides a powerful tool to map unique and overlapping variance between multiple risk factors. Moreover, hopelessness emerged to be an important focus of clinical attention.

Patient-reported functioning in major depressive disorder

OBJECTIVES

Compared with the general population, patients with major depressive disorder (MDD) report substantial deficits in their functioning that often go beyond the clinical resolution of depressive symptoms. This study examines the impact of MDD and its treatment on functioning.

METHODS

From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult outpatients with MDD at entry and exit points of each level of antidepressant treatment and again 12 months post treatment. Functioning was measured using the Work and Social Adjustment Scale (WSAS).

RESULTS

The results show that only 7% of patients with MDD reported within-normal functioning before treatment. The proportion of patients achieving within-normal functioning (WSAS) scores significantly increased after treatment. However, the majority of patients (>60%) were still in the abnormal range on functioning at exit. Although remitted patients had greater improvements compared with nonremitters, a moderate proportion of remitted patients continued to experience ongoing deficits in functioning after treatment (20-40%). Follow-up data show that the proportions of patients experiencing normal scores for functioning after 12 months significantly decreased from the end of treatment to the follow-up phase, from 60.1% to 49% (p < 0.0001), a finding that was particularly significant in nonremitters. Limitations of this study include the reliance on self-report of functioning and the lack of information on patients who dropped out.

CONCLUSION

This study points to the importance of functional outcomes of MDD treatment as well as the need to develop personalized interventions to improve functioning in MDD.

Quality of Life Enhancement Programme for Individuals with Mood Disorder: A Randomized Controlled Pilot Study

Objective/Background

To investigate the efficacy and feasibility of the Quality of Life Enhancement Programme (QOLEP) for individuals with mood disorder.

Methods

Twenty-one individuals with mood disorder were recruited from psychiatric rehabilitation centres in Taipei City and were randomly assigned to either the treatment group (N = 11) or the control group (N = 10). The treatment group received an 8-week QOLEP. The control group received only “phone contact”, which included support for everyday situations pertaining to daily life and emotions. The primary outcome measure was evaluating improvements in quality of life using the World Health Organization Quality of Life-BREF-Taiwan version questionnaire. The feasibility of the intervention was assessed by the recruitment rate, dropout rate of the participants, and by its content and delivery. The content and delivery were assessed by the group satisfaction questionnaire. The mixed-effects linear model was applied to analyze the efficacy of QOLEP.

Results

The individuals who participated in the eight-session QOLEP showed significant improvement in their level of depression compared with the control group [pre vs. post, treatment group: 25.8 (19.2) vs. 17.8 (13.1); control group: 13.3 (17.3) vs. 13.3 (14.4)]. The criteria of feasibility were met in this study. Most of the participants were satisfied with engaging in the QOLEP activities within a supportive environment.

Conclusion

The participants who received the 8-week QOLEP demonstrated significant improvement in the level of depression. Studies with a sample size of at least 104 participants are recommended in the future.

Life Adaptation Skills Training (LAST) for persons with depression: A randomized controlled study

BAKGROUND

To investigate the efficacy of the "Life Adaptation Skills Training (LAST)" program for persons with depression.

METHODS

Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33), or a control group (N=35). The intervention group received 24-sessions of the LAST program, as well as phone contact mainly related to support for a total of 24 times. The control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of Life-BREF-Taiwan version. Secondary outcome measures included the Occupational self-assessment, the Mastery scale, the Social support questionnaire, the Beck anxiety inventory, the Beck depression inventory-II, and the Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the incremental efficacy of the LAST program, and the partial eta squared (ηp(2)) was used to examine the within- and between- group effect size.

RESULTS

The subjects who participated in the LAST program showed significant incremental improvements with moderate to large between-group effect sizes on their level of anxiety (-5.45±2.34, p<0.05; ηp(2)=0.083) and level of suicidal ideation (-3.09±1.11, p<0.01; ηp(2)=0.157) when compared to the control group. The reduction of suicidal ideations had a maintenance effect for three months after the end of intervention (-3.44±1.09, p<0.01), with moderate between-group effect sizes (ηp(2)=0.101). Both groups showed significant improvement on overall QOL, overall health, physical QOL, psychological QOL, level of anxiety, and level of depression. The within-group effect sizes achieved large effects in the intervention group (ηp(2)=0.328-0.544), and were larger than that of the control group.

LIMITATIONS

A small sample size in the study, a high dropout rate, lower compliance rates for the intervention group, and lacking of true control group.

CONCLUSIONS

The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of anxiety and suicidal ideations for persons with depression.

A time to be stressed? Time perspectives and cortisol dynamics among healthy adults

Perceptions of past, present, and future events may be related to stress pathophysiology. We assessed whether Time Perspective (TP) is associated with cortisol dynamics among healthy adults (N=61, Ages=18-35, M=22.9, SD=4.1) exposed to the Trier Social Stress Test (TSST). TP was measured according to two profiles: maladaptive Deviation from Balanced TP (DBTP) and adaptive Deviation from Negative TP (DNTP). Eight salivary cortisol samples were analyzed using area under the curve with respect to ground (AUCg) and to increase (AUCi). Statistic analyses involved partial correlations controlling for depressive symptoms. Results for both sexes showed that higher DBTP scores were associated with lower cortisol AUCg scores, while higher DNTP scores were associated with higher cortisol AUCg scores. These novel findings suggest that maladaptive TP profiles influence hypocortisolism, whereas adaptive TP profiles influence hypercortisolism. Thus, TP profiles may impact conditions characterized by altered cortisol concentrations.

Navigating Into the Future or Driven by the Past

Prospection (Gilbert & Wilson, 2007), the representation of possible futures, is a ubiquitous feature of the human mind. Much psychological theory and practice, in contrast, has understood human action as determined by the past and viewed any such teleology (selection of action in light of goals) as a violation of natural law because the future cannot act on the present. Prospection involves no backward causation; rather, it is guidance not by the future itself but by present, evaluative representations of possible future states. These representations can be understood minimally as "If X, then Y" conditionals, and the process of prospection can be understood as the generation and evaluation of these conditionals. We review the history of the attempt to cast teleology out of science, culminating in the failures of behaviorism and psychoanalysis to account adequately for action without teleology. A wide range of evidence suggests that prospection is a central organizing feature of perception, cognition, affect, memory, motivation, and action. The authors speculate that prospection casts new light on why subjectivity is part of consciousness, what is "free" and "willing" in "free will," and on mental disorders and their treatment. Viewing behavior as driven by the past was a powerful framework that helped create scientific psychology, but accumulating evidence in a wide range of areas of research suggests a shift in framework, in which navigation into the future is seen as a core organizing principle of animal and human behavior.

Depression and prospection

OBJECTIVES

Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions.

METHODS

We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive.

RESULTS

Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further.

CONCLUSIONS

Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.

Future orientation and health quality of life in primary care: vitality as a mediator

PURPOSE

Temporal perspective, including views about future goals, may influence motivational processes related to health. An adaptive sense of future orientation is linked to better health, but little research has examined potential underlying factors, such as vitality.

METHOD

In a sample of 101 primary care patients, we examined whether belief in the changeability of the future was related to mental and physical energization and, in turn, to health-related quality of life. Participants were working, uninsured primary care patients, who completed self-report measures of future orientation, vitality, and health-related quality of life.

RESULTS

Mediation models, covarying age, sex, and race/ethnicity indicated that vitality significantly mediated the association between future orientation and the outcomes of general health, mental health, social functioning, bodily pain, and role limitations due to emotional and physical reasons. Vitality exerted an indirect-only effect on the relation between future orientation and physical functioning.

CONCLUSIONS

Our findings suggest that adaptive beliefs about the future may promote, or allow access to, physical and mental energy and, in turn, may result in better mental and physical health functioning. Individual-level and public health interventions designed to promote future orientation and vitality may beneficially influence quality of life and well-being.

Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial

AIMS

To examine the health-related quality of life (HRQOL) in patients with transient ischemic attack (TIA) or minor stroke and assess the impact of recurrent stroke on HRQOL.

METHODS

Health-related quality of life data on patients participated in the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial were analyzed. The available 90-day EuroQoL data (EQ-5D) were used to calculate EQ-5D index score. Poor HRQOL was defined as an EQ-5D index score ≤0.5. The characteristics of HRQOL and factors predicting poor HRQOL in these patients were then explored.

RESULTS

Among the total 5170 patients enrolled, 90-day HRQOL data were obtained from 5104 patients for analysis. The mean EQ-5D index score at day 90 was 0.88 ± 0.21 for all patients, but only 0.42 ± 0.35 for those with recurrent strokes. Poor 90-day HRQOL was found in 294 (5.8%) patients. Patients with poor HRQOL had more strokes during follow-up than patients with good HRQOL (94.9 vs. 4.7%, P < 0.001). Age, history of hypertension and diabetes, and NIHSS at baseline were independent risk factors for predicting poor HRQOL. Stroke recurrence, NIHSS at baseline, age, and minor stroke on admission became independent risk factors once stroke recurrence was added into the model.

CONCLUSIONS

Stroke recurrence was associated with poor HRQOL in patients with TIA or minor strokes. Interventions focusing on controlling risk factors and prevention of worsening of neurological function may prevent poor HRQOL in these patients.

Protein kinase C is essential for kainate-induced anxiety-related behavior and glutamatergic synapse upregulation in prelimbic cortex

AIM

Anxiety is one of common mood disorders, in which the deficit of serotonergic and GABAergic synaptic functions in the amygdala and prefrontal cortex is believed to be involved. The pathological changes at the glutamatergic synapses and neurons in these brain regions as well as their underlying mechanisms remain elusive, which we aim to investigate.

METHODS

An agonist of kainate-type glutamate receptors, kainic acid, was applied to induce anxiety-related behaviors. The morphology and functions of glutamatergic synapses in the prelimbic region of mouse prefrontal cortex were analyzed using cellular imaging and electrophysiology.

RESULTS

After kainate-induced anxiety is onset, the signal transmission at the glutamatergic synapses is upregulated, and the dendritic spine heads are enlarged. In terms of the molecular mechanisms, the upregulated synaptic plasticity is associated with the expression of more protein kinase C (PKC) in the dendritic spines. Chelerythrine, a PKC inhibitor, reverses kainate-induced anxiety and anxiety-related glutamatergic synapse upregulation.

CONCLUSION

The activation of glutamatergic kainate-type receptors leads to anxiety-related behaviors and glutamatergic synapse upregulation through protein kinase C in the prelimbic region of the mouse prefrontal cortex.

Hope and expectancies for future events in depression

The present study investigated prospective cognition with the Hope scale (Snyder et al., 1991) and the Unrealistic Optimism Scale (Weinstein, 1980) in clinically depressed (CD; n = 61), previously depressed (PD; n = 42), and never depressed controls (ND; n = 46). In line with previous research, significant negative correlations between hope and symptoms of depression were found. Previously depressed reported lower levels of hope than NDs, but were more hopeful than CDs. In addition, relationships between depressive symptoms, dysfunctional attitudes, and expectations for the future were examined. As hypothesized, the CDs estimated their probability of experiencing positive events in the future as lower and their probability of experiencing negative events as higher than the two other groups. The PDs differed not from the NDs in their probability estimates. Implications of the findings are discussed.

Improving Quality of Life for Patients with Major Depressive Disorder by Increasing Hope and Positive Expectations with Future Directed Therapy (FDT)

OBJECTIVE

Impaired quality of life is a significant problem for people with major depressive disorder and is often not addressed through symptom remediation alone. This study examines a new therapy for the treatment for depression that focuses on reducing hopelessness and increasing positive future anticipation, which are factors posited to contribute to quality of life. The new treatment was compared to depressed patients in the same setting treated with group cognitive behavioral therapy.

DESIGN

This study used a quasi-experimental design to examine the differences between future directed therapy and cognitive behavioral therapy on improving quality of life in patients with major depressive disorder. The main variables assessed at pre and post-treatment were quality of life, depressive symptoms, and hopelessness.

SETTING

Outpatient Department of Psychiatry Cedars-Sinai Medical Center Participants: Twenty-two patients completed the future directed therapy intervention and 20 patients completed the cognitive behavioral therapy intervention.

MEASUREMENTS

Patient-reported outcomes were collected using the Quick Inventory of Depressive Symptoms, the Beck Hopelessness Scale, and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form.

RESULTS

Though both treatments were effective at improving depression, hopelessness and positive future anticipation, those patients treated with future directed therapy demonstrated significant improvements in quality of life (p=0.002) while those treated in the cognitive behavioral therapy group did not (p=0.463). The magnitude of change for the main variables was significantly larger in the future directed therapy group and change in hopelessness and change in positive anticipation predicted change in quality of life in the future directed therapy group but not the cognitive behavioral therapy group.

CONCLUSIONS

Future directed therapy is a useful treatment for patients with major depressive disorder and quality of life impairment.

Quality of life in obsessive compulsive disorder

Obsessive-compulsive disorder (OCD) has a profound impact with a high disease burden. In order to truly understand the scope of the effect OCD has on the patient population, one must take into account not only the relentless symptoms beleaguering the patients but also examine their overall ability to enjoy their life. Quality of life (QOL) assessments/improvements are becoming an increasingly important component of healthcare, especially in the mental health field. This review examines QOL in OCD, as well as the influence of comorbidities, and the impact that OCD treatment has on QOL. We searched MEDLINE/PUBMED and PsycINFO databases from 1980-2011 using keywords "obsessive compulsive disorder" OR "OCD" AND "quality of life" OR "QOL." Fifty-eight studies meeting specific selection criteria were ultimately included in this review. The results show that QOL in OCD is significantly impaired when compared to QOL in the general population and in patients with other psychiatric and medical disorders. Likewise, QOL in OCD also appears to be largely affected by comorbid conditions, which should be taken into account when developing a treatment plan. Furthermore, QOL in OCD has been shown to improve with medications and with both individual and group psychotherapy, albeit not to the levels enjoyed by community norms. QOL assessment in both clinical and research settings is important to examine the disease burden, to monitor treatment effectiveness, and to determine full recovery from OCD. Treatment providers should strive to not only reach symptom abatement, but also to assure that patients have regained satisfaction and functioning in their daily lives.

The importance of quality of life in patients with alcohol abuse and dependence

LEARNING OBJECTIVES

After participating in this educational activity, the reader should be better able to identify the instruments that are currently being used to measure quality of life (QoL) in alcohol abuse and dependence; determine the impact of alcohol abuse and dependence on QoL; and evaluate the impact of treating alcohol abuse and dependence on QoL.

OBJECTIVE

Quality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. This review aims to examine QoL in alcohol abuse and dependence by reviewing the instruments used to measure it and by analyzing the impact of alcohol abuse and dependence and of treatment on QoL.

METHODS

Studies were identified using a database search of PubMed and PsycINFO from the past 40 years (1971-2011) using the following keywords: abuse OR dependence, OR use AND alcohol, AND Quality of Life, QoL, Health-related quality of life, HRQOL. Two authors agreed independently on including 50 studies that met specific selection criteria.

RESULTS

Although several global measures of QoL have established reliability and validity, many alcohol-specific measures of QoL have not yet been validated. Nevertheless, QoL has been shown to be significantly impaired in those with alcohol abuse and dependence, particularly in the domains of mental health and social functioning, the very areas that show the greatest improvement with abstinence and its maintenance. Moreover, the literature demonstrates the utility of using QoL measures throughout assessment and treatment as a motivational tool and as a marker for treatment efficacy.

CONCLUSIONS

Measuring and monitoring QoL during assessment and treatment can add important value to patient recovery, for QoL improves with treatment and successful abstinence. Therefore, targeted, disease-specific assessments of QoL are warranted to address the impairments in the physical, mental, and social domains in alcohol abuse and dependence, thereby improving long-term outcomes.

Emotional responding in depression: distinctions in the time course of emotion

The current studies were designed to investigate if the emotion context insensitivity hypothesis (ECI; Rottenberg & Gotlib, 2004) is applicable across the time course of emotion. Recent affective science research has pointed to the importance of considering anticipation and maintenance of emotion. In the current studies, we assessed emotion responses among college students with depression symptoms in anticipation of, during, and after an emotional picture using the emotion modulated startle paradigm. People with and without depression symptoms did not differ in blink magnitude in anticipation of emotional pictures suggesting that some anticipatory processes may not be impaired by depression symptoms. In contrast, individuals with depression symptoms did not exhibit blink magnitudes that varied by valence, either during viewing or after the pictures were removed from view. These findings suggest that ECI is relevant not only for those diagnosed with major depressive disorder, but also for people with depression symptoms that may not cross the diagnostic threshold. These data also point to the importance of considering the time course of emotion to better understand emotional deficits in individuals with differing levels of depression symptoms. Identifying where emotion goes awry across the time course of emotion can help inform treatment development.

Quality of life in panic disorder: looking beyond symptom remission

PURPOSE

Panic Disorder (PD) is a classic example of a disease where symptom remission may be achieved, yet patient quality of life (QOL) remains low, providing further support for the need to measure QOL as an additional outcome in patient care. The objectives of this review are to examine the substantial QOL impairments in PD and to determine whether modern treatments for PD, which have been proven to achieve symptom remission, have been shown to restore QOL.

METHODS

We identified studies on QOL in PD from 1980 to 2010 by searching MEDLINE, PsycINFO, and PubMed databases.

RESULTS

The literature reveals substantial QOL impairments in PD, often resulting in poor sense of health, frequent utilization of medical services, occupational deficiency, financial dependency, and marital strife. Modern therapies have been demonstrated to achieve symptom remission and improve QOL in PD; however, post-treatment QOL is still significantly lower than community averages.

CONCLUSIONS

QOL needs to be added as an essential outcome measure in patient care. Further research should be conducted to better understand the nature of comorbidities in PD as well as to determine whether additional interventions that have been studied in other psychiatric disorders, such as exercise, meditation, yoga, humor, massage, and nutritional supplements, can be utilized to improve QOL in PD to normal community levels.