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Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS. Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:696-722. [PMID: 38073271 DOI: 10.1111/aphw.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 05/02/2024]
Abstract
Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amanda C M Fu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivy W Y Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivia H C Jung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wacy W S Lui
- Center for Personal Growth and Crisis Intervention of the Corporate Clinical Psychology Services, Hospital Authority, Ma Tau Wai, Hong Kong
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Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. Biol Psychiatry Glob Open Sci 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
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Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
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Schreiner MW, Miller RH, Jacobsen AM, Crowell SE, Kaufman EA, Farstead B, Feldman DA, Thomas L, Bessette KL, Welsh RC, Watkins ER, Langenecker SA. Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention. medRxiv 2023:2023.10.09.23296759. [PMID: 37873244 PMCID: PMC10592982 DOI: 10.1101/2023.10.09.23296759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Rumination is a transdiagnostic problem that is common in major depressive disorder (MDD). Rumination Focused Cognitive Behavioral Therapy (RF-CBT) explicitly targets the ruminative habit. This study examined changes in brain activation during a rumination induction task in adolescents with remitted MDD following RF-CBT. We also evaluated the reliability of the rumination task among adolescents who received treatment as usual (TAU). Method Fifty-five adolescents ages 14-17 completed a self-relevant rumination induction fMRI task and were then randomized to either RF-CBT (n = 30) or TAU (n = 25). Participants completed the task a second time either following 10-14 sessions of RF-CBT or the equivalent time delay for the TAU group. We assessed activation change in the RF-CBT group using paired-samples t-tests and reliability by calculating intraclass correlation coefficients (ICCs) of five rumination-related ROIs during each of three blocks for the TAU and RF-CBT groups separately (Rumination Instruction, Rumination Prompt, and Distraction). Results Following treatment, participants in the RF-CBT group demonstrated an increase in activation of the left precuneus during Rumination Instruction and the left angular and superior temporal gyri during Rumination Prompt ( p < .01). The TAU group demonstrated fair to excellent reliability ( M = .52, range = .27-.86) across most ROIs and task blocks. In contrast, the RF-CBT group demonstrated poor reliability across most ROIs and task blocks ( M = .21, range = -.19-.69). Conclusion RF-CBT appears to lead to rumination-related brain change. We demonstrated that the rumination induction task has fair to excellent reliability among individuals who do not receive an intervention that explicitly targets the ruminative habit, whereas reliability of this task is largely poor in the context of RF-CBT. This has meaningful implications in longitudinal and intervention studies, particularly when conceptualizing it as an important target for intervention. It also suggests one of many possible mechanisms for why fMRI test-retest reliability can be low that appears unrelated to the methodology itself.
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Westlund Schreiner M, Roberts H, Dillahunt AK, Farstead B, Feldman D, Thomas L, Jacobs RH, Bessette KL, Welsh RC, Watkins ER, Langenecker SA, Crowell SE. Negative association between non-suicidal self-injury in adolescents and default mode network activation during the distraction blocks of a rumination task. Suicide Life Threat Behav 2023; 53:510-521. [PMID: 36942887 PMCID: PMC10441767 DOI: 10.1111/sltb.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Rumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non-suicidal self-injury (NSSI). Despite the link between self-reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI. METHOD We collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast. RESULTS Lifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum. CONCLUSION Difficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well-being and neurobiological change.
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Affiliation(s)
- Mindy Westlund Schreiner
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Alina K Dillahunt
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Brian Farstead
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daniel Feldman
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Leah Thomas
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Rachel H Jacobs
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Katie L Bessette
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Robert C Welsh
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | | | - Scott A Langenecker
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
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Edge D, Watkins ER, Limond J, Mugadza J. The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression - A systematic review and meta-analysis. Behav Res Ther 2023; 164:104292. [PMID: 37003138 DOI: 10.1016/j.brat.2023.104292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. METHOD A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. RESULTS After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of -0.27 (95% CI [ -0.37, -0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of -0.21 (95% CI [-0.31, -0.10], p < .001). CONCLUSIONS Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.
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Affiliation(s)
- Daniel Edge
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom.
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jenny Limond
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jane Mugadza
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
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Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Sahker E, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Watkins ER, Noma H, Horikoshi M, Iwami T, Furukawa TA. Corrigendum to "Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial" [J. Affect. Disord. 322 (2023) 156-162]. J Affect Disord 2023; 325:824-825. [PMID: 36682915 DOI: 10.1016/j.jad.2023.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rie Toyomoto
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan; Population Health and Policy Research Unit, Medical Education Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Centre, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako-Gakuin College, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Hisashi Noma
- Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- National Centre of Neurology and Psychiatry/National Centre for Cognitive Behaviour Therapy and Research, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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O'Loughlin J, Casanova F, Fairhurst-Hunter Z, Hughes A, Bowden J, Watkins ER, Freathy RM, Millwood IY, Lin K, Chen Z, Li L, Lv J, Walters RG, Howe LD, Kuchenbaecker K, Tyrrell J. Mendelian randomisation study of body composition and depression in people of East Asian ancestry highlights potential setting-specific causality. BMC Med 2023; 21:37. [PMID: 36726144 PMCID: PMC9893684 DOI: 10.1186/s12916-023-02735-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Extensive evidence links higher body mass index (BMI) to higher odds of depression in people of European ancestry. However, our understanding of the relationship across different settings and ancestries is limited. Here, we test the relationship between body composition and depression in people of East Asian ancestry. METHODS Multiple Mendelian randomisation (MR) methods were used to test the relationship between (a) BMI and (b) waist-hip ratio (WHR) with depression. Firstly, we performed two-sample MR using genetic summary statistics from a recent genome-wide association study (GWAS) of depression (with 15,771 cases and 178,777 controls) in people of East Asian ancestry. We selected 838 single nucleotide polymorphisms (SNPs) correlated with BMI and 263 SNPs correlated with WHR as genetic instrumental variables to estimate the causal effect of BMI and WHR on depression using the inverse-variance weighted (IVW) method. We repeated these analyses stratifying by home location status: China versus UK or USA. Secondly, we performed one-sample MR in the China Kadoorie Biobank (CKB) in 100,377 participants. This allowed us to test the relationship separately in (a) males and females and (b) urban and rural dwellers. We also examined (c) the linearity of the BMI-depression relationship. RESULTS Both MR analyses provided evidence that higher BMI was associated with lower odds of depression. For example, a genetically-instrumented 1-SD higher BMI in the CKB was associated with lower odds of depressive symptoms [OR: 0.77, 95% CI: 0.63, 0.95]. There was evidence of differences according to place of residence. Using the IVW method, higher BMI was associated with lower odds of depression in people of East Asian ancestry living in China but there was no evidence for an association in people of East Asian ancestry living in the USA or UK. Furthermore, higher genetic BMI was associated with differential effects in urban and rural dwellers within China. CONCLUSIONS This study provides the first MR evidence for an inverse relationship between BMI and depression in people of East Asian ancestry. This contrasts with previous findings in European populations and therefore the public health response to obesity and depression is likely to need to differ based on sociocultural factors for example, ancestry and place of residence. This highlights the importance of setting-specific causality when using genetic causal inference approaches and data from diverse populations to test hypotheses. This is especially important when the relationship tested is not purely biological and may involve sociocultural factors.
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Affiliation(s)
- Jessica O'Loughlin
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Francesco Casanova
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Zammy Fairhurst-Hunter
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda Hughes
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Bowden
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Rachel M Freathy
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Jessica Tyrrell
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Sahker E, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Watkins ER, Noma H, Horikoshi M, Iwami T, Furukawa TA. Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial. J Affect Disord 2023; 322:156-162. [PMID: 36379323 DOI: 10.1016/j.jad.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure. RESULTS After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values <0.05). The higher the PHQ-9 total score at baseline (range: 5-14), the greater the decrease after 8 weeks. For each 5-point increase at baseline, the change from baseline to 8 weeks was bigger by 2.8 points. The more frequent the exercise habits (range: 0-2 points), the less effective the self-monitoring component. The difference in PHQ-9 change scores between presence or absence of self-monitoring was smaller by 0.94 points when the participant exercised one level more frequently. Additionally, the study suggested seven out of 36 PFs and 14 out of 160 EMs examined were candidates for future research. LIMITATIONS Generalizability is limited to university students with subthreshold depression. CONCLUSIONS These results provide some helpful information for the future development of individualized iCBT algorithms for depression.
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Affiliation(s)
- Rie Toyomoto
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan; Population Health and Policy Research Unit, Medical Education Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Centre, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako-Gakuin College, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Hisashi Noma
- Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- National Centre of Neurology and Psychiatry/National Centre for Cognitive Behaviour Therapy and Research, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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9
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Thomas LR, Bessette KL, Westlund Schreiner M, Dillahunt AK, Frandsen SB, Pocius SL, Schubert BL, Farstead BW, Roberts H, Watkins ER, Kerig PK, Crowell SE, Langenecker SA. Early Emergence of Rumination has no Association with Performance on a Non-affective Inhibitory Control Task. Child Psychiatry Hum Dev 2023:10.1007/s10578-022-01484-8. [PMID: 36637686 PMCID: PMC9839218 DOI: 10.1007/s10578-022-01484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 11/16/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
Rumination is a vulnerability for depression and potentially linked to inhibitory control weaknesses. We aimed to replicate the association observed in adults between inhibitory control and rumination in adolescents, and to examine putative moderating roles of childhood maltreatment and perceived family cohesion in an adolescent sample at risk for depression due to familial/personal history. Ninety adolescents aged 11-17 (M = 14.6, SD = 1.8) completed self-report scales of rumination, maltreatment, and family cohesion, and performed a task assessing inhibitory control. Hierarchical regression models showed no significant relation between inhibitory control and moderator variables on rumination. However, adolescents who reported higher levels of maltreatment and who perceived lower family cohesion tended to indicate higher levels of rumination (BChilhood Maltreatment = 27.52, 95% CIs [5.63, 49.41], BFamily Cohesion = -0.40, 95% CIs [-0.65, -0.15]). These findings demonstrate an alternative understanding of factors that increase depression onset risk and recurrence in adolescents.
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Affiliation(s)
- Leah R Thomas
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA.
- Department of Psychology, University of Utah, 84112, Salt Lake City, UT, USA.
| | - Katie L Bessette
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
- Department of Psychology, University of Illinois at Chicago, 60607, Chicago, IL, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 90024, Los Angeles, CA, USA
| | - Melinda Westlund Schreiner
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | - Alina K Dillahunt
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | - Summer B Frandsen
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | - Stephanie L Pocius
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | - Briana Lee Schubert
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | - Brian W Farstead
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
| | | | | | - Patricia K Kerig
- Department of Psychology, University of Utah, 84112, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
- Department of Psychology, University of Utah, 84112, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah, 84112, Salt Lake City, UT, USA
| | - Scott A Langenecker
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, 84108, Salt Lake City, UT, USA
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10
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Cohen ZD, DeRubeis RJ, Hayes R, Watkins ER, Lewis G, Byng R, Byford S, Crane C, Kuyken W, Dalgleish T, Schweizer S. The development and internal evaluation of a predictive model to identify for whom Mindfulness-Based Cognitive Therapy (MBCT) offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication. Clin Psychol Sci 2023; 11:59-76. [PMID: 36698442 PMCID: PMC7614103 DOI: 10.1177/21677026221076832] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Depression is highly recurrent, even following successful pharmacological and/or psychological intervention. We aimed to develop clinical prediction models to inform adults with recurrent depression choosing between antidepressant medication (ADM) maintenance or switching to Mindfulness-Based Cognitive Therapy (MBCT). Using data from the PREVENT trial (N=424), we constructed prognostic models using elastic net regression that combined demographic, clinical and psychological factors to predict relapse at 24 months under ADM or MBCT. Only the ADM model (discrimination performance: AUC=.68) predicted relapse better than baseline depression severity (AUC=.54; one-tailed DeLong's test: z=2.8, p=.003). Individuals with the poorest ADM prognoses who switched to MBCT had better outcomes compared to those who maintained ADM (48% vs. 70% relapse, respectively; superior survival times [z=-2.7, p=.008]). For individuals with moderate-to-good ADM prognosis, both treatments resulted in similar likelihood of relapse. If replicated, the results suggest that predictive modeling can inform clinical decision-making around relapse prevention in recurrent depression.
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Affiliation(s)
| | | | - Rachel Hayes
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula, University of Exeter
| | | | - Glyn Lewis
- Division of Psychiatry, Faulty of Brain Sciences, University College London
- Community Primary Care Research Group, University of Plymouth
| | - Richard Byng
- Community Primary Care Research Group, University of Plymouth
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care, South West Peninsula, England
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
| | - Catherine Crane
- Department of Psychiatry, Medical Sciences Division, University of Oxford
| | - Willem Kuyken
- Department of Psychiatry, Medical Sciences Division, University of Oxford
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England
| | - Susanne Schweizer
- Department of Psychology, University of Cambridge
- School of Psychology, University of New South Wales
- Susanne Schweizer, Department of Psychology, University of Cambridge
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11
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Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Sahker E, Ogawa Y, Hollon SD, Collins LM, Watkins ER, Wason J, Noma H, Horikoshi M, Iwami T, Furukawa TA. Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial. Evid Based Ment Health 2022; 25:e18-e25. [PMID: 35577537 PMCID: PMC9811098 DOI: 10.1136/ebmental-2022-300455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE To examine the efficacy of five components of iCBT for subthreshold depression. METHODS We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER UMINCTR-000031307.
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Affiliation(s)
- Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | | | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Center, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako Gakuin University, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychitary and Cognitive-Behavioral Medicine, Nagoya City University, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychitary and Cognitive-Behavioral Medicine, Nagoya City University, Nagoya, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Linda M Collins
- Department of Scoial and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - James Wason
- Population Health Scineces Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hisashi Noma
- Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Masaru Horikoshi
- National Center of Neurology and psychiatry/National Center for Cognitive Behavior Therapy and Research, Kodaira, Tokyo, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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12
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Rogiers R, Baeken C, Watkins ER, van den Abbeele D, Remue J, de Raedt R, Lemmens GMD. A Psychoeducational CBT-based Group Intervention ("Drop It") for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes. Int J Group Psychother 2022; 72:257-292. [PMID: 38446560 DOI: 10.1080/00207284.2022.2066535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive negative thinking (RNT)-such as worry and rumination-is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled "Drop It" that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT.
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13
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Pechtel P, Harris J, Karl A, Clunies-Ross C, Bower S, Moberly NJ, Pizzagalli DA, Watkins ER. Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse. Soc Cogn Affect Neurosci 2022; 17:1035-1043. [PMID: 35438797 PMCID: PMC9629466 DOI: 10.1093/scan/nsac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 01/12/2023] Open
Abstract
Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA + major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.
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Affiliation(s)
- Pia Pechtel
- Correspondence should be addressed to Pia Pechtel, Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter EX4 4QQ, UK. E-mail:
| | - Jennifer Harris
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Anke Karl
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Caroline Clunies-Ross
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Susie Bower
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Nicholas J Moberly
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA 02478, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA,McLean Imaging Center, McLean Hospital, Belmont, MA 02478 USA
| | - Edward R Watkins
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
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14
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Casanova F, O’Loughlin J, Martin S, Beaumont RN, Wood AR, Watkins ER, Freathy RM, Hagenaars SP, Frayling TM, Yaghootkar H, Tyrrell J. Higher adiposity and mental health: causal inference using Mendelian randomization. Hum Mol Genet 2021; 30:2371-2382. [PMID: 34270736 PMCID: PMC8643500 DOI: 10.1093/hmg/ddab204] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/14/2022] Open
Abstract
Higher adiposity is an established risk factor for psychiatric diseases including depression and anxiety. The associations between adiposity and depression may be explained by the metabolic consequences and/or by the psychosocial impact of higher adiposity. We performed one- and two- sample Mendelian randomization (MR) in up to 145 668 European participants from the UK Biobank to test for a causal effect of higher adiposity on 10 well-validated mental health and well-being outcomes derived using the Mental Health Questionnaire (MHQ). We used three sets of adiposity genetic instruments: (a) a set of 72 BMI genetic variants, (b) a set of 36 favourable adiposity variants and (c) a set of 38 unfavourable adiposity variants. We additionally tested causal relationships (1) in men and women separately, (2) in a subset of individuals not taking antidepressants and (3) in non-linear MR models. Two-sample MR provided evidence that a genetically determined one standard deviation (1-SD) higher BMI (4.6 kg/m2) was associated with higher odds of current depression [OR: 1.50, 95%CI: 1.15, 1.95] and lower well-being [ß: -0.15, 95%CI: -0.26, -0.04]. Findings were similar when using the metabolically favourable and unfavourable adiposity variants, with higher adiposity associated with higher odds of depression and lower well-being scores. Our study provides further evidence that higher BMI causes higher odds of depression and lowers well-being. Using genetics to separate out metabolic and psychosocial effects, our study suggests that in the absence of adverse metabolic effects higher adiposity remains causal to depression and lowers well-being.
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Affiliation(s)
- Francesco Casanova
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Jessica O’Loughlin
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Susan Martin
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Andrew R Wood
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Rachel M Freathy
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Saskia P Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Timothy M Frayling
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
| | - Jess Tyrrell
- Genetics of Complex Traits, The College of Medicine and Health, RD&E Hospital, University of Exeter, Exeter EX2 5DW, UK
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15
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O'Loughlin J, Casanova F, Jones SE, Hagenaars SP, Beaumont RN, Freathy RM, Watkins ER, Vetter C, Rutter MK, Cain SW, Phillips AJK, Windred DP, Wood AR, Weedon MN, Tyrrell J. Using Mendelian Randomisation methods to understand whether diurnal preference is causally related to mental health. Mol Psychiatry 2021; 26:6305-6316. [PMID: 34099873 PMCID: PMC8760058 DOI: 10.1038/s41380-021-01157-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Late diurnal preference has been linked to poorer mental health outcomes, but the understanding of the causal role of diurnal preference on mental health and wellbeing is currently limited. Late diurnal preference is often associated with circadian misalignment (a mismatch between the timing of the endogenous circadian system and behavioural rhythms), so that evening people live more frequently against their internal clock. This study aims to quantify the causal contribution of diurnal preference on mental health outcomes, including anxiety, depression and general wellbeing and test the hypothesis that more misaligned individuals have poorer mental health and wellbeing using an actigraphy-based measure of circadian misalignment. Multiple Mendelian Randomisation (MR) approaches were used to test causal pathways between diurnal preference and seven well-validated mental health and wellbeing outcomes in up to 451,025 individuals. In addition, observational analyses tested the association between a novel, objective measure of behavioural misalignment (Composite Phase Deviation, CPD) and seven mental health and wellbeing outcomes. Using genetic instruments identified in the largest GWAS for diurnal preference, we provide robust evidence that early diurnal preference is protective for depression and improves wellbeing. For example, using one-sample MR, a twofold higher genetic liability of morningness was associated with lower odds of depressive symptoms (OR: 0.92, 95% CI: 0.88, 0.97). It is possible that behavioural factors including circadian misalignment may contribute in the chronotype depression relationship, but further work is needed to confirm these findings.
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Affiliation(s)
- Jessica O'Loughlin
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Francesco Casanova
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Samuel E Jones
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Saskia P Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Rachel M Freathy
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Edward R Watkins
- Psychology, Mood Disorders Centre, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sean W Cain
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel P Windred
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew R Wood
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Michael N Weedon
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, The College of Medicine and Health, University of Exeter, The RILD Building, RD&E Hospital, Exeter, UK.
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16
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Edge D, Newbold A, Ehring T, Rosenkranz T, Frost M, Watkins ER. Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking. BMC Psychiatry 2021; 21:519. [PMID: 34674669 PMCID: PMC8532278 DOI: 10.1186/s12888-021-03536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence skills via a mobile app may be an effective, scalable and acceptable way to do this. A particular risk factor for anxiety and depression is elevated worry and rumination (repetitive negative thinking, RNT). An app designed to reduce RNT may prevent future incidence of depression and anxiety. METHOD/DESIGN The Emotional Competence for Well-Being in Young Adults study developed an emotional competence app to be tested via randomised controlled trials in a longitudinal prospective cohort. This off-shoot study adapts the app to focus on targeting RNT (worry, rumination), known risk factors for poor mental health. In this study, 16-24 year olds in the UK, who report elevated worry and rumination on standardised questionnaires are randomised to (i) receive the RNT-targeting app immediately for 6 weeks (ii) a waiting list control who receive the app after 6 weeks. In total, the study will aim to recruit 204 participants, with no current diagnosis of major depression, bipolar disorder or psychosis, across the UK. Assessments take place at baseline (pre-randomisation), 6 and 12 weeks post-randomisation. Primary endpoint and outcome for the study is level of rumination assessed on the Rumination Response Styles Questionnaire at 6 weeks. Worry, depressive symptoms, anxiety symptoms and well-being are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. DISCUSSION This trial aims to better understand the benefits of tackling RNT via an mobile phone app intervention in young people. This prevention mechanism trial will establish whether targeting worry and rumination directly via an app provides a feasible approach to prevent depression and anxiety, with scope to become a widescale public health strategy for preventing poor mental health and promoting well-being in young people. TRIAL REGISTRATION ClinicalTrials.gov , NCT04950257 . Registered 6 July 2021 - Retrospectively registered.
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Affiliation(s)
- Daniel Edge
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | - Alexandra Newbold
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | | | | | | | - Edward R. Watkins
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
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Roberts H, Mostazir M, Moberly NJ, Watkins ER, Adlam AL. Working memory updating training reduces state repetitive negative thinking: Proof-of-concept for a novel cognitive control training. Behav Res Ther 2021; 142:103871. [PMID: 34004447 PMCID: PMC8214071 DOI: 10.1016/j.brat.2021.103871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
Repetitive negative thinking (RNT) is a proximal risk factor implicated in the onset and maintenance of common mental health problems such as depression and anxiety. Adolescence may be a key developmental window in which to target RNT and prevent the emergence of such disorders. Impairments in updating the contents of working memory are hypothesised to causally contribute to RNT, and some theorists have suggested these difficulties may be specific to the manipulation of negative information. The present study compared the effects of computerised adaptive working memory updating training (in which the task becomes more difficult as performance improves) to a non-adaptive control task in reducing levels of RNT. 124 healthy young people were randomised to 20 sessions of (i) working memory updating training using neutral stimuli, (ii) working memory updating training using negative stimuli, or (iii) non-adaptive working memory updating training. Adaptive working memory updating training using neutral, but not negative, stimuli resulted in significant improvements to working memory updating for negative material, as assessed using an unpractised task, and significant reductions in susceptibility to state RNT. These findings demonstrate proof-of-concept that working memory updating training has the potential to reduce susceptibility to episodes of state RNT.
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Roberts H, Jacobs RH, Bessette KL, Crowell SE, Westlund-Schreiner M, Thomas L, Easter RE, Pocius SL, Dillahunt A, Frandsen S, Schubert B, Farstead B, Kerig P, Welsh RC, Jago D, Langenecker SA, Watkins ER. Mechanisms of rumination change in adolescent depression (RuMeChange): study protocol for a randomised controlled trial of rumination-focused cognitive behavioural therapy to reduce ruminative habit and risk of depressive relapse in high-ruminating adolescents. BMC Psychiatry 2021; 21:206. [PMID: 33892684 PMCID: PMC8062943 DOI: 10.1186/s12888-021-03193-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adolescent-onset depression often results in a chronic and recurrent course, and is associated with worse outcomes relative to adult-onset depression. Targeting habitual depressive rumination, a specific known risk factor for relapse, may improve clinical outcomes for adolescents who have experienced a depressive episode. Randomized controlled trials (RCTs) thus far have demonstrated that rumination-focused cognitive behavioral therapy (RFCBT) reduces depressive symptoms and relapse rates in patients with residual depression and adolescents and young adults with elevated rumination. This was also observed in a pilot RCT of adolescents at risk for depressive relapse. Rumination can be measured at the self-report, behavioral, and neural levels- using patterns of connectivity between the Default Mode Network (DMN) and Cognitive Control Network (CCN). Disrupted connectivity is a putative important mechanism for understanding reduced rumination via RFCBT. A feasibility trial in adolescents found that reductions in connectivity between DMN and CCN regions following RFCBT were correlated with change in rumination and depressive symptoms. METHOD This is a phase III two-arm, two-stage, RCT of depression prevention. The trial tests whether RFCBT reduces identified risk factors for depressive relapse (rumination, patterns of neural connectivity, and depressive symptoms) in adolescents with partially or fully remitted depression and elevated rumination. In the first stage, RFCBT is compared to treatment as usual within the community. In the second stage, the comparator condition is relaxation therapy. Primary outcomes will be (a) reductions in depressive rumination, assessed using the Rumination Response Scale, and (b) reductions in resting state functional magnetic resonance imaging connectivity of DMN (posterior cingulate cortex) to CCN (inferior frontal gyrus), at 16 weeks post-randomization. Secondary outcomes include change in symptoms of depression following treatment, recurrence of depression over 12 months post-intervention period, and whether engagement with therapy homework (as a dose measure) is related to changes in the primary outcomes. DISCUSSION RFCBT will be evaluated as a putative preventive therapy to reduce the risk of depressive relapse in adolescents, and influence the identified self-report, behavioral, and neural mechanisms of change. Understanding mechanisms that underlie change in rumination is necessary to improve and further disseminate preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03859297 , registered 01 March 2019.
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Affiliation(s)
- Henrietta Roberts
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK
| | | | - Katie L Bessette
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, 84108, USA
| | | | - Leah Thomas
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Rebecca E Easter
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Stephanie L Pocius
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Alina Dillahunt
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Summer Frandsen
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Briana Schubert
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Brian Farstead
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Patricia Kerig
- Department of Psychology, University of Utah, Salt Lake City, UT, 84108, USA
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - David Jago
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK
| | - Scott A Langenecker
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84108, USA
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, EX4 4LN, UK.
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Mollaahmetoglu OM, Palmer E, Maschauer E, Nolan MC, Stevens T, Carlyle M, Hardy L, Watkins ER, Morgan CJA. The acute effects of alcohol on state rumination in the laboratory. Psychopharmacology (Berl) 2021; 238:1671-1686. [PMID: 33635385 PMCID: PMC8139935 DOI: 10.1007/s00213-021-05802-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE Rumination is a repetitive, negative, self-focused thinking style associated with various forms of psychopathology. Recent studies suggest that rumination increases craving for alcohol and predicts harmful drinking and alcohol-related problems. However, the acute effects of alcohol on rumination have not been previously studied. It is proposed that alcohol may reduce ruminative thinking through decreasing negative mood. OBJECTIVES In the present study, we aimed to test the previously unexplored effects of acute alcohol consumption on rumination in a hazardous drinking population. METHODS We conducted a randomised placebo-controlled laboratory study to examine the effect of low (0.4 g kg-1) and high doses (0.8 g kg-1) of alcohol on state rumination compared to placebo. Participants completed a rumination induction task prior to receiving drinks. We then measured state rumination and mood at repeated time points; 30 min, 60 min and 90 min post-drinks consumption. RESULTS We found a significant decrease in state rumination in the low-dose alcohol group compared to placebo at 30 min post-alcohol consumption, but no difference was observed between the high-dose alcohol and placebo groups. Mediation analysis provided evidence for an indirect effect of alcohol on state rumination through concurrent changes in negative mood. CONCLUSIONS These findings suggest that acute alcohol consumption can regulate negative mood and concurrently rumination, providing preliminary evidence for the role of rumination in alcohol use disorders. Rumination may be a treatment target in alcohol use disorders.
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Affiliation(s)
- O. Merve Mollaahmetoglu
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Edward Palmer
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Emily Maschauer
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Melissa C. Nolan
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Tobias Stevens
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Molly Carlyle
- School of Psychology, University of Queensland, St. Lucia, QLD Australia
| | - Lorna Hardy
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Edward R. Watkins
- SMART Lab, University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
| | - Celia J. A. Morgan
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG UK
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Bessette KL, Jacobs RH, Heleniak C, Peters AT, Welsh RC, Watkins ER, Langenecker SA. Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. PLoS One 2020; 15:e0233539. [PMID: 32555582 PMCID: PMC7299403 DOI: 10.1371/journal.pone.0233539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
CLINICAL TRIALS REGISTRATION NCT01905267, https://clinicaltrials.gov/ct2/show/NCT01905267.
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Affiliation(s)
- Katie L. Bessette
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Charlotte Heleniak
- Department of Psychology, Columbia University, New York City, NY, United States of America
| | - Amy T. Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Robert C. Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | | | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
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21
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Feldhaus CG, Jacobs RH, Watkins ER, Peters AT, Bessette K, Langenecker SA. Rumination-focused cognitive behavioral therapy decreases anxiety and increases behavioral activation among remitted adolescents. J Child Fam Stud 2020; 29:1982-1991. [PMID: 33737799 PMCID: PMC7968389 DOI: 10.1007/s10826-020-01711-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Rumination involves a repetitive, passive focus on one's thoughts and feelings and has been hypothesized as a mechanism contributing to multiple psychopathologies. The current investigation explores secondary outcomes from a pilot study to examine whether rumination-focused cognitive behavior therapy (RFCBT) alleviates symptoms of anxiety, increases behavioral activation, or increases global functioning among adolescents with a history of Major Depressive Disorder (MDD). METHODS Thirty-three adolescents were randomized to receive either RFCBT (n = 17) or assessment only (AO; n = 16) over the course of eight weeks. Mixed effects regression models were used to conduct intent-to-treat (ITT) analyses. RESULTS The quadratic interaction for group-by-time-by-time was significant for anxiety. Adolescents in the RFCBT group experienced a significant decrease in anxiety across the first six weeks of intervention (F = 7.01, df = 108.49, p = .009). The group-by-time interaction was significant for the behavioral activation outcome (F = 4.28, df = 25.60, p = .049) with youth randomized to RFCBT demonstrating increasing activation compared to AO. Global functioning did not significantly differ between groups (F = .40, df = 1, p > .05). CONCLUSIONS Preliminary evidence suggests that RFCBT may hold promise as an intervention that alleviates both depressive and anxiety symptoms when comorbid.
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Affiliation(s)
- Claudia G Feldhaus
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Rachel H Jacobs
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Edward R Watkins
- University of Exeter, Exeter, UK, Stocker Rd, Exeter EX4 4PY, United Kingdom
| | - Amy T Peters
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Katie Bessette
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
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Rosenkranz T, Takano K, Watkins ER, Ehring T. Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm. PLoS One 2020; 15:e0231783. [PMID: 32310979 PMCID: PMC7170251 DOI: 10.1371/journal.pone.0231783] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic process and a promising target for prevention and treatment of mental disorders. RNT is typically assessed via self-report questionnaires with most studies focusing on one type of RNT (i.e., worry or rumination) and one specific disorder (i.e., anxiety or depression). However, responses to such questionnaires may be biased by memory and metacognitive beliefs. Recently, Ecological Momentary Assessment (EMA) has been employed to minimize these biases. This study aims to develop an EMA paradigm to measure RNT as a transdiagnostic process in natural settings. Based on empirical and theoretical considerations, an item pool was created encompassing RNT content and processes. We then (1) tested model fit of a content-related and a process-related model for assessing RNT as an individual difference variable, (2) investigated the reliability and construct validity of the proposed scale(s), and (3) determined the optimal sampling design. One hundred fifty healthy participants aged 18 to 40 years filled out baseline questionnaires on rumination, worry, RNT, symptoms of depression, anxiety, and stress. Participants received 8 semi-random daily prompts assessing RNT over 14 days. After the EMA phase, participants answered questionnaires on depression, anxiety, and stress again. Multilevel confirmatory factor analysis revealed excellent model fit for the process-related model but unsatisfactory fit for the content-related model. Different hybrid models were additionally explored, yielding one model with satisfactory fit. Both the process-related and the hybrid scale showed good reliability and good convergent validity and were significantly associated with symptoms of depression, anxiety, and stress after the EMA phase when controlling for baseline scores. Further analyses found that a sampling design of 5 daily assessments across 10 days yielded the best tradeoff between participant burden and information retained by EMA. In sum, this paper presents a promising paradigm for assessing RNT in daily life.
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Affiliation(s)
| | | | - Edward R. Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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23
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Hvenegaard M, Moeller SB, Poulsen S, Gondan M, Grafton B, Austin SF, Kistrup M, Rosenberg NGK, Howard H, Watkins ER. Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial. Psychol Med 2020; 50:11-19. [PMID: 30630555 DOI: 10.1017/s0033291718003835] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression. METHODS A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224). RESULTS RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered. CONCLUSIONS This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.
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Affiliation(s)
- Morten Hvenegaard
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Stine B Moeller
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Gondan
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ben Grafton
- Cognition and Emotion Lab, School of Psychology, University of Western Australia, Crawley, Australia
| | - Stephen F Austin
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Morten Kistrup
- Psychiatric Outpatient Service, Mental Health Centre North Zealand, Hillerød, Denmark
| | - Nicole G K Rosenberg
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen, Denmark
| | - Henriette Howard
- Mental Health Centre for Child and Adolescent Psychiatry, Glostrup, Denmark
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
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Abstract
A large amount of research time and resources are spent trying to develop or improve psychological therapies. However, treatment development is challenging and time-consuming, and the typical research process followed-a series of standard randomized controlled trials-is inefficient and sub-optimal for answering many important clinical research questions. In other areas of health research, recognition of these challenges has led to the development of sophisticated designs tailored to increase research efficiency and answer more targeted research questions about treatment mechanisms or optimal delivery. However, these innovations have largely not permeated into psychological treatment development research. There is a recognition of the need to understand how treatments work and what their active ingredients might be, and a call for the use of innovative trial designs to support such discovery. One approach to unpack the active ingredients and mechanisms of therapy is the factorial design as exemplified in the Multiphase Optimization Strategy (MOST) approach. The MOST design allows identification of the active components of a complex multi-component intervention (such as CBT) using a sophisticated factorial design, allowing the development of more efficient interventions and elucidating their mechanisms of action. The rationale, design, and potential advantages of this approach will be illustrated with reference to the IMPROVE-2 study, which conducts a fractional factorial design to investigate which elements (e.g., thought challenging, activity scheduling, compassion, relaxation, concreteness, functional analysis) within therapist-supported internet-delivered CBT are most effective at reducing symptoms of depression in 767 adults with major depression. By using this innovative approach, we can first begin to work out what components within the overall treatment package are most efficacious on average allowing us to build an overall more streamlined and potent therapy. This approach also has potential to distinguish the role of specific versus non-specific common treatment components within treatment.
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Affiliation(s)
- Edward R Watkins
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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25
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Trick L, Watkins ER, Henley W, Gandhi MM, Dickens C. Perseverative negative thinking predicts depression in people with acute coronary syndrome. Gen Hosp Psychiatry 2019; 61:16-25. [PMID: 31733604 DOI: 10.1016/j.genhosppsych.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS. METHODS Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later. RESULTS 169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months. CONCLUSIONS Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.
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Affiliation(s)
- Leanne Trick
- Mental Health Research Group, University of Exeter Medical School, United Kingdom of Great Britain and Northern Ireland.
| | - Edward R Watkins
- School of Psychology, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - William Henley
- Health Statistics Group, University of Exeter Medical School, United Kingdom of Great Britain and Northern Ireland
| | - Manish M Gandhi
- Cardiology Department, Royal Devon and Exeter NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Chris Dickens
- Mental Health Research Group, University of Exeter Medical School, United Kingdom of Great Britain and Northern Ireland
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Woodford J, Farrand P, Watkins ER, LLewellyn DJ. "I Don't Believe in Leading a Life of My Own, I Lead His Life": A Qualitative Investigation of Difficulties Experienced by Informal Caregivers of Stroke Survivors Experiencing Depressive and Anxious Symptoms. Clin Gerontol 2018; 41:293-307. [PMID: 29185911 DOI: 10.1080/07317115.2017.1363104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Health and social care services are increasingly reliant on informal caregivers to provide long-term support to stroke survivors. However, caregiving is associated with elevated levels of depression and anxiety in the caregiver that may also negatively impact stroke survivor recovery. This qualitative study aims to understand the specific difficulties experienced by caregivers experiencing elevated symptoms of anxiety and depression. METHODS Nineteen semi-structured interviews were conducted with caregivers experiencing elevated levels of depression and anxiety, with a thematic analysis approach adopted for analysis. RESULTS Analysis revealed three main themes: Difficulties adapting to the caring role; Uncertainty; and Lack of support. CONCLUSIONS Caregivers experienced significant difficulties adapting to changes and losses associated with becoming a caregiver, such as giving up roles and goals of importance and value. Such difficulties persisted into the long-term and were coupled with feelings of hopelessness and worry. Difficulties were further exacerbated by social isolation, lack of information and poor long-term health and social care support. CLINICAL IMPLICATIONS A greater understanding of difficulties experienced by depressed and anxious caregivers may inform the development of psychological support targeting difficulties unique to the caring role. Improving caregiver mental health may also result in health benefits for stroke survivors themselves.
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Affiliation(s)
- Joanne Woodford
- a Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - Paul Farrand
- a Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - Edward R Watkins
- b Mood Disorders Centre, Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - David J LLewellyn
- c University of Exeter Medical School, University of Exeter , Exeter , United Kingdom.,d The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (NIHR PenCLAHRC) , Exeter, United Kingdom
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Richardson AJ, Leckie T, Watkins ER, Fitzpatrick D, Galloway R, Grimaldi R, Baker P. Post marathon cardiac troponin T is associated with relative exercise intensity. J Sci Med Sport 2018; 21:880-884. [PMID: 29588114 DOI: 10.1016/j.jsams.2018.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/15/2018] [Accepted: 02/17/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to investigate whether measures of cardiopulmonary fitness and relative exercise intensity were associated with high sensitivity cardiac troponin T (cTnT) rise after a road marathon. METHODS Fifty-two marathon runners (age 39±11 years, body mass 76.2±12.9kg, height 1.74±0.09m) attended the laboratory between 2 and 3 weeks prior to attempting the Brighton Marathon, UK. Running economy at 10kmh-1 (RE10) and race pace (RERP), ventilatory threshold (VT) and VO2max tests were completed. CTnT was measured within 48h prior to the marathon and within 10min of completing the marathon, using a high sensitivity assay. Heart rates (HR) were recorded throughout the marathon. RESULTS Runners demonstrated a significant increase in cTnT over the marathon (pre-race 5.60±3.27ngL-1, post-race 74.52±30.39ngL-1, p<0.001). Markers of endurance performance such as running economy (10kmh-1 223±18mlkg-1km-1; race pace 225±22mlkg-1km-1), VT (38.5±6.4mlkg-1min-1) and V˙O2max (50.9±7.7mlkg-1min-1) were not associated with post-race cTnT. Runners exercise intensity correlated with post-race cTnT (mean HR %VT 104±5%, r=0.50; peak HR %VT 118±8%, r=0.68; peak HR %V˙O2max 96±6, r=0.60, p<0.05) and was different between the low, medium and high cTnT groups (p<0.05). CONCLUSIONS CTnT increases above reference limits during a marathon. Magnitude of cTnT rise is related to exercise intensity relative to ventilatory threshold and V˙O2max, but not individuals' absolute cardiopulmonary fitness, training state or running history.
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Affiliation(s)
- A J Richardson
- Centre of Sport and Exercise Medicine (SESAME), University of Brighton, Welkin Laboratories, UK; Brighton Marathon Research Group, UK.
| | - T Leckie
- Anaesthetics Department, Eastbourne DGH, East Sussex Healthcare Trust, UK; Brighton Marathon Research Group, UK
| | - E R Watkins
- Centre of Sport and Exercise Medicine (SESAME), University of Brighton, Welkin Laboratories, UK
| | | | - R Galloway
- Royal Sussex County Hospital, Brighton and Sussex Hospital NHS Trust, UK; Brighton Marathon Research Group, UK
| | - R Grimaldi
- Royal Sussex County Hospital, Brighton and Sussex Hospital NHS Trust, UK; Brighton Marathon Research Group, UK
| | - P Baker
- Centre of Sport and Exercise Medicine (SESAME), University of Brighton, Welkin Laboratories, UK; Brighton Marathon Research Group, UK
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Finning K, Richards DA, Moore L, Ekers D, McMillan D, Farrand PA, O'Mahen HA, Watkins ER, Wright KA, Fletcher E, Rhodes S, Woodhouse R, Wray F. Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation. BMJ Open 2017; 7:e014161. [PMID: 28408544 PMCID: PMC5541446 DOI: 10.1136/bmjopen-2016-014161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/21/2017] [Accepted: 03/08/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER ISRCTN27473954, 09/12/2011.
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Affiliation(s)
| | | | - Lucy Moore
- University of Exeter Medical School, Exeter, UK
| | - David Ekers
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Paul A Farrand
- School of Psychology, University of Exeter, Exeter, UK
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | | | | | - Kim A Wright
- School of Psychology, University of Exeter, Exeter, UK
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Stange JP, Bessette KL, Jenkins LM, Peters AT, Feldhaus C, Crane NA, Ajilore O, Jacobs RH, Watkins ER, Langenecker SA. Attenuated intrinsic connectivity within cognitive control network among individuals with remitted depression: Temporal stability and association with negative cognitive styles. Hum Brain Mapp 2017; 38:2939-2954. [PMID: 28345197 DOI: 10.1002/hbm.23564] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 02/06/2023] Open
Abstract
Many individuals with major depressive disorder (MDD) experience cognitive dysfunction including impaired cognitive control and negative cognitive styles. Functional connectivity magnetic resonance imaging studies of individuals with current MDD have documented altered resting-state connectivity within the default-mode network and across networks. However, no studies to date have evaluated the extent to which impaired connectivity within the cognitive control network (CCN) may be present in remitted MDD (rMDD), nor have studies examined the temporal stability of such attenuation over time. This represents a major gap in understanding stable, trait-like depression risk phenotypes. In this study, resting-state functional connectivity data were collected from 52 unmedicated young adults with rMDD and 47 demographically matched healthy controls, using three bilateral seeds in the CCN (dorsolateral prefrontal cortex, inferior parietal lobule, and dorsal anterior cingulate cortex). Mean connectivity within the entire CCN was attenuated among individuals with rMDD, was stable and reliable over time, and was most pronounced with the right dorsolateral prefrontal cortex and right inferior parietal lobule, results that were corroborated by supplemental independent component analysis. Attenuated connectivity in rMDD appeared to be specific to the CCN as opposed to representing attenuated within-network coherence in other networks (e.g., default-mode, salience). In addition, attenuated connectivity within the CCN mediated relationships between rMDD status and cognitive risk factors for depression, including ruminative brooding, pessimistic attributional style, and negative automatic thoughts. Given that these cognitive markers are known predictors of relapse, these results suggest that attenuated connectivity within the CCN could represent a biomarker for trait phenotypes of depression risk. Hum Brain Mapp 38:2939-2954, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | - Amy T Peters
- University of Illinois at Chicago, Chicago, Illinois
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Jacobs RH, Watkins ER, Peters AT, Feldhaus CG, Barba A, Carbray J, Langenecker SA. Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI. PLoS One 2016; 11:e0163952. [PMID: 27880789 PMCID: PMC5120778 DOI: 10.1371/journal.pone.0163952] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/13/2016] [Indexed: 01/17/2023] Open
Abstract
This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood. Trial Registration: ClinicalTrials.gov NCT01905267
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Affiliation(s)
- Rachel H. Jacobs
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- * E-mail:
| | | | - Amy T. Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Claudia G. Feldhaus
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Alyssa Barba
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Julie Carbray
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
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Watkins ER, Ramponi C, Barnard PJ. Reducing specificity of autobiographical memory in nonclinical participants: The role of rumination and schematic models. Cogn Emot 2015; 20:328-50. [PMID: 26529210 DOI: 10.1080/02699930500342589] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Two experiments are reported in which nondysphoric participants, not prone to excessive levels of rumination in everyday life, were asked to retrieve autobiographical memories using the Williams and Broadbent ( 1986 ) procedure (AMT). In the first experiment, two variants of a self-related category fluency task were interleaved among sets of autobiographical memory cues. In one variant (blocked) a normal model of analytic rumination was induced by grouping prompts on a single superordinate theme together. In the other (intermixed) prompts from several different themes were grouped together. It was predicted that the blocked variant would reduce the number of specific memories recollected and increase the number of categoric memories relative to the intermixed variant. This prediction was confirmed and provides the first demonstration of a bidirectional causal influence of analytic rumination on the balance between specific and categoric retrievals. A second experiment showed no alteration in this balance when the same fluency manipulation involved animal-related categories rather than self-related ones. The results support a two component model of autobiographical retrieval being driven in part by the extent to which an analytic mode of processing is adopted in the short term and in part by the level of differentiation in self-related schematic models.
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Affiliation(s)
- Edward R Watkins
- a Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK.,b University of Exeter , UK.,c Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK
| | - Cristina Ramponi
- a Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK.,b University of Exeter , UK.,c Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK
| | - Philip J Barnard
- a Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK.,b University of Exeter , UK.,c Medical Research Council Cognition and Brain Sciences Unit , Cambridge , UK
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Abstract
Rumination has been robustly implicated in the onset and maintenance of depression. However, despite empirically well-supported theories of the consequences of trait rumination (response styles theory; Nolen-Hoeksema, 1991), and of the processes underlying state episodes of goal-oriented repetitive thought (control theory; Martin & Tesser, 1989, 1996), the relationship between these theories remains unresolved. Further, less theoretical and clinical attention has been paid to the maintenance and treatment of trait depressive rumination. We propose that conceptualizing rumination as a mental habit (Hertel, 2004) helps to address these issues. Elaborating on this account, we propose a framework linking the response styles and control theories via a theoretical approach to the relationship between habits and goals (Wood & Neal, 2007). In this model, with repetition in the same context, episodes of self-focused repetitive thought triggered by goal discrepancies can become habitual, through a process of automatic association between the behavioral response (i.e., repetitive thinking) and any context that occurs repeatedly with performance of the behavior (e.g., physical location, mood), and in which the repetitive thought is contingent on the stimulus context. When the contingent response involves a passive focus on negative content and abstract construal, the habit of depressive rumination is acquired. Such habitual rumination is cued by context independent of goals and is resistant to change. This habit framework has clear treatment implications and generates novel testable predictions.
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Affiliation(s)
- Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter
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Bassanini A, Caselli G, Fiore F, Ruggiero GM, Sassaroli S, Watkins ER. Why “why” seems better than “how”. Processes underlining repetitive thinking in an Italian non-clinical sample. Personality and Individual Differences 2014. [DOI: 10.1016/j.paid.2014.01.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kuyken W, Byford S, Byng R, Dalgleish T, Lewis G, Taylor R, Watkins ER, Hayes R, Lanham P, Kessler D, Morant N, Evans A. Update to the study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment depressive relapse/recurrence: the PREVENT trial. Trials 2014; 15:217. [PMID: 24916319 PMCID: PMC4066271 DOI: 10.1186/1745-6215-15-217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. A recently developed treatment, mindfulness-based cognitive therapy (MBCT), shows potential as a brief group program for people with recurring depression. This trial asks the policy research question; is MBCT with support to taper/discontinue antidepressant medication (MBCT-TS) superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant medication (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? An explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change. The design is a single-blind, parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Results Depressive relapse/recurrence over two years is the primary outcome variable. Analyses will be conducted following CONSORT standards and overseen by the trial’s Data Monitoring and Safety Committee. Initial analyses will be conducted on an intention-to-treat basis, with subsequent analyses being per protocol. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre- and post-treatment and a qualitative study of service users’ views and experiences. Conclusions If the results of our exploratory trial are extended to this definitive trial, MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. Trial registration Trial registered 7 May 2009; ISRCTN26666654.
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Affiliation(s)
- Willem Kuyken
- Mood Disorders Centre, School of Psychology, Perry Road, University of Exeter, Exeter EX4 4QG, UK.
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Woodford J, Farrand P, Watkins ER, Richards DA, Llewellyn DJ. Supported cognitive-behavioural self-help versus treatment-as-usual for depressed informal carers of stroke survivors (CEDArS): study protocol for a feasibility randomized controlled trial. Trials 2014; 15:157. [PMID: 24886151 PMCID: PMC4017968 DOI: 10.1186/1745-6215-15-157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/15/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Increased life expectancy has resulted in a greater provision of informal care within the community for patients with chronic physical health conditions. Informal carers are at greater risk of poor mental health, with one in three informal carers of stroke survivors experiencing depression. However, currently no psychological treatments tailored to the unique needs of depressed informal carers of stroke survivors exist. Furthermore, informal carers of stroke survivors experience a number of barriers to attending traditional face-to-face psychological services, such as lack of time and the demands of the caring role. The increased flexibility associated with supported cognitive behavioral therapy self-help (CBTsh), such as the ability for support to be provided by telephone, email, or face-to-face, alongside shorter support sessions, may help overcome such barriers to access. CBTsh, tailored to depressed informal carers of stroke survivors may represent an effective and acceptable solution. METHODS/DESIGN This study is a Phase II (feasibility) randomized controlled trial (RCT) following guidance in the MRC Complex Interventions Research Methods Framework. We will randomize a sample of depressed informal carers of stroke survivors to receive CBT self-help supported by mental health paraprofessionals, or treatment-as-usual. Consistent with the objectives of assessing the feasibility of trial design and procedures for a potential larger scale trial we will measure the following outcomes: a) feasibility of patient recruitment (recruitment and refusal rates); (b) feasibility and acceptability of data collection procedures; (c) levels of attrition; (d) likely intervention effect size; (e) variability in number, length and frequency of support sessions estimated to bring about recovery; and (f) acceptability of the intervention. Additionally, we will collect data on the diagnosis of depression, symptoms of depression and anxiety, functional impairment, carer burden, quality of life, and stroke survivor mobility skill, self-care and functional ability, measured at four and six months post-randomization. DISCUSSION This study will provide important information for the feasibility and design of a Phase III (effectiveness) trial in the future. If the intervention is identified to be feasible, effective, and acceptable, a written CBTsh intervention for informal carers of stroke survivors, supported by mental health paraprofessionals, could represent a cost-effective model of care. TRIAL REGISTRATION Current Controlled Trials ISRCTN63590486.
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Affiliation(s)
- Joanne Woodford
- Mood Disorders Centre, Psychology, College of Life and Environmental Sciences, University of Exeter, Perry Road, Exeter EX4 4QG, UK.
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Daugla DM, Gami JP, Gamougam K, Naibei N, Mbainadji L, Narbé M, Toralta J, Kodbesse B, Ngadoua C, Coldiron ME, Fermon F, Page AL, Djingarey MH, Hugonnet S, Harrison OB, Rebbetts LS, Tekletsion Y, Watkins ER, Hill D, Caugant DA, Chandramohan D, Hassan-King M, Manigart O, Nascimento M, Woukeu A, Trotter C, Stuart JM, Maiden M, Greenwood BM. Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study [corrected]. Lancet 2014; 383:40-47. [PMID: 24035220 PMCID: PMC3898950 DOI: 10.1016/s0140-6736(13)61612-8] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND A serogroup A meningococcal polysaccharide-tetanus toxoid conjugate vaccine (PsA-TT, MenAfriVac) was licensed in India in 2009, and pre-qualified by WHO in 2010, on the basis of its safety and immunogenicity. This vaccine is now being deployed across the African meningitis belt. We studied the effect of PsA-TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic. METHODS We obtained data for the incidence of meningitis before and after vaccination from national records between January, 2009, and June, 2012. In 2012, surveillance was enhanced in regions where vaccination with PsA-TT had been undertaken in 2011, and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken. Meningococcal carriage was studied in an age-stratified sample of residents aged 1-29 years of a rural area roughly 13-15 and 2-4 months before and 4-6 months after vaccination. Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods. FINDINGS Roughly 1·8 million individuals aged 1-29 years received one dose of PsA-TT during a vaccination campaign in three regions of Chad in and around the capital N'Djamena during 10 days in December, 2011. The incidence of meningitis during the 2012 meningitis season in these three regions was 2·48 per 100,000 (57 cases in the 2·3 million population), whereas in regions without mass vaccination, incidence was 43·8 per 100,000 (3809 cases per 8·7 million population), a 94% difference in crude incidence (p<0·0001), and an incidence rate ratio of 0·096 (95% CI 0·046-0·198). Despite enhanced surveillance, no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions. 32 serogroup A carriers were identified in 4278 age-stratified individuals (0·75%) living in a rural area near the capital 2-4 months before vaccination, whereas only one serogroup A meningococcus was isolated in 5001 people living in the same community 4-6 months after vaccination (adjusted odds ratio 0·019, 95% CI 0·002-0·138; p<0·0001). INTERPRETATION PSA-TT was highly effective at prevention of serogroup A invasive meningococcal disease and carriage in Chad. How long this protection will persist needs to be established. FUNDING The Bill & Melinda Gates Foundation, the Wellcome Trust, and Médecins Sans Frontères.
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Affiliation(s)
- D M Daugla
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - J P Gami
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - K Gamougam
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - N Naibei
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - L Mbainadji
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - M Narbé
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - J Toralta
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - B Kodbesse
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - C Ngadoua
- Ministry of Public Health, N'Djamena, Chad
| | - M E Coldiron
- Epicentre, Médecins sans Frontères, Paris, France
| | - F Fermon
- Epicentre, Médecins sans Frontères, Paris, France
| | - A-L Page
- Epicentre, Médecins sans Frontères, Paris, France
| | - M H Djingarey
- WHO Intercountry Support Team, Ougadougou, Burkina Faso
| | - S Hugonnet
- Department of Pandemic and Epidemic Diseases, WHO, Geneva, Switzerland
| | - O B Harrison
- Department of Zoology, University of Oxford, Oxford, UK
| | - L S Rebbetts
- Department of Zoology, University of Oxford, Oxford, UK
| | - Y Tekletsion
- Department of Zoology, University of Oxford, Oxford, UK
| | - E R Watkins
- Department of Zoology, University of Oxford, Oxford, UK
| | - D Hill
- Department of Zoology, University of Oxford, Oxford, UK
| | - D A Caugant
- Norwegian Institute for Public Health, Oslo, Norway
| | - D Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - M Hassan-King
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - O Manigart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - M Nascimento
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - A Woukeu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - C Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - J M Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - McJ Maiden
- Department of Zoology, University of Oxford, Oxford, UK
| | - B M Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Roberts H, Watkins ER, Wills AJ. Cueing an unresolved personal goal causes persistent ruminative self-focus: an experimental evaluation of control theories of rumination. J Behav Ther Exp Psychiatry 2013; 44:449-55. [PMID: 23810947 DOI: 10.1016/j.jbtep.2013.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 04/02/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Control theory predicts that the detection of goal discrepancies initiates ruminative self-focus (Martin & Tesser, 1996). Despite the breadth of applications and interest in control theory, there is a lack of experimental evidence evaluating this prediction. The present study provided the first experimental test of this prediction. METHODS We examined uninstructed state rumination in response to the cueing of resolved and unresolved goals in a non-clinical population using a novel measure of online rumination. RESULTS Consistent with control theory, cueing an unresolved goal resulted in significantly greater recurrent intrusive ruminative thoughts than cueing a resolved goal. Individual differences in trait rumination moderated the impact of the goal cueing task on the extent of state rumination: individuals who had a stronger tendency to habitually ruminate were more susceptible to the effects of cueing goal discrepancies. LIMITATIONS The findings await replication in a clinically depressed sample where there is greater variability and higher levels of trait rumination. CONCLUSIONS These results indicate that control theories of goal pursuit provide a valuable framework for understanding the circumstances that trigger state rumination. Additionally, our measure of uninstructed online state rumination was found to be a valid and sensitive index of the extent and temporal course of state rumination, indicating its value for further investigating the proximal causes of state rumination.
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Affiliation(s)
- Henrietta Roberts
- Mood Disorders Centre, Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, UK.
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Caselli G, Gemelli A, Querci S, Lugli AM, Canfora F, Annovi C, Rebecchi D, Ruggiero GM, Sassaroli S, Spada MM, Watkins ER. The effect of rumination on craving across the continuum of drinking behaviour. Addict Behav 2013; 38:2879-83. [PMID: 24045029 DOI: 10.1016/j.addbeh.2013.08.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/21/2013] [Accepted: 08/21/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems. AIMS The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour. METHODS Participants of three groups of alcohol-dependent drinkers (N=26), problem drinkers (N=26) and social drinkers (N=29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase. RESULTS Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. CONCLUSIONS Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.
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Schaich A, Watkins ER, Ehring T. Can concreteness training buffer against the negative effects of rumination on PTSD? An experimental analogue study. J Behav Ther Exp Psychiatry 2013; 44:396-403. [PMID: 23659920 DOI: 10.1016/j.jbtep.2013.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/21/2013] [Accepted: 03/27/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Trauma-related rumination has been found to be an important maintaining factor for PTSD. On the background of the processing mode account of ruminative thinking, this study tested whether the relationship between rumination and analogue PTSD symptoms can be modified by training participants in a concrete mode of processing. METHODS Healthy participants were trained in either an abstract or a concrete style of processing. Afterwards, they watched a stressful film. The interactive effect of training condition and trait rumination on intrusive memories of the film was examined. RESULTS Following abstract training, a positive relationship between trait rumination and intrusive memories of the film emerged. As hypothesized, this relationship disappeared following concrete training. LIMITATIONS include the lack of a no-training control group and the analogue paradigm used. CONCLUSIONS The study provides preliminary evidence that the relationship between trait rumination and analogue PTSD symptoms can be modified. If replicated in future studies, it may be promising to examine the value of concreteness training for prevention and/or treatment of PTSD.
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Affiliation(s)
- Anja Schaich
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, The Netherlands
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McEvoy PM, Watson H, Watkins ER, Nathan P. The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct. J Affect Disord 2013; 151:313-20. [PMID: 23866301 DOI: 10.1016/j.jad.2013.06.014] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/10/2013] [Accepted: 06/08/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Repetitive negative thinking (RNT) increases vulnerability to multiple anxiety and depressive disorders and, as a common risk factor, elevated RNT may account for the high levels of comorbidity observed between emotional disorders. The aims of this study were to (a) compare two common forms of RNT (worry and rumination) across individuals with non-comorbid anxiety or depressive disorders, and (b) to examine the relationship between RNT and comorbidity. METHODS A structured diagnostic interview and measures of rumination, worry, anxiety, and depression were completed by a large clinical sample with an anxiety disorder or depression (N=513) presenting at a community mental health clinic. RESULTS Patients without (n=212) and with (n=301) comorbid diagnoses did not generally differ across the principal diagnosis groups (depression, generalised anxiety disorder, social anxiety disorder, panic disorder) on worry or rumination. As predicted, comorbidity was associated with a higher level of RNT. LIMITATIONS Cross-sectional design precluded causal conclusions and findings may not generalize to excluded anxiety disorders. CONCLUSIONS Consistent with the transdiagnostic hypothesis, RNT was associated with a range of anxiety disorders and depression and with comorbidity for those with a principal depressive disorder, supporting recent evidence that RNT is a transdiagnostic process. The presence of RNT, specifically worry and rumination, should be assessed and treated regardless of diagnostic profile. Future research may show that both pure and comorbid depressed or anxious patients receive incremental benefit from transdiagnostic protocols developed to treat core pathological processes of RNT traditionally associated with separate disorders.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology, University of Western Australia, Perth, Australia.
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Watson LA, Berntsen D, Kuyken W, Watkins ER. Involuntary and voluntary autobiographical memory specificity as a function of depression. J Behav Ther Exp Psychiatry 2013; 44:7-13. [PMID: 22805538 DOI: 10.1016/j.jbtep.2012.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 05/23/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES This study tests the hypothesis derived from the CaR-FA-X model (Capture and Rumination, Functional Avoidance and Executive Function model, Williams et al., 2007), that depressed individuals will be less specific during voluntary than involuntary autobiographical memory retrieval and looks at the relative contributions of rumination, avoidance and executive function to memory specificity. METHODS Twenty depressed and twenty never depressed individuals completed a memory diary, recording 10 involuntary and 10 voluntary autobiographical memories. Psychiatric status (assessed with the Structured Clinical Interview for DSM-IV, SCID-1), psychopathology, rumination, avoidance and executive function were assessed prior to completion of the memory diary. RESULTS Both groups were more specific during involuntary than voluntary memory retrieval. No overall group differences were identified. However, when non-remitted depressed participants were compared to partially remitted and never depressed participants the expected interaction was identified; non-remitted depressed individuals were less specific during voluntary, but not during involuntary recall. Consistent with theory, negative correlations between memory specificity, rumination and avoidance were also present. LIMITATIONS The study presents an important yet preliminary finding which warrants further replication with a larger sample size. CONCLUSIONS The findings provide support for a number of models of autobiographical memory retrieval in particular the CaR-FA-X model of memory specificity.
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Affiliation(s)
- L A Watson
- Center on Autobiographical Memory Research, Department of Psychology, Aarhus University, Denmark.
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Gaté MA, Watkins ER, Simmons JG, Byrne ML, Schwartz OS, Whittle S, Sheeber LB, Allen NB. Maternal parenting behaviors and adolescent depression: the mediating role of rumination. J Clin Child Adolesc Psychol 2013; 42:348-57. [PMID: 23323840 DOI: 10.1080/15374416.2012.755927] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Substantial evidence suggests that rumination is an important vulnerability factor for adolescent depression. Despite this, few studies have examined environmental risk factors that might lead to rumination and, subsequently, depression in adolescence. This study examined the hypothesis that an adverse family environment is a risk factor for rumination, such that the tendency to ruminate mediates the longitudinal association between a negative family environment and adolescent depressive symptoms. It also investigated adolescent gender as a moderator of the relationship between family environment and adolescent rumination. Participants were 163 mother-adolescent dyads. Adolescents provided self-reports of depressive symptoms and rumination across three waves of data collection (approximately at ages 12, 15, and 17 years). Family environment was measured via observational assessment of the frequency of positive and aggressive parenting behaviors during laboratory-based interactions completed by mother-adolescent dyads, collected during the first wave. A bootstrap analysis revealed a significant indirect effect of low levels of positive maternal behavior on adolescent depressive symptoms via adolescent rumination, suggesting that rumination might mediate the relationship between low levels of positive maternal behavior and depressive symptoms for girls. This study highlights the importance of positive parenting behaviors as a possible protective factor against the development of adolescent rumination and, subsequently, depressive symptoms. One effective preventive approach to improving adolescent mental health may be providing parents with psychoeducation concerning the importance of pleasant and affirming interactions with their children.
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Affiliation(s)
- Michael A Gaté
- Melbourne School of Psychological Sciences and Orygen Youth Health Research Centre, University of Melbourne, Australia
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Watson LA, Berntsen D, Kuyken W, Watkins ER. The characteristics of involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Conscious Cogn 2012; 21:1382-92. [PMID: 22850328 DOI: 10.1016/j.concog.2012.06.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/23/2012] [Accepted: 06/30/2012] [Indexed: 12/17/2022]
Abstract
This study compares involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Twenty depressed and twenty never depressed individuals completed a memory diary; recording their reactions to 10 involuntary and 10 voluntary memories over 14-30 days. Psychiatric status (Structured Clinical Interview for DSM-IV, SCID-1), psychopathology, rumination and avoidance were assessed. For both groups, involuntary memories more frequently lead to strong reactions than voluntarily memories. For both modes of retrieval, depressed individuals reported more frequent negative reactions than never depressed individuals and rated memories as more central to identity with higher levels of rumination and avoidance. Depressed individuals retrieved both positive and negative memories during involuntary retrieval. These findings support the view that involuntary memory retrieval represents a basic mode of retrieval during healthy and disordered cognition, and that during depression, both involuntary and voluntary memories are central to identity and associated with rumination and avoidance.
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Affiliation(s)
- L A Watson
- Center on Autobiographical Memory Research, Department of Psychology, Aarhus University, Denmark.
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Watkins ER, Taylor RS, Byng R, Baeyens C, Read R, Pearson K, Watson L. Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial. Psychol Med 2012; 42:1359-1371. [PMID: 22085757 PMCID: PMC3359637 DOI: 10.1017/s0033291711002480] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 09/29/2011] [Accepted: 09/30/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND The development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression. METHOD One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization). RESULTS The addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI -1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes. CONCLUSIONS This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.
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Affiliation(s)
- E R Watkins
- Mood Disorders Centre, University of Exeter, UK.
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Watkins ER, Moberly NJ, Moulds ML. When the ends outweigh the means: mood and level of identification in depression. Cogn Emot 2011; 25:1214-27. [PMID: 22017614 PMCID: PMC3471317 DOI: 10.1080/02699931.2010.532389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 09/12/2010] [Accepted: 10/04/2010] [Indexed: 11/03/2022]
Abstract
Research in healthy controls has found that mood influences cognitive processing via level of action identification: happy moods are associated with global and abstract processing; sad moods are associated with local and concrete processing. However, this pattern seems inconsistent with the high level of abstract processing observed in depressed patients, leading Watkins (2008, 2010) to hypothesise that the association between mood and level of goal/action identification is impaired in depression. We tested this hypothesis by measuring level of identification on the Behavioural Identification Form after happy and sad mood inductions in never-depressed controls and currently depressed patients. Participants used increasingly concrete action identifications as they became sadder and less happy, but this effect was moderated by depression status. Consistent with Watkins' (2008) hypothesis, increases in sad mood and decreases in happiness were associated with shifts towards the use of more concrete action identifications in never-depressed individuals, but not in depressed patients. These findings suggest that the putatively adaptive association between mood and level of identification is impaired in major depression.
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Affiliation(s)
- Edward R Watkins
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
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Abstract
Transdiagnostic models of psychopathology are increasingly prominent because they focus on fundamental processes underlying multiple disorders, help to explain comorbidity among disorders, and may lead to more effective assessment and treatment of disorders. Current transdiagnostic models, however, have difficulty simultaneously explaining the mechanisms by which a transdiagnostic risk factor leads to multiple disorders (i.e., multifinality) and why one individual with a particular transdiagnostic risk factor develops one set of symptoms while another with the same transdiagnostic risk factor develops another set of symptoms (i.e., divergent trajectories). In this article, we propose a heuristic for developing transdiagnostic models that can guide theorists in explicating how a transdiagnostic risk factor results in both multifinality and divergent trajectories. We also (a) describe different levels of transdiagnostic factors and their relative theoretical and clinical usefulness, (b) suggest the types of mechanisms by which factors at 1 level may be related to factors at other levels, and (c) suggest the types of moderating factors that may determine whether a transdiagnostic factor leads to certain specific disorders or symptoms and not others. We illustrate this heuristic using research on rumination, a process for which there is evidence it is a transdiagnostic risk factor.
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Pearson KA, Watkins ER, Mullan EG. Rejection sensitivity prospectively predicts increased rumination. Behav Res Ther 2011; 49:597-605. [DOI: 10.1016/j.brat.2011.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 04/17/2011] [Accepted: 06/10/2011] [Indexed: 11/30/2022]
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Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H, Bathurst N, Eastman R, Scott J. Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial. Br J Psychiatry 2011; 199:317-22. [PMID: 21778171 DOI: 10.1192/bjp.bp.110.090282] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND About 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive-behavioural therapy (CBT). AIMS To test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression. METHOD Forty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150). RESULTS Adding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination. CONCLUSIONS This is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.
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Affiliation(s)
- Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, UK.
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Galfin JM, Watkins ER. Construal level, rumination, and psychological distress in palliative care. Psychooncology 2011; 21:680-3. [PMID: 21381149 DOI: 10.1002/pon.1948] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 11/28/2010] [Accepted: 01/28/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with a life-limiting illness, such as cancer, and their carers experience elevated psychological distress. However, the psychological mechanisms underpinning distress in palliative care have been little studied. Recent theories predict that individuals who experience increased uncertainty in the context of ongoing difficulties, such as palliative patients and their carers, will (a) think more abstractly; (b) ruminate more; and (c) be more distressed. METHODS Palliative patients (n = 36, 90% with cancer), their carers (n = 29), and age-matched controls (n = 30) completed standardized questionnaires to assess anxiety, depression, and rumination, and open-ended interviews to identify their concerns and idiosyncratic levels of rumination. Concerns were analyzed linguistically for level of abstraction. RESULTS As predicted, (i) palliative patients and carers reported significantly more uncertainty, rumination, and abstract thinking than controls; (ii) uncertainty, abstractness, and rumination were associated with psychological distress. CONCLUSIONS Abstraction and rumination are psychological mechanism potentially involved in increased psychological distress in palliative care.
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Galfin JM, Watkins ER, Harlow T. Evaluation of a training programme to teach a guided self-help psychological intervention to hospice staff. Int J Palliat Nurs 2011; 17:119-24. [DOI: 10.12968/ijpn.2011.17.3.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: A recent trial demonstrated that a brief guided self-help intervention reduces anxiety in palliative patients. This study investigated whether training palliative nurses to deliver a guided self-help intervention would improve their routine management of psychological distress. Design: A randomized controlled cluster trial compared a team of nurses who attended training (n=5) with a team allocated to a no-training control condition (n=5) on self-reported behaviour and confidence in addressing psychological distress. Ratings of patient psychological distress at routine clinical assessments were also examined pre- and post-training to assess the impact of training on patient distress. Results: As predicted, patients cared for by the trained team demonstrated a significantly greater reduction in distress post-training than patients cared for by the untrained team. However, there was no significant difference in self-reported behaviour and confidence. Conclusion: These findings suggest that brief workshop-based training improves clinical outcomes on psychological distress and may be a means to increase the accessibility of effective psychological interventions in palliative care.
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Affiliation(s)
- JM Galfin
- Mood Disorders Centre, College of Life and Environmental Sciences, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - ER Watkins
- Mood Disorders Centre, College of Life and Environmental Sciences, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - T Harlow
- Palliative Medicine, Hospiscare, Exeter, UK
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