Neurotic Personality Traits and Risk for Adverse Alcohol Outcomes: Chained Mediation through Emotional Disorder Symptoms and Drinking to Cope

BACKGROUND

Rates of alcohol abuse are high on Canadian postsecondary campuses. Individual trait differences have been linked to indices of alcohol use/misuse, including neurotic traits like anxiety sensitivity (AS) and hopelessness (HOP). We know little, though, about how these traits confer vulnerability. AS and HOP are related to anxiety and depression, respectively, and to drinking to cope with symptoms of those disorders. Neurotic personality may therefore increase risk of alcohol use/abuse via (1) emotional disorder symptoms and/or (2) coping drinking motives.

OBJECTIVES

Allan and colleagues (2014) found chained mediation through AS-generalized anxiety-coping motives-alcohol problems and AS-depression-coping motives-alcohol problems. We sought to expand their research by investigating how emotional disorder symptoms (anxiety, depression) and specific coping motives (drinking to cope with anxiety, depression) may sequentially mediate the AS/HOP-to-hazardous alcohol use/drinking harms relationships among university students.

METHODS

This study used cross-sectional data collected in Fall 2014 as part of the Movember-funded Caring Campus Project (N = 1,883). The survey included the SURPS, adapted DMQ-R SF, and AUDIT-3.

RESULTS

AS and HOP were both related to hazardous alcohol and drinking harms via emotional disorder symptoms and, in turn, coping drinking motives. All indirect pathways incorporating both mediators were statistically significant, and additional evidence of partial specificity was found. Conclusions/Importance: The study's results have important implications for personality-matched interventions for addictive disorders.

Determinants and incidence of depression in multiple sclerosis: A prospective cohort study

OBJECTIVE

To estimate the incidence and explore potential determinants of incidence of depression in MS.

METHODS

A prospective cohort study used a sample of 192 patients from the southern Alberta MS clinic registry. Participants completed baseline risk factor assessment questionnaires using either online, mail or telephone surveys, and completed the Patient Health Questionnaire every 2weeks for 6months to assess depressive symptoms in real time. Risk factors assessed included biopsychosocial variables such as socioeconomic status, illness-related factors, childhood risk factors, psychosocial factors, and health behaviors. Cox proportional hazard models were fit to estimate predictors of incidence.

RESULTS

2-week incidence of depression for females was 0.019 (95% CI 0.013-0.029) and for males was 0.044 (0.026-0.074). Strongest predictor of depression incidence risk included fatigue impact, low mobility, resiliency, self-esteem, self-efficacy, and coping style.

CONCLUSION

Depression in MS exhibits a risk factor profile similar to that of depression in the general population, with the additional impact of MS illness-related factors. Potentially modifiable risk factors, such as coping with stress and resiliency, present opportunities for focus of further research in depression in MS treatment and prevention efforts. Some differences in determinants of incidence were found compared to the prevalence risk factors, highlighting the danger of using cross-sectional data to make assumptions about risk. For example, the finding that depression incidence was higher for men is opposite to the higher depression prevalence estimates found for women as well as the consensus in the literature.

Different receptors mediate the electrophysiological and growth cone responses of an identified neuron to applied dopamine

Neurotransmitters are among the many cues that may guide developing axons toward appropriate targets in the developing nervous system. We have previously shown in the mollusk Lymnaea stagnalis that dopamine, released from an identified pre-synaptic cell, differentially affects growth cone behavior of its target and non-target cells in vitro. Here, we describe a group of non-target cells that also produce an inhibitory electrophysiological response to applied dopamine. We first determined, using pharmacological blockers, which receptors mediate this physiological response. We demonstrated that the dopaminergic electrophysiological responses of non-target cells were sensitive to a D2 receptor antagonist, as are known target cell responses. However, the non-target cell receptors were linked to different G-proteins and intracellular signaling pathways than the target cell receptors. Despite the presence of a D2-like receptor at the soma, the growth cone collapse of these non-target cells was mediated by D1-like receptors. This study shows that different dopamine receptor sub-types mediated the inhibitory physiological and growth cone responses of an identified cell type. We therefore not only provide further evidence that D2- and D1-like receptors can be present on the same neuron in invertebrates, but also show that these receptors are likely involved in very different cellular functions.

A longitudinal investigation of information processing and cognitive organization in clinical depression: stability of schematic interconnectedness

This study longitudinally investigated information processing and cognitive organization in clinical depression. The main hypothesis was that individuals whose depression had remitted would show a significant cognitive shift on information processing (e.g., deactivation of negative processing) but not on cognitive organizational tasks, Forty-five individuals with clinical depression completed 2 information processing and 2 cognitive organizational tasks at initial assessment. At 6-month follow-up, the sample (23 remitted, 22 stable depressed) was readministered the tasks. As expected, information processing shifted significantly in individuals who had improved symptomatically, whereas negative cognitive organizational indices remained stable. The implications of these results are discussed as they pertain to the cognitive vulnerability, maintenance, treatment, and recurrence of depression. Directions for future research are suggested.

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

This study investigated information processing and cognitive organization in clinical depression. The specificity of various cognitive mechanisms to depression was also examined. Twenty-six depressed/anxious individuals, 24 pure depressives, 25 never-depressed anxious controls, and 25 nonpsychiatric controls completed a modified Stroop task, the Self-Referent Encoding Task, and two tasks designed to assess cognitive structure. Comorbid depressed/anxious, depressed, and anxious groups performed similarly to one another but differed significantly from nonpsychiatric controls, on the processing and organization of negative content. Specificity to depression was also obtained, as both depressed groups endorsed and recalled less positive information and organized positive self-relevant information with less interconnectedness than anxious individuals and nonpsychiatric controls. These results suggest that depressed individuals have an interconnected negative self-representational system and lack a well-organized positive template of self. These findings are discussed in terms of cognitive models of depression and the tripartite model of depression and anxiety.

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

This study investigated information processing and cognitive organization in clinical depression. The specificity of various cognitive mechanisms to depression was also examined. Twenty-six depressed/anxious individuals, 24 pure depressives, 25 never-depressed anxious controls, and 25 nonpsychiatric controls completed a modified Stroop task, the Self-Referent Encoding Task, and two tasks designed to assess cognitive structure. Comorbid depressed/anxious, depressed, and anxious groups performed similarly to one another but differed significantly from nonpsychiatric controls, on the processing and organization of negative content. Specificity to depression was also obtained, as both depressed groups endorsed and recalled less positive information and organized positive self-relevant information with less interconnectedness than anxious individuals and nonpsychiatric controls. These results suggest that depressed individuals have an interconnected negative self-representational system and lack a well-organized positive template of self. These findings are discussed in terms of cognitive models of depression and the tripartite model of depression and anxiety.

The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be used to assessed for mental disorders in order to ensure that they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency.

Cognitive therapy: looking backward, looking forward

This article reviews some of the historical factors associated with the unprecedented strength and popularity of cognitive therapy, and offers predictions for the next half-century of this approach to treatment. It is predicted that the future will bring with it increased demands on cognitive therapy for evaluation of processes of change (including identification of therapeutic specifics and nonspecifics, technical specification of the process of therapy, and examination of therapist and patient predictors of change), and accountability and efficiency in the public and private sectors. With the increase in personal autonomy, globalization, and technology, the demands from the general public also will increase. One possible risk of the trend towards increased technology is that cognitive therapy may become overly technical. Although specific therapy techniques are crucial to delivering effective treatment, it is also the "nonspecifics" of therapy that add to the "art" of psychotherapy. The final challenge of cognitive therapy also may be the most difficult--to continue to be an empirically based science while maintaining its role in the art of healing.

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.

Cognitive-behavioral treatment for depression: relapse prevention

This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.

Cognitive-behavioral treatment for depression: relapse prevention

This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.

A component analysis of cognitive-behavioral treatment for depression

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Predictive utility of the CSQ in low back pain: individual vs. composite measures

Researchers have typically used factor-analytic composite measures of coping, instead of individual scales, to predict rehabilitation outcome. There are, however, both advantages and disadvantages to using individual or composite scores. This study extended the findings of Jensen et al. (1992), by prospectively comparing the individual and composite scores of the Coping Strategies Questionnaire (CSQ) in the prediction of 4 types of adjustment to low back pain. Two-hundred patients completed the CSQ, the Oswestry Index, the SCL-90R, and 4 lifting tasks at admission and discharge from a multidisciplinary pain clinic. Return to work was determined at 9-month follow-up. The CSQ scales were factor-analyzed to devise composite indices, and the 3 resultant factors were compared to the individual scales in the prediction of pain and other outcomes. The results indicated that the relative predictive utility of the composite or individual scales depended on which outcome measure was used to define adjustment.

A component analysis of cognitive-behavioral treatment for depression

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Self-medication and memory in an elderly Canadian sample

The ability of elderly people to self-medicate is a critical function for successful independent living. The current research investigated the predictive value of three aspects of memory potentially related to success or failure in a self-medication program. Results show that a combination of memory measures successfully discriminated between those subjects who advanced in the program and those who did not. The results of the present study provide information that will aid in improving the selection process for admission to self-medication programs.

Social problem-solving in depressed, conduct-disordered, and normal adolescents

Although past theory and research implicate social problem-solving deficits in both depression and aggressive disorders, research examining carefully diagnosed groups of adolescent depressed and conduct-disordered groups had not previously been conducted. In the current study three groups of adolescents (major depression, conduct-disordered, and normal) were studied using two social problem-solving measures. Both the Means-Ends Problem-Solving task (MEPS) and the Social Situations Analysis measure (SSA) failed to show social problem-solving problem deficits in the depressed group relative to their normal age peers, but did provide corroborative evidence for social problem-solving deficits in the conduct-disordered sample. Relative to the other two groups, the conduct-disordered adolescents were found to generate fewer means to a social end, to anticipate fewer obstacles in the pursuit of solutions to interpersonal situations, and to generate fewer assertive behavioral solutions to difficult social situations. The results are discussed in relation to other work with depressed and aggressive youth, and directions for future research are given.

A meta-analysis of the efficacy of cognitive therapy for depression

In meta-analysis format the effectiveness of Beck's cognitive therapy for depression was reviewed. Twenty-eight studies were identified that used a common outcome measure of depression, and comparisons of cognitive therapy with other therapeutic modalities were made. The results document a greater degree of change for cognitive therapy compared with a waiting list or no-treatment control, pharmacotherapy, behavior therapy, and other psychotherapies. The degree of change associated with cognitive therapy was not significantly related to the length of therapy or the proportion of women in the studies, and although it was related to the age of the clientele, a lack of adequate representativeness of various age groups renders these results equivocal. Implications for further outcome and process studies in cognitive therapy are discussed.

A meta-analysis of the efficacy of cognitive therapy for depression

In meta-analysis format the effectiveness of Beck's cognitive therapy for depression was reviewed. Twenty-eight studies were identified that used a common outcome measure of depression, and comparisons of cognitive therapy with other therapeutic modalities were made. The results document a greater degree of change for cognitive therapy compared with a waiting list or no-treatment control, pharmacotherapy, behavior therapy, and other psychotherapies. The degree of change associated with cognitive therapy was not significantly related to the length of therapy or the proportion of women in the studies, and although it was related to the age of the clientele, a lack of adequate representativeness of various age groups renders these results equivocal. Implications for further outcome and process studies in cognitive therapy are discussed.

Marital and social adjustment in depressed and remarried women

The current study investigated the hypothesis that marital and social adjustment deficits would be observed in married women who had been depressed previously. Three groups of subjects, currently depressed (N = 12), remitted (N = 12), and nondepressed (N = 12), who met criteria for participation completed the Dyadic Adjustment Scale and the Social Adjustment Scale. The results revealed that any residual social adjustment deficit in the remitted group was confined to social and leisure adjustment. Scores on the Dyadic Adjustment Scale, the work subscale of the Social Adjustment Scale, and the overall score on the Social Adjustment Scale revealed differences between the remitted and currently depressed groups. The results were discussed with reference to the likely correlational nature of marital and social maladjustment in depression and to future research needs.

The interactional model of anxiety: an evaluation of the differential hypothesis

The interactional model of anxiety states that individuals who score high on trait anxiety measure for a specific situation dimension will respond with elevated state anxiety only in reaction to encounters with congruent situations. We tested this model by presenting subjects who scored high or low on ego threat, physical danger, novelty ambiguity, and daily routine trait measures with stressors representative of the four situation dimensions. The interactional model was partially supported for ego threat trait anxiety. However, results generally supported the influence of situation rather than the trait or interaction on anxiety response. The lack of trait factor independence for the novelty ambiguity and daily routine trait dimensions is discussed as a potential reason for the nonsupport of the interactional model. Finally, we suggest that the experimental design used in this study is a more accurate and vigorous test of the differential hypothesis than past research.

The role of activity level and cognition in depressed mood in a university sample

This study examined the role of activity level and cognition on mood by contrasting a monitor only (N = 22), increase pleasant events (N = 20), and increase pleasant events plus focusing on event pleasantness (N = 23) groups over a 2-week period. The results show that subjects who were instructed to increase their number of pleasant events did so and obtained more pleasure as a result. The group which increased pleasant events and focused on event pleasantness also showed a significant decrease in level of depression. The results are interpreted to support the role of monitoring and pleasant events on mood, but the potential necessity for cognitive change to create "antidepressant" effects.

The interactional model of anxiety: An evaluation of the differential hypothesis

The interactional model of anxiety states that individuals who score high on trait anxiety measure for a specific situation dimension will respond with elevated state anxiety only in reaction to encounters with congruent situations. We tested this model by presenting subjects who scored high or low on ego threat, physical danger, novelty ambiguity, and daily routine trait measures with stressors representative of the four situation dimensions. The interactional model was partially supported for ego threat trait anxiety. However, results generally supported the influence of situation rather than the trait or interaction on anxiety response. The lack of trait factor independence for the novelty ambiguity and daily routine trait dimensions is discussed as a potential reason for the nonsupport of the interactional model. Finally, we suggest that the experimental design used in this study is a more accurate and vigorous test of the differential hypothesis than past research.

Reliability of a measure of the quality of cognitive therapy

This study investigates some of the psychometric properties of the Cognitive Therapy Scale (CTS) using a sample of experienced psychotherapists. Four raters, experienced in cognitive therapy, rated a total of 21 independent, videotaped psychotherapy sessions, and provided ratings along the dimensions of therapist competence measured by the CTS. Analyses included item intercorrelations, item-total correlations, and two assessments of inter-rater reliability. Inter-rater reliabilities showed a significant positive correlation for all items of the CTS and the internal reliability was strong. The potential of the CTS to address both the competency of cognitive therapists and trainees is discussed.

An analysis of anxiety and depression scales

The relationship between the constructs of anxiety and depression are examined through the administration of nine self-report scales to male and female undergraduates. The results showed strong correlations among all measures, and factor analyses revealed one major "psychological distress" factor for each sex. No sex differences were found on the measure employed. The discussion focused on the implications of the findings for research in the areas of anxiety and depression, and further research that is required.

Sources of differential stress response associated with psychometrically designated anxiety proneness

This research examined different aspects of the expression of psychometrically designated anxiety proneness related to dimensions of "ego threat" and "novelty ambiguity." In an ego-threatening situation, subjects were presented with abstract-reasoning items whose stress-relevant properties-item difficulty-had earlier been scaled among comparable samples. In the first study, comparisons focused on objective outcomes (records of task failure) as well as appraised outcome records and appraised task effort necessary for adequate performance. In the second study, comparisons emphasized direct physiological and subjective reactions to the stressing situational properties. Results indicate that anxiety proneness is associated with variation in direct reactions to the stressing properties but not with variation in the configuration of the objective or appraised properties themselves. Implications for current concepts on the expression of anxiety proneness and for its psychometric prediction are discussed, as are certain similarities between the present findings and those from research on other sources of individual differences in stress response. Differential sensitivities of alternative indices of stress reaction to variation in anxiety proneness are considered in the light of earlier studies.