1
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Sandman CF, Craske MG. Experiential processing increases positive affect and decreases dampening appraisals during autobiographical memory recall in an anhedonic sample. Behav Res Ther 2024; 181:104606. [PMID: 39067316 DOI: 10.1016/j.brat.2024.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/18/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
Anhedonia is characterized by diminished reward processing, which may be explained in part by dampening appraisals, or thoughts that blunt positive emotions. Experiential processing, or attending to sensory and bodily experience, may curb dampening appraisals, as compared to analytical processing, or conceptually thinking about an event. In this study, 96 participants with elevated anhedonia completed writing tasks, in which they recalled positive autobiographical memories. Participants recalled the first memory as they naturally would to assess spontaneous use of processing mode and were then randomized to recall the second positive memory using either experiential, analytical, or control instructions. Both spontaneous and instructed experiential processing were associated with greater positive affect and less dampening compared to analytical processing. Clinical implications include savoring pleasant sensations to reduce dampening and enhance positive affect in anhedonia.
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Affiliation(s)
- Christina F Sandman
- Department of Psychology, University of California, Los Angeles (UCLA), USA.
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles (UCLA), USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), USA
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2
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Jackson LE, Wilson KA, MacNamara A. Savoring mental imagery: Electrocortical effects and association with depression. Behav Res Ther 2024; 179:104559. [PMID: 38761557 DOI: 10.1016/j.brat.2024.104559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
The ability to focus on and increase positive emotion in response to mental imagery may play a key role in emotional wellbeing. Moreover, deficits in this ability might underlie emotional disorders such as depression. Here, we set out to determine whether people could use savoring to upregulate subjective and electrocortical response to mental imagery of previously viewed positive and neutral pictures, and whether this would be negatively affected by depression. On each trial, participants (N = 49) viewed a positive or neutral picture, prior to simply re-imagining the previously presented picture ("view") or re-imagining the picture while savoring it ("savor"). Results showed that savoring increased electrocortical and subjective response to imagined stimuli; however, this effect was only evident at the electrocortical level when controlling for depression. Moreover, depression moderated electrocortical findings, such that individuals who were more depressed showed a reduced effect of savoring on neural response to mental imagery. Results are in line with recent work that has shown the benefits of positive affect treatment for depression, to suggest that deficits in savoring mental imagery may play a role in the development and/or maintenance of depression.
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Affiliation(s)
| | | | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, USA; Department of Psychiatry and Behavioral Sciences, USA; Institute for Neuroscience, Texas A&M University, College Station, TX, USA.
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3
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Kryza-Lacombe M, Spaulding I, Ku CK, Pearson N, Stein MB, Taylor CT. Amplification of positivity for depression and anxiety: Neural prediction of treatment response. Behav Res Ther 2024; 178:104545. [PMID: 38714105 DOI: 10.1016/j.brat.2024.104545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/09/2024]
Abstract
Psychosocial treatments targeting the positive valence system (PVS) in depression and anxiety demonstrate efficacy in enhancing positive affect (PA), but response to treatment varies. We examined whether individual differences in neural activation to positive and negative valence incentive cues underlies differences in benefitting from a PVS-targeted treatment. Individuals with clinically elevated depression and/or anxiety (N = 88, ages 18 to 55) participated in one of two randomized, waitlist-controlled trials of Amplification of Positivity (AMP; NCT02330627, NCT03196544), a cognitive and behavioral intervention targeting the PVS. Participants completed a monetary incentive delay (MID) task during fMRI acquisition at baseline measuring neural activation to the possibility of gaining or losing money. Change in PA from before to after treatment was assessed using the Positive and Negative Affect Schedule. No significant associations were observed between baseline neural activation during gain anticipation and AMP-related changes in PA in regions of interest (striatum and insula) or whole-brain analyses. However, higher baseline striatal and insula activation during loss anticipation was associated with greater increases in PA post-AMP. This study provides preliminary evidence suggesting neural reactivity to negative valence cues may inform who stands to benefit most from treatments targeting the PVS.
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Affiliation(s)
- Maria Kryza-Lacombe
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Isabella Spaulding
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Cheuk King Ku
- Department of Psychiatry, University of California, San Diego, USA
| | - Nana Pearson
- Department of Psychiatry, University of California, San Diego, USA
| | - Murray B Stein
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA; Department of Psychiatry, University of California, San Diego, USA
| | - Charles T Taylor
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA; Department of Psychiatry, University of California, San Diego, USA.
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4
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Hutchinson T, Riddleston L, Lavi I, Pile V, Meehan A, Shukla M, Lau J. Does Prospective Mental Imagery Predict Symptoms of Negative Affect and Anhedonia in Young People? Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01695-1. [PMID: 38704800 DOI: 10.1007/s10578-024-01695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/07/2024]
Abstract
Adolescent depression is associated with unhelpful emotional mental imagery. Here, we investigated whether vividness of negative and positive prospective mental imagery predict negative affect and anhedonia in adolescents. 111 people from Israel completed measures of prospective mental imagery, negative affect, and anhedonia at two time-points approximately three months apart. Using three cross-lagged panel models, we showed once 'concurrent' (across-variable, within-time) and 'stability' paths (across-time, within-variable) were estimated, there were no significant cross-lag paths between: i) T1 prospective negative mental imagery and T8 negative affect (i.e. increased vividness of negative future imagery at Time 1 did not predict increased negative affect at Time 8); ii) T1 prospective positive mental imagery and T8 negative affect (i.e. reduced vividness of positive future imagery at Time 1 did not predict increased negative affect at Time 8); and iii) T1 prospective positive mental imagery and T8 anhedonia (i.e. reduced vividness of positive future imagery at Time 1 did not predict increased anhedonia at Time 8). Given high levels of attrition, future research should aim to explore these associations in a larger, more diverse population, as such data could inform on whether modifying earlier prospective mental imagery may influence later time/context-specific effects of prospective mental imagery on negative affect and anhedonia.
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Affiliation(s)
- Taryn Hutchinson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura Riddleston
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Iris Lavi
- Department of Psychology, University of Bath, Bath, UK
- School of Social Work, The Centre for Research and Study of the Family, University of Haifa, Haifa, Israel
| | - Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alan Meehan
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Meenakshi Shukla
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Jennifer Lau
- Youth Resilience Unit, Queen Mary, University of London, London, UK.
- Newham Centre for Mental Health, London, E13 8SP, UK.
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5
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Furman BW, Craighead WE, Mayberg HS, Mletzko T, Nemeroff CB, Dunlop BW. The utility of measuring daily hassles and uplifts in understanding outcomes to treatments for major depressive disorder. Psychiatry Res 2024; 335:115859. [PMID: 38574700 PMCID: PMC11015958 DOI: 10.1016/j.psychres.2024.115859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/09/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Little is known about the effects of common daily experiences in patients with major depressive disorder (MDD). The Daily Hassles and Uplifts Scale (HUPS) was assessed in 142 treatment-naïve adult MDD outpatients randomized to 12 weeks of treatment with either antidepressant medication (ADM) or Cognitive Behavior Therapy (CBT). Three HUPS measures were analyzed: hassle frequency (HF), uplift frequency (UF), and the mean hassle intensity to mean uplift intensity ratio (MHI:MUI). Remission after treatment was not predicted by these baseline HUPS measures and did not moderate outcomes by treatment type. In contrast, HUPS measures significantly changed with treatment and were impacted by remission status. Specifically, HF and MHI:MUI decreased and UF increased from baseline to week 12, with remission leading to significantly greater decreases in HF and MHI:MUI compared to non-remission. ADM-treated patients demonstrated significant improvements on all three HUPS measures regardless of remission status. In contrast, remitters to CBT demonstrated significant improvements in HF and MHI:MUI but not UF; among CBT non-remitters the only significant change was a reduction in HF. The changes in HUPS measures are consistent with how affective biases are impacted by treatments and support the potential value of increasing attention to positive events in CBT.
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Affiliation(s)
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA; Department of Psychology, Emory University, Atlanta, USA
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tanja Mletzko
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Institute for Early Life Adversity Research, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA.
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6
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Arens EA, Donnerstag L, Hofmann SG, Stangier U. [Video-Based Online Metta-Meditation Therapy for Depression: A Pilot Trial Evaluating the Acceptability and Feasibility]. VERHALTENSTHERAPIE 2024; 34:32-43. [PMID: 38645510 PMCID: PMC11025693 DOI: 10.1159/000534381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 04/23/2024]
Abstract
Background In the course of the Covid-19 pandemic, it has become clear what relevance non-contact psychotherapeutic online interventions in mental health care could possibly have in the future. The present pilot study aims to test whether a Metta-based group program is also an acceptable and feasible treatment when conducted as video-based intervention. Metta meditations aim at showing unconditional benevolence and kindness to oneself and to other people. Methods Eight patients with depressive disorder participated in a video-based implementation of the Metta-based group program. Quality of the therapeutic relationship, the implementation of methods as well as the acceptance of the video-based therapy on the part of the participants were surveyed as target variables. Results Data indicated good feasibility in terms of a sustainable therapeutic relationship, the possibility of teaching meditation techniques, and the establishment of a concentrated working atmosphere. Videobased therapy met with good acceptance among the participants. Potential indications for its clinical effectiveness are evident. Conclusion Teaching Metta meditation in a group program for the treatment of depression can be practicably implemented in a video-based therapy and meets with good acceptance by the patients. Further studies on moderators of acceptance and efficacy of video-based therapy are needed.
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Affiliation(s)
- Elisabeth A. Arens
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Lucas Donnerstag
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Stefan G. Hofmann
- Abteilung für Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Marburg, Deutschland
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Ulrich Stangier
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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7
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Ji JL, MacLeod C. Less bang for my buck: Diminished anticipated enjoyment contributes to dysphoria-linked deficit in activity behavioural engagement choice. Behav Res Ther 2024; 177:104526. [PMID: 38598897 DOI: 10.1016/j.brat.2024.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/04/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
This study experimentally investigated the role of anticipated enjoyment and effort in mediating dysphoria-related deficit in activity engagement behavioural choice. Using a novel activity information processing task (about a fictional "new" Nintendo Wii sports game called "Tornado Ball"), N = 249 participants (n = 95 High Dysphoria; n = 154 Low Dysphoria) were presented information about the benefits (enjoyable features) and costs (mental and physical effort barriers) as product reviews from another player. The order of cost vs. benefit information was manipulated such that participants either heard cost information before benefit information, or vice versa. They then rated what their anticipated enjoyment and effort will be if they were to play Tornado Ball, before being given the opportunity to choose to try it themselves or not. The High Dysphoria group reported lower anticipated enjoyment (but not higher effort) relative to the Low Dysphoria group, but only when cost information was presented first. Importantly, a moderated mediation showed that the High Dysphoria group reported lower tendency to choose activity engagement (game play) as a function of having lower anticipated enjoyment, but only when cost information was presented first. The present finding indicate that reduced anticipated enjoyment may causally contribute to dysphoria-linked deficits in activity engagement behavioural choice.
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Affiliation(s)
- Julie L Ji
- School of Psychology, University of Plymouth, UK; Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia.
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
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8
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Cogan AB, Persons JB, Kring AM. Using the Beck Depression Inventory to Assess Anhedonia: A Scale Validation Study. Assessment 2024; 31:431-443. [PMID: 37039528 PMCID: PMC10822059 DOI: 10.1177/10731911231164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Anhedonia is central to several psychological disorders and a frequent target of psychosocial and pharmacological treatments. We evaluated the psychometric properties of two widely used anhedonia measures derived from the Beck Depression Inventory: a 3-item (BDI-Anh3) and a 4-item version (BDI-Anh4). We evaluated these measures in a large undergraduate sample, a community sample, and a clinical sample. Both the BDI-Anh3 and the BDI-Anh4 showed adequate internal consistency, with BDI-Anh4 performing somewhat better, across the three samples. Both measures showed good convergent and discriminant validity, even after controlling for shared variance with other items on the BDI. These findings indicate that both measures have sufficient reliability and validity to support their use by researchers and clinicians.
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Affiliation(s)
| | - Jacqueline B. Persons
- University of California, Berkeley, USA
- Oakland Cognitive Behavior Therapy Center, CA, USA
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Crapolicchio E, Cinquegrana V, Regalia C. The Role of Positivity on Depressive Symptoms in Women Seeking Help for Intimate Partner Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7078. [PMID: 37998309 PMCID: PMC10671117 DOI: 10.3390/ijerph20227078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
Intimate partner violence (IPV) is a complex and pervasive global phenomenon. Despite extensive research on physical and sexual violence, there has been a relative lack of investigation into the detrimental and distinctive consequences of psychological violence against women. This is surprising given the profound impact it has on the psychological well-being of victims, notably in the form of depression, which is commonly observed as an outcome in cases of psychological IPV victimization. The present study analyzes the impact of psychological IPV on depressive symptoms, considering the moderating influence of personal positivity, defined as positive self-perceptions, optimistic life perspectives, and a hopeful view of the future in a sample of 171 Italian women seeking assistance from anti-violence centers in different localities of Italy. The findings show that in line with the hypothesis, the association between psychological violence and depressive symptoms is moderated by the levels of perceived positivity, even when controlling for instances of physical violence. These results and implications for interventions are discussed within the framework of existing literature on positive psychology and psychological well-being in the context of IPV.
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Affiliation(s)
| | - Vincenza Cinquegrana
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Camillo Regalia
- Department of Psychology, Catholic University of Sacred Heart, 20123 Milan, Italy;
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10
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Bogaert L, Van der Gucht K, Kuppens P, Kock M, Schreuder MJ, Kuyken W, Raes F. The effect of universal school-based mindfulness on anhedonia and emotional distress and its underlying mechanisms: A cluster randomised controlled trial via experience sampling in secondary schools. Behav Res Ther 2023; 169:104405. [PMID: 37797436 PMCID: PMC10938062 DOI: 10.1016/j.brat.2023.104405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
This cluster randomised controlled trial examined the effectiveness of universal school-based mindfulness training (MT; vs. passive control) to lower anhedonia and emotional distress among mid-adolescents (15-18 years). It further examined three potential mechanisms: dampening of positive emotions, non-acceptance/suppression of negative emotions, and perceived social pressure not to experience/express negative emotions. Adolescents (ncontrol = 136, nintervention = 95) participated in three assessment points (before, after and two/three months after the in-class MT), consisting of Experience Sampling (ES) assessments and self-report questionnaires (SRQs) to corroborate the ES assessments. Analyses were based on general linear modelling and multilevel modelling. Overall, no evidence was found for a significant beneficial and long-lasting impact of the MT on adolescents' mental health. Importantly, some barriers inherently linked to universal MT approaches (low engagement in and mixed attitudes towards the MT) may have tempered the effectiveness of the MT in the current trial. Further research should prioritise overcoming these barriers to optimise programme implementation. Additionally, given the potential complex interplay of moderators at micro- (home practice), meso- (school climate), and macro-level (broader context), research should simultaneously focus on alternative ways of delivering MT at schools to strengthen adolescents' mental health.
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Affiliation(s)
- Liesbeth Bogaert
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium; Leuven Mindfulness Centre, KU Leuven, Belgium; KU Leuven Child and Youth Institute, KU Leuven, Belgium.
| | - Katleen Van der Gucht
- Leuven Mindfulness Centre, KU Leuven, Belgium; KU Leuven Child and Youth Institute, KU Leuven, Belgium; Research Unit Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Belgium; Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Peter Kuppens
- Leuven Mindfulness Centre, KU Leuven, Belgium; Research Unit Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Belgium
| | - Merle Kock
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium; Leuven Mindfulness Centre, KU Leuven, Belgium; KU Leuven Child and Youth Institute, KU Leuven, Belgium
| | - Marieke J Schreuder
- Research Unit Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Belgium
| | - Willem Kuyken
- Department of Psychiatry, Medical Sciences Division, University of Oxford, United Kingdom; University of Oxford Mindfulness Research Centre, University of Oxford, United Kingdom
| | - Filip Raes
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium; Leuven Mindfulness Centre, KU Leuven, Belgium; KU Leuven Child and Youth Institute, KU Leuven, Belgium.
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11
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Yarrington JS, Metts AV, Zinbarg RE, Nusslock R, Wolitzky-Taylor K, Hammen CL, Kelley NJ, Bookheimer S, Craske MG. The Role of Positive and Negative Aspects of Life Events in Depressive and Anxiety Symptoms. Clin Psychol Sci 2023; 11:910-920. [PMID: 37766940 PMCID: PMC10530959 DOI: 10.1177/21677026221141654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Negative or stressful life events are robust risk factors for depression and anxiety. Less attention has been paid to positive aspects of events and whether positivity buffers the impact of negative aspects of events. The present study examined positivity and negativity of interpersonal and non-interpersonal episodic life events in predicting anxiety and depressive symptoms in a sample of 373 young adults. Regressions tested main and interactive effects of positivity and negativity ratings of events in predicting symptom factors (Fears, Anhedonia-Apprehension (AA), General Distress (GD)) relevant to anxiety and depression. A significant interaction demonstrated that positivity protected against high levels of negativity of non-interpersonal events in predicting GD. A main effect of interpersonal negativity predicting higher AA was observed. Results for Fears were non-significant. Findings suggest that positivity of life events may buffer against negativity in predicting symptoms shared between anxiety and depression.
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Affiliation(s)
- Julia S. Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Allison V. Metts
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208
- The Family Institute at Northwestern University, Evanston, IL 60208
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL 60208
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90024
| | - Constance L. Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | | | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90024
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
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12
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Shan M, Yang Z, Sun Z, Yang Y, Cheng Q, Pan Y. Association between platelet to lymphocyte ratio and depression and symptom severity among adults in the United States: A cross-sectional study. Heliyon 2023; 9:e20127. [PMID: 37809517 PMCID: PMC10559847 DOI: 10.1016/j.heliyon.2023.e20127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Background The pathogenesis of depression has not yet been fully understood. The association between platelet to lymphocyte ratio (PLR) and depression has been investigated in previous studies, however, the results were controversial. The objective of the study was to explore the potential relationship between PLR and depression and symptom severity. Methods A cross-sectional study was conducted based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018. Totally 30,032 adults were analyzed, and 2480 reported depression. Depression and symptom severity were assessed with the Patient Health Questionnaire (PHQ-9). PLR was calculated as the ratio of platelets to lymphocytes. Multivariable weighted-logistic regression models and generalized additive model (GAM) were employed to evaluate the linear and nonlinear association between PLR and depression and symptom severity. Results There was a negative association for Q3 (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.68 to 0.99) when comparing participants for Q1 between 10-PLR and depression after fully adjusting the covariates; however, there was no significant association between 10-PLR and symptom severity. GAM showed that 10-PLR was associated with depression and symptom severity in a nonlinear manner. The inflection points were at 12.15. Subgroup analyses showed nonlinear relationships only in specific subgroups. Conclusions: PLR is associated with depression among adults in the United States. U-shaped nonlinear relationships and threshold effects were observed between 10-PLR and depression and symptom severity. Additionally, inflammatory mechanisms vary in different sociodemographic subgroups.
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Affiliation(s)
- Moshui Shan
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Zhi Yang
- Department of Pharmacy, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Zhonghua Sun
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Yi Yang
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Qi Cheng
- Department of Psychiatry, The 904th Hospital of the Chinese PLA Joint Logistics Support Force, Changzhou, China
| | - Yu Pan
- Department of Medical Psychology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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13
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Kock M, Belmans E, Raes F. Fear of Happiness Predicts Concurrent but not Prospective Depressive Symptoms in Adolescents. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e10495. [PMID: 37732149 PMCID: PMC10508257 DOI: 10.32872/cpe.10495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background It is increasingly recognised that the study of responses to positive emotions significantly contributes to our understanding of psychopathology. Notably, positive emotions are not necessarily experienced as pleasurable. Instead, some believe that experiencing happiness may have negative consequences, referred to as fear of happiness (FOH), or they experience a fear of losing control over positive emotions (FOLC). According to reward devaluation theory, such an association of positivity with negative outcomes will result in positive stimuli being devalued over time, contributing to or maintaining depressive symptoms. The prospective relationship between fears of positivity and depressive symptoms is yet to be examined in adolescents. The present longitudinal study investigated whether FOH and FOLC prospectively predict depressive symptoms. Method 128 adolescents between 16-18 years of age (M = 16.87, SD = 0.80) recruited from two secondary schools in Flanders, Belgium, completed measures of depressive symptoms (Depression Anxiety Stress Scales) including consummatory anhedonia, FOH (Fear of Happiness Scale), and FOLC (Affective Control Scale) in their classroom at baseline and 2-months follow-up. Regression analyses were performed to test the association between FOH, FOLC, and depressive symptoms. Results FOH concurrently, but not prospectively, predicted depressive symptoms. There was no significant association between FOH and consummatory anhedonia. FOLC was not a significant predictor of depressive symptoms or consummatory anhedonia. Conclusion These findings suggest that FOH may only be concurrently related to depressive symptoms. Considering prior findings in adults, future research should investigate the association of FOH with anticipatory anhedonia in adolescents.
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Affiliation(s)
- Merle Kock
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Leuven Mindfulness Centre, KU Leuven, Leuven, Belgium
| | - Eline Belmans
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
| | - Filip Raes
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Leuven Mindfulness Centre, KU Leuven, Leuven, Belgium
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14
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Bogaert L, Dunn BD, Walentynowicz M, Raes F. ‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions. Acta Psychol (Amst) 2023; 235:103901. [PMID: 37018932 DOI: 10.1016/j.actpsy.2023.103901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are Avoidance Of Positivity (AOP; referring to avoidance behaviour towards positivity) and Fear Of Positivity (FOP; referring to anxious or unpleasant feelings related to positivity). However, traditionally manifestations of AOP and FOP are considered in isolation, and self-report scales used to measure both concepts show considerable content overlap. Therefore, the first study aim was to examine how AOP and FOP relate to one another, depressive symptomatology and anhedonia, through new clearly delineated scales. For exploratory purposes, general and state-specific versions were developed. The second aim was to uncover beliefs that underlie the tendency towards AOP/FOP. An adult community sample (n = 197) completed online measures of AOP, FOP, depressive symptoms and anhedonia, and answered open-ended questions about reasons for AOP and FOP. Cross-sectionally, preliminary evidence was found for AOP and FOP being positively associated with one another, depressive symptomatology and anhedonia. Even after controlling for depressive symptomatology, anhedonia remained positively associated with AOP and FOP. So, AOP and FOP may be viable candidate mechanisms maintaining anhedonia that are worth further investigation and may be appropriate to target during treatment. Answers to the open-ended questions (n = 77) reflected various beliefs underlying AOP/FOP, which were broader than simply anticipating negative consequences of feeling positive and also touched on themes of unworthiness and social inappropriateness of feeling positive. Some theoretical and clinical implications of different beliefs underlying AOP/FOP are discussed.
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15
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Hutchinson T, Riddleston L, Pile V, Meehan A, Shukla M, Lau J. Is Future Mental Imagery Associated with Reduced Impact of the COVID-19 Pandemic on Negative Affect and Anhedonic Symptoms in Young People? COGNITIVE THERAPY AND RESEARCH 2023; 47:168-180. [PMID: 36779180 PMCID: PMC9899113 DOI: 10.1007/s10608-023-10352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
Background Difficulties with prospective mental images are associated with adolescent depression. Current treatments mainly focus on verbal techniques to reduce negative affect (e.g. low mood) rather than enhancing positive affect, despite anhedonia being present in adolescents. We investigated the concurrent relationships between the vividness of negative and positive prospective mental imagery and negative affect and positive affect; and examined whether negative and positive prospective mental imagery moderated the impact of recent stress (COVID-19-linked stress) on negative and positive affect. Methods 2602 young people (12-25 years) completed the Prospective Imagery Task and self-reported on symptoms of negative affect, anhedonia and COVID-19 linked stress. Results Elevated vividness of negative future mental imagery and reduced vividness of positive future mental imagery were associated with increased negative affect, whereas only reduced vividness of positive future imagery was associated with increased symptoms of anhedonia. Elevated vividness of negative future images amplified the association between COVID-19 linked stress and negative affect, while elevated vividness of positive future images attenuated the association between COVID-19 linked stress and anhedonia. Conclusions Future mental imagery may be differentially associated with negative and positive affect, but this needs to be replicated in clinical populations to support novel adolescent psychological treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10352-1.
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Affiliation(s)
- Taryn Hutchinson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Laura Riddleston
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alan Meehan
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Meenakshi Shukla
- Department of Psychology, University of Allahabad, Prayagraj, India
| | - Jennifer Lau
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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16
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Murphy ST, Vittorio LN, Strunk DR. Vindicating pollyanna? An experimental test of cognitive restructuring and positive thinking interventions. Psychother Res 2022:1-8. [DOI: 10.1080/10503307.2022.2152397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Alsayednasser B, Widnall E, O'Mahen H, Wright K, Warren F, Ladwa A, Khazanov GK, Byford S, Kuyken W, Watkins E, Ekers D, Reed N, Fletcher E, McMillan D, Farrand P, Richards D, Dunn BD. How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? A secondary analysis of the COBRA randomized controlled trial. Behav Res Ther 2022; 159:104185. [PMID: 36371903 DOI: 10.1016/j.brat.2022.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 12/14/2022]
Abstract
A secondary analysis of the COBRA randomized controlled trial was conducted to examine how well Cognitive Behavioural Therapy (CBT) and Behavioural Activation (BA) repair anhedonia. Patients with current major depressive disorder (N = 440) were randomized to receive BA or CBT, and anhedonia and depression outcomes were measured after acute treatment (six months) and at two further follow up intervals (12 and 18 months). Anhedonia was assessed using the Snaith Hamilton Pleasure Scale (SHAPS; a measure of consummatory pleasure). Both CBT and BA led to significant improvements in anhedonia during acute treatment, with no significant difference between treatments. Participants remained above healthy population averages of anhedonia at six months, and there was no further significant improvement in anhedonia at 12-month or 18-month follow up. Greater baseline anhedonia severity predicted reduced repair of depression symptoms and fewer depression-free days across the follow-up period in both the BA and CBT arms. The extent of anhedonia repair was less marked than the extent of depression repair across both treatment arms. These findings demonstrate that CBT and BA are similarly and only partially effective in treating anhedonia. Therefore, both therapies should be further refined or novel treatments should be developed in order better to treat anhedonia.
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Affiliation(s)
| | | | | | - Kim Wright
- Mood Disorders Centre, University of Exeter, UK
| | - Fiona Warren
- College of Medicine and Health, University of Exeter, UK
| | - Asha Ladwa
- Mood Disorders Centre, University of Exeter, UK
| | | | - Sarah Byford
- Health Service & Population Research Department, Kings College London, UK
| | | | - Ed Watkins
- Mood Disorders Centre, University of Exeter, UK
| | - David Ekers
- Department of Health Science, University of York, UK; Tees Esk and Wear Valleys NHS Foundation Trust, UK
| | - Nigel Reed
- Mood Disorders Centre, University of Exeter, UK
| | - Emily Fletcher
- College of Medicine and Health, University of Exeter, UK
| | - Dean McMillan
- Department of Health Sciences and Hull York Medical School, University of York, UK
| | | | - David Richards
- College of Medicine and Health, University of Exeter, UK; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
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18
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Leboeuf I, Antoine P. Exploring the processes of connection and disconnection in imagery work in a patient with depression and dependent personality disorder. J Clin Psychol 2022. [DOI: 10.1002/jclp.23464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabelle Leboeuf
- Université de Lille, CNRS, UMR 9193—SCALAB—Sciences Cognitives et Sciences Affectives Lille France
| | - Pascal Antoine
- Université de Lille, CNRS, UMR 9193—SCALAB—Sciences Cognitives et Sciences Affectives Lille France
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19
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Sun CW, Yan C, Lv QY, Wang YJ, Xiao WY, Wang Y, Yi ZH, Wang JK. Emotion Context Insensitivity is generalized in individuals with major depressive disorder but not in those with subclinical depression. J Affect Disord 2022; 313:204-213. [PMID: 35777495 DOI: 10.1016/j.jad.2022.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Depressed individuals experience deficits in emotional reactivity. One well-established theory is the Emotion Context Insensitivity (ECI) theory. To better understand impairments in emotional reactivity, we investigated whether the ECI theory is applicable to anticipatory, consummatory, and remembered affect, in both clinical and subclinical depression. METHODS Participants were divided into four groups: Major Depressive Disorder Group (MDD, N = 60), Control Group for MDD (ControlMDD, N = 50), Subclinical Depression Group (SD, N = 56), and Control Group for SD (ControlSD, N = 56). The Hamilton Depression Rating Scale and the Beck Depression Inventory were used to assess the severity of depression and anhedonia symptoms. The Monetary Incentive Delay Task evaluated participants' affective responses towards monetary stimuli. RESULTS The MDD group was more insensitive to both monetary reward and loss across most types of affect than was the control group. Compared with the controls, the SD group exhibited lower reactivity in anticipatory positive affect but enhanced reactivity in consummatory positive, anticipatory, and remembered negative affect. LIMITATIONS Emotional affect was evaluated by subjective ratings, which may lack objectivity. Additionally, laboratory settings and monetary rewards used in this study may cause the results less generalized to daily life and to other types of rewards. CONCLUSION The pattern of emotional reactivity in the MDD group was partly consistent with the ECI theory, whereas the SD group showed greater arousal and instability of emotional reactions. These different patterns could facilitate the understanding of emotional reactivity and develop further treatments across the course of depression.
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Affiliation(s)
- Ching-Wen Sun
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Changning Mental Health Center, Shanghai, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Changning Mental Health Center, Shanghai, China.
| | - Qin-Yu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya-Jing Wang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Wen-Yi Xiao
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zheng-Hui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ji-Kun Wang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
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20
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Crauwels B, Vansteelandt K, Obbels J, Lambrichts S, Pilato E, Demyttenaere K, Sienaert P. The Effect of Electroconvulsive Therapy on Positive Affect and Hedonism in Patients With Depression: A Prospective Study. J ECT 2022; 38:110-116. [PMID: 34966039 DOI: 10.1097/yct.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The outcome of antidepressant treatments is generally assessed with standardized symptom scales such as the Quick Inventory of Depressive Symptomatology-Clinician Rating (QIDS-C). These scales, however, might not reflect patients' expectations for treatment, including a recovery of positive affect (PA) and hedonism. The Leuven Affect and Pleasure Scale (LAPS) was developed to better reflect patients' expectations for treatment. We used the LAPS to investigate changes in PA and hedonism alongside depressive symptoms during electroconvulsive therapy (ECT) and over 12 weeks after treatment. METHODS Fifty-three patients with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, depressive episode, referred for ECT, were included in this prospective study. The LAPS and QIDS-C were administered before and 1 and 12 weeks after the ECT course. LAPS normative levels were obtained in 149 healthy controls. RESULTS Pearson correlations revealed only moderate overlap of the QIDS-C with PA and hedonism. Piecewise linear mixed models indicated significant improvements in depressive symptoms (QIDS-C and LAPS negative affect), PA, and hedonism during ECT. In the 12 weeks after ECT treatment, negative affect and QIDS-C further improved, but PA and hedonism plateaued. Exploratory analyses indicated that only fully remitted patients (QIDS-C) attained normative levels on PA and hedonism at 12 weeks after ECT. CONCLUSIONS Standardized symptom scales (QIDS-C) may incompletely reflect clinical change in ECT treatment for depression. Although ECT improved depressive symptoms, PA, and hedonism in patients with depression, only fully remitted patients attained normative levels of PA and hedonism, due to plateaus in improvement. These plateaus were not observed for depressive symptoms, which further improved after ECT discontinuation.
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Affiliation(s)
- Bo Crauwels
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Kristof Vansteelandt
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Jasmien Obbels
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Simon Lambrichts
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Eva Pilato
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
| | - Koen Demyttenaere
- Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Katholieke Universiteit Leuven-KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven
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21
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Ji JL, Murphy FC, Grafton B, MacLeod C, Holmes EA. Emotional mental imagery generation during spontaneous future thinking: relationship with optimism and negative mood. PSYCHOLOGICAL RESEARCH 2022; 86:617-626. [PMID: 33723673 DOI: 10.1007/s00426-021-01501-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Optimism is known to buffer against negative mood. Thus, understanding the factors that contribute to individual variation in optimism may inform interventions for mood disorders. Preliminary evidence suggests that the generation of mental imagery-based representations of positive relative to negative future scenarios is related to optimism. This study investigated the hypothesis that an elevated tendency to generate positive relative to negative mental imagery during spontaneous future thinking would be associated with reduced negative mood via its relationship to higher optimism. Participants (N = 44) with varied levels of naturally occurring negative mood reported current levels of optimism and the real-time occurrence and characteristics of spontaneous thoughts during a sustained attention computer task. Consistent with hypotheses, higher optimism statistically mediated the relationship between a higher proportional frequency of positive relative to negative mental imagery during spontaneous future thinking and lower negative mood. Further, the relationship between emotional mental imagery and optimism was found for future, but not past, thinking, nor for verbal future or past thinking. Thus, a greater tendency to generate positive rather than negative imagery-based mental representations when spontaneously thinking about the future may influence how optimistic one feels, which in turn may influence one's experience of negative mood.
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Affiliation(s)
- Julie L Ji
- School of Psychological Science, University of Western Australia, Perth, Australia.
| | - Fionnuala C Murphy
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Ben Grafton
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Colin MacLeod
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
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22
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Abstract
Anhedonia, a loss of interest or pleasure in activities, is a transdiagnostic symptom that characterizes many individuals suffering from depression and anxiety. Most psychological interventions are designed to decrease negative affect rather than increase positive affect, and are largely ineffective for reducing anhedonia. More recently, affective neuroscience has been leveraged to inform treatments for anhedonia by targeting aspects of the Positive Valence Systems, including impairments in reward anticipation, reward responsiveness, and reward learning. In this chapter, we review the efficacy of treatments and, when possible, highlight links to reward constructs. Augmented behavioral approaches and targeted cognitive interventions designed to target reward anticipation, responsiveness, and learning show preliminary efficacy in reducing anhedonia, while there is a relative lack of treatments that target positive emotion regulation and reward devaluation. In addition to developing treatments that address these targets, the field will benefit from establishing standardized measurement of anhedonia across units of analysis, mapping mechanisms of change onto aspects of reward processing, and examining anhedonia outcomes in the long-term.
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23
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McNeil GD, Repetti RL. Increases in positive emotions as precursors to therapeutic change. Clin Psychol Psychother 2021; 29:1113-1124. [PMID: 34862687 DOI: 10.1002/cpp.2698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
Increases in positive emotions may not only be indicators of progress in therapy but also precursors to that improvement. Conducted in a psychology training clinic, this naturalistic, repeated-measures study tracked changes over the course of therapy in 34 clients' emotional experience and two of the primary targets of clinical interventions, symptom distress and relationship functioning. During treatment, positive emotions increased, negative emotions decreased, and improvements were seen in therapeutic outcomes. Positive and negative emotions were correlated, as were changes in positive and negative emotions. However, despite this association, increases in positive emotions were a significant predictor of concurrent improvements in symptom distress and relationship functioning, even when decreases in negative emotions were included in the same model. Additionally, positive emotions not only predicted change in these treatment outcomes over the same time period, but they also predicted future change. This study contributes to research on the critical role positive emotions play in psychotherapy and may encourage the development of interventions focusing on increasing positive emotions. These findings highlight the distinct functioning of positive emotions separate from negative and the value of attending to positive emotions during therapy.
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Affiliation(s)
- Galen D McNeil
- University of California, Los Angeles, California, USA.,UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
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24
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Brick L, Nugent N, Armey M. Affective variability and childhood abuse increase the risk for nonsuicidal self-injury following psychiatric hospitalization. J Trauma Stress 2021; 34:1118-1131. [PMID: 34655112 DOI: 10.1002/jts.22739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022]
Abstract
Childhood abuse is associated with myriad negative behavioral health outcomes, including nonsuicidal self-injury (NSSI). Models aimed at understanding the mechanism whereby childhood abuse may exert negative effects frequently highlight alterations or dysregulations in experienced affect, particularly during times of stress. The period immediately following discharge from psychiatric hospitalization represents a time of risk for individuals experiencing NSSI. We aimed to investigate the extent to which childhood abuse predicts affective variability and examine whether affective variability predicts who will experience NSSI thoughts or behaviors in the 6 months following hospital discharge. Participants were adults (N = 133) engaged in a 3-week ecological momentary assessment study immediately following psychiatric hospitalization who returned for a 6-month follow-up. Location scale modeling (LSM) was used to model the impact of childhood abuse on affect variability; estimates of affect variability were then resampled and examined as risk factors for NSSI at follow-up. Overall, individuals who experienced childhood abuse reported lower positive affect intensity. Participants exposed to emotional and sexual abuse reported less between-person variability in positive affect, and those who experienced sexual abuse evidenced higher between-person variability in negative affect. Models indicated that higher overall negative affect was associated with a higher NSSI risk, ORs ∼ 1.82-2.10 even after accounting for childhood abuse and lifetime NSSI. These findings indicate the importance of in vivo affect as a critical influence on behavior during high-risk periods, reinforcing the need to move beyond traditional cross-sectional approaches of assessment, analysis, and treatment.
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Affiliation(s)
- Leslie Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nicole Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Butler Hospital, Providence, Rhode Island, USA
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25
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Frank P, Jokela M, Batty GD, Cadar D, Steptoe A, Kivimäki M. Association Between Systemic Inflammation and Individual Symptoms of Depression: A Pooled Analysis of 15 Population-Based Cohort Studies. Am J Psychiatry 2021; 178:1107-1118. [PMID: 34645276 DOI: 10.1176/appi.ajp.2021.20121776] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence from anti-inflammatory drug trials for the treatment of depression has been inconsistent. This may be ascribed to the differing symptom-specific effects of inflammation. Accordingly, the authors explored the associations between systemic inflammation and an array of individual symptoms of depression across multiple studies. METHODS This random-effects pooled analysis included 15 population-based cohorts and 56,351 individuals age 18 years and older. Serum or plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at baseline. Using validated self-report measures, 24 depressive symptoms were ascertained in 15 cross-sectional studies, and, in seven cohorts, were also assessed at follow-up (mean follow-up period, 3.2 years). RESULTS The prevalence of depressive symptoms ranged from 1.1% (suicidal ideation) to 21.5% (sleep problems). In cross-sectional analyses, higher concentrations of CRP were robustly associated with an increased risk of experiencing four physical symptoms (changes in appetite, felt everything was an effort, loss of energy, sleep problems) and one cognitive symptom (little interest in doing things). These associations remained after adjustment for sociodemographic variables, behavioral factors, and chronic conditions; in sex- and age-stratified analyses; in longitudinal analyses; when using IL-6 as the inflammatory marker of interest; in depressed individuals; and after excluding chronically ill individuals. For four exclusively emotional symptoms (bothered by things, hopelessness about the future, felt fearful, life had been a failure), the overall evidence was strongly against an association with inflammation. CONCLUSIONS These findings suggest symptom-specific rather than generalized effects of systemic inflammation on depression. Future trials exploring anti-inflammatory treatment regimens for depression may benefit from targeting individuals presenting with symptom profiles characterized by distinct inflammation-related physical and cognitive symptoms.
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Affiliation(s)
- Philipp Frank
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
| | - Markus Jokela
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
| | - G David Batty
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
| | - Dorina Cadar
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
| | - Andrew Steptoe
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
| | - Mika Kivimäki
- Research Department of Epidemiology and Public Health (Frank, Batty, Kivimäki) and Research Department of Behavioural Science and Health (Frank, Cadar, Steptoe), University College London; Department of Psychology and Logopedics (Jokela) and Clinicum Unit (Kivimäki), Faculty of Medicine, University of Helsinki, Helsinki
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26
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Harvey AR. Integrated neuroimmune processing of threat, injury, and illness: An ecological framework mapping social alienation onto lifetime health vulnerability. Brain Behav Immun Health 2021; 18:100349. [PMID: 34723222 PMCID: PMC8531850 DOI: 10.1016/j.bbih.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Social alienation is a pre-eminent ecological threat for humans. In clinical and social care settings its impact is acknowledged in conditions as diverse as severe mood disturbance, chronic pain, and metabolic non-communicable diseases. An integrated psychoneuroimmune perspective shows how threat, injury, healing, and recovery follow through as a continuous process, but accepted cultural and clinical paradigms separating mental from physical illness provide little common ground on which to analyse and apply this continuum in practice. By reviewing the ecological relationships between emotional threat, tissue dyshomeostasis and injury, infection, pain, and mood this article explores not only how primeval somatic responses underpin the evolutionary foundations of depression and somatisation, but also links them to escalating physical non-communicable disease through archived socioeconomic adversity (allostatic load). Social alienation (in the absence of trauma) may prime and activate this ancient repertoire in which sensitised responses lay the foundation for persistent maladaptive states of aversive sensory misinterpretation, behavioural avoidance, anhedonia, and neuroinflammation presenting as widespread non-nociceptive pain, non-pain somatisation, and severe depression. The ecological perspective illuminates perverse clinical presentations, shows how some approaches to care may facilitate self-reinforcement in maladaptive syndromes, and offers pointers for inclusive rehabilitative clinical and social care.
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Affiliation(s)
- Andrew R. Harvey
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS2 9JT, UK
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27
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Westermann K, Woud ML, Cwik JC, Graz C, Nyhuis PW, Margraf J, Blackwell SE. Feasibility of computerised positive mental imagery training as a treatment adjunct in in-patient mental health settings: randomised controlled trial. BJPsych Open 2021. [PMCID: PMC8596293 DOI: 10.1192/bjo.2021.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background
Positive affect and anhedonia are important but challenging targets for mental health treatments. Previous research indicates the potential of a computerised cognitive training paradigm involving generation of positive mental imagery, termed positive mental imagery training (PMIT), to increase positive affect and reduce anhedonia.
Aims
Our main aim was to investigate the feasibility of PMIT as a positive affect-focused, transdiagnostic adjunct to treatment as usual for patients in in-patient mental health settings.
Method
We ran an open feasibility, randomised controlled trial with three parallel arms: treatment as usual; treatment as usual plus PMIT; and treatment as usual plus an active comparator, cognitive control training. Fifty-seven patients from two different in-patient mental health treatment clinics in Germany were randomised in a 1:1:1 ratio. PMIT and cognitive control training comprised an introductory session followed by eight 15-min training sessions over 2 weeks. Clinical outcomes such as positive affect (primary outcome measure) and anhedonia were assessed at pre- and post-training, and at a further 2-week follow-up.
Results
Adherence was good and attrition was low. The patterns of results for the outcome data were not consistent with a specific effect of PMIT on positive affect, but were more consistent with a specific effect on anhedonia.
Conclusions
The results indicate feasibility and potential promise of a larger efficacy trial investigating PMIT as a treatment adjunct in in-patient mental health settings. Limitations include lack of researcher blinding, small sample size and lack of pre-specified feasibility outcomes. Anhedonia may be a more suitable primary outcome for a future larger trial.
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Khazanov GK, Forbes CN, Dunn BD, Thase ME. Addressing anhedonia to increase depression treatment engagement. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:255-280. [PMID: 34625993 DOI: 10.1111/bjc.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/30/2021] [Indexed: 12/14/2022]
Abstract
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective.
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | | | | | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Nieto I, Vazquez C. Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program. J Anxiety Disord 2021; 83:102459. [PMID: 34358756 DOI: 10.1016/j.janxdis.2021.102459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative interpretation bias is a potential risk factor for emotional disorders. In this study, we tested a clinically inspired 4-session online Cognitive Bias Modification-Interpretation (CBM-IClin) program to modify negative interpretation biases. METHODS We randomized one hundred and twenty-one volunteer young adults (Mean age = 21.6 years, SD = 3.5; 85 % women) with varying levels of emotional distress to either an experimental or waitlist control group. Mediation analyses were used to disentangle the associations between the intervention, changes in interpretation biases (assessed by both a self-report and an experimental task), and changes in measures of cognitive vulnerability and symptoms of depression and anxiety. RESULTS The results showed that the CBM-IClin could change negative interpretation biases. Also, it had a direct effect on the change in negative memory bias, an indirect effect on the change in depression symptoms via the change in interpretation bias, and both direct and indirect effects on the change in self-reported dysfunctional attitudes. LIMITATIONS The study included a non-clinical sample of participants and it did not control for some potential confounding factors (e.g., attentional disorders). Furthermore, participants' engagement during the sessions at home was not supervised. CONCLUSIONS The CBM-IClin is a potential tool to prevent and intervene in emotional disorders in young adults and could complement other traditional CBM procedures or clinical interventions.
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Affiliation(s)
- Inés Nieto
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain.
| | - Carmelo Vazquez
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain
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Ji JL, Geiles D, Saulsman LM. Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities. Behav Res Ther 2021; 145:103947. [PMID: 34433114 DOI: 10.1016/j.brat.2021.103947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
Preliminary evidence suggests mental imagery-based episodic simulation of planned reward activities may amplify motivation and promote greater behavioural engagement, particularly for activities with high motivational barriers (Renner, Murphy, Ji, Manly, & Holmes, 2019). This study conducted a conceptual replication and extension of Renner et al. (2019). N = 81 first-year university students self-selected and scheduled two reward activities (one hedonic, one mastery) for the following week before being randomly allocated to either an Imagery-Experiential elaboration condition (n = 27), a Verbal-Reasoning elaboration condition (n = 28), or a Scheduling-only Control condition (n = 26). Following the lab session, all participants received standardized daily prompts to complete daily activity diaries online for seven days. The Imagery-Experiential condition reported greater increases in anticipatory pleasure (state mood), anticipated pleasure, and self-reported motivation compared to the Scheduling-only Control condition, and greater increases in anticipatory pleasure (state mood), but not anticipated pleasure or motivation, relative to the Verbal-Reasoning condition. Consistent with Renner et al. (2019), the Imagery-Experiential condition, but not the Verbal-Reasoning condition, reported more frequent engagement in high motivational barrier activities than the Scheduling-only Control condition. Exploratory mediational analyses suggested that mental imagery may exert unique motivational impacts via its impact on anticipatory pleasure (state mood), although indirect effects were only observed for self-reported motivation change in the lab, with real world behavioural effects falling short of statistical significance.
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Affiliation(s)
- Julie L Ji
- School of Psychological Science, University of Western Australia, Australia.
| | - Dylan Geiles
- School of Psychological Science, University of Western Australia, Australia
| | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Australia
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Fiskum C, Andersen TG, Johns UT, Jacobsen K. Differences in affect integration in children with and without internalizing difficulties. Scand J Child Adolesc Psychiatr Psychol 2021; 9:147-159. [PMID: 34345613 PMCID: PMC8312267 DOI: 10.21307/sjcapp-2021-016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Affect represents an important source of information about our internal state and the external world that can motivate and vitalize us. When affect is poorly integrated, this can lead to problems with self-regulation and psychopathology. Few studies have investigated affect integration in children. Objective: This study investigates differences in affect integration in children with and without internalizing difficulties. Method: Thirty-three Norwegian children (aged 9–13) with and 24 children without internalizing difficulties were interviewed with the Affect Consciousness Interview (ACI), a measure of affect integration. Data from the ACI was analyzed across nine affective categories (Interest/Excitement, Enjoyment/Joy, Fear/Panic, Anger/Rage, Shame/Humiliation, Sadness/Despair, Envy/Jealousy, Guilt/Remorse, and Tenderness/Care), and four dimensions (Awareness, Tolerance, Emotional, and Conceptual expressivity). Results: The children differed significantly in affect integration across all dimensions and all assessed affects, both positive and negative. Emotional Expressivity, Anger/Rage, and Sadness/Despair were particularly less integrated in the children with internalizing problems. Conclusions: Assessment of affect integration can provide useful information on possible underlying factors in internalizing problems in children and may help guide and personalize therapeutic interventions. Based on knowledge from empirical infant psychology interventions mimicking rich, early intersubjective experiences are recommended to increase affect integration.
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Affiliation(s)
- Charlotte Fiskum
- Department of Psychology, Norwegian University of Science and Technology, Norway.,Department of child and Adolescent Psychiatry (BUP), St. Olav's University Hospital, Norway
| | | | | | - Karl Jacobsen
- Department of Psychology, Norwegian University of Science and Technology, Norway
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Prospective mental imagery in depression: Impact on reward processing and reward-motivated behaviour. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3013. [PMID: 36397959 PMCID: PMC9667131 DOI: 10.32872/cpe.3013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background Mental imagery has long been part of cognitive behavioural therapies. More recently, a resurgence of interest has emerged for prospective mental imagery, i.e. future-directed imagery-based thought, and its relation to reward processing, motivation and behaviour in the context of depression. Method We conducted a selective review on the role of prospective mental imagery and its impact on reward processing and reward-motivated behaviour in depression. Results Based on the current literature, we propose a conceptual mechanistic model of prospective mental imagery. Prospective mental imagery of engaging in positive activities can increase reward anticipation and reward motivation, which can transfer to increased engagement in reward-motivated behaviour and more experiences of reward, thereby decreasing depressive symptoms. We suggest directions for future research using multimodal assessments to measure the impact of prospective mental imagery from its basic functioning in the lab to real-world and clinical implementation. Conclusion Prospective mental imagery has the potential to improve treatment for depression where the aim is to increase reward-motivated behaviours. Future research should investigate how exactly and for whom prospective mental imagery works. This review provides a selected update of the literature on prospective mental imagery. Prospective mental imagery might decrease depression via reward processing and reward-motivated behaviours. Suggestions for future research to investigate these hypotheses are provided.
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Abstract
Depression is both prevalent and costly, and many individuals do not adequately respond to existing psychopharmacological and behavioral interventions. The current article describes the use of neuroscience in augmenting behavioral interventions for depression in two primary areas: anhedonia and cognitive deficits/biases. Neuroscience research has increased our understanding of the neural bases of reward processing and regulation of positive affect, and anhedonia among depressed samples can be related to deficits in each of these domains. Treatments that specifically target reward processing and regulation of positive affect in order to reduce anhedonia represent a recent advance in the field. Depression is also associated with aberrant processes relating to working memory, autobiographical memory, attentional bias, and interpretive bias. Neuroscience findings have increasingly been leveraged to augment the efficacy of cognitive-training and bias-modification interventions in these domains. The use of neuroscience to inform the development and augmentation of behavioral interventions for depression is a promising avenue of continued research.
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Chen K, Barnes-Horowitz N, Treanor M, Sun M, Young KS, Craske MG. Virtual Reality Reward Training for Anhedonia: A Pilot Study. Front Psychol 2021; 11:613617. [PMID: 33488482 PMCID: PMC7817899 DOI: 10.3389/fpsyg.2020.613617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 02/01/2023] Open
Abstract
Anhedonia is a risk factor for suicide and poor treatment response in depressed individuals. Most evidence-based psychological therapies target symptoms of heightened negative affect (e.g., negative inferential style) instead of deficits in positive affect (e.g., attenuated reward response) and typically show little benefit for anhedonia. Viewing positive scenes through virtual reality (VR) has been shown to increase positive affect and holds great promise for addressing anhedonic symptoms. In this pilot study, six participants with clinically significant depression completed 13 sessions of exposure to positive scenes in a controlled VR environment. Significant decreases were found in self-reported anhedonia, depression, anxiety, and impairments in functioning from baseline to 1-month follow-up. Negative affect decreased over all 13 sessions, and positive affect increased over sessions 8-13. Results suggest that positive experiences in VR may be a novel avenue for the treatment of anhedonia in depressed individuals.
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Affiliation(s)
- Kelly Chen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Nora Barnes-Horowitz
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Treanor
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Sun
- Department of Psychology, Dartmouth College, Hanover, NH, United States
| | - Katherine S. Young
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
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Fried EI, von Stockert S, Haslbeck JMB, Lamers F, Schoevers RA, Penninx BWJH. Using network analysis to examine links between individual depressive symptoms, inflammatory markers, and covariates. Psychol Med 2020; 50:2682-2690. [PMID: 31615595 DOI: 10.1017/s0033291719002770] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies investigating the link between depressive symptoms and inflammation have yielded inconsistent results, which may be due to two factors. First, studies differed regarding the specific inflammatory markers studied and covariates accounted for. Second, specific depressive symptoms may be differentially related to inflammation. We address both challenges using network psychometrics. METHODS We estimated seven regularized Mixed Graphical Models in the Netherlands Study of Depression and Anxiety (NESDA) data (N = 2321) to explore shared variances among (1) depression severity, modeled via depression sum-score, nine DSM-5 symptoms, or 28 individual depressive symptoms; (2) inflammatory markers C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); (3) before and after adjusting for sex, age, body mass index (BMI), exercise, smoking, alcohol, and chronic diseases. RESULTS The depression sum-score was related to both IL-6 and CRP before, and only to IL-6 after covariate adjustment. When modeling the DSM-5 symptoms and CRP in a conceptual replication of Jokela et al., CRP was associated with 'sleep problems', 'energy level', and 'weight/appetite changes'; only the first two links survived covariate adjustment. In a conservative model with all 38 variables, symptoms and markers were unrelated. Following recent psychometric work, we re-estimated the full model without regularization: the depressive symptoms 'insomnia', 'hypersomnia', and 'aches and pain' showed unique positive relations to all inflammatory markers. CONCLUSIONS We found evidence for differential relations between markers, depressive symptoms, and covariates. Associations between symptoms and markers were attenuated after covariate adjustment; BMI and sex consistently showed strong relations with inflammatory markers.
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Affiliation(s)
- E I Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - S von Stockert
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - J M B Haslbeck
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - F Lamers
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - R A Schoevers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Aalbers S, Spreen M, Pattiselanno K, Verboon P, Vink A, van Hooren S. Efficacy of emotion-regulating improvisational music therapy to reduce depressive symptoms in young adult students: A multiple-case study design. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weinbrecht A, Roepke S, Renneberg B. Fear of positive evaluation in borderline personality disorder. PLoS One 2020; 15:e0237944. [PMID: 32817666 PMCID: PMC7444514 DOI: 10.1371/journal.pone.0237944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Being afraid of others' positive appraisal of oneself is called fear of positive evaluation. Fear of positive evaluation has been studied intensively in the context of social anxiety disorder (SAD). It is not known if individuals with borderline personality disorder (BPD) fear positive evaluation and which factors are associated with fear of positive evaluation in BPD. METHODS We applied the fear of positive evaluation scale and further self-report measures (e.g., social phobia inventory, rejection sensitivity questionnaire) to 36 patients with BPD, 29 patients with SAD and 35 healthy controls (HC). RESULTS A one-way ANOVA revealed that patients with BPD and patients with SAD reported significantly higher fear of positive evaluation than HC. Patients with BPD and SAD did not differ in their fear of positive evaluation. A hierarchical regression analysis revealed an association between rejection sensitivity and fear of positive evaluation in the BPD sample. However, this association disappeared when controlling for social anxiety. CONCLUSION Our results indicate that individuals with BPD fear positive evaluation as much as individuals with SAD do, which has implications for clinical practice. Our results further imply that social anxiety is decisive for high fear of positive evaluation in patients with SAD and patients with BPD.
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Affiliation(s)
- Anna Weinbrecht
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
- * E-mail:
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
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Werner-Seidler A, Hitchcock C, Hammond E, Hill E, Golden AM, Breakwell L, Ramana R, Moore R, Dalgleish T. Emotional complexity across the life story: Elevated negative emodiversity and diminished positive emodiversity in sufferers of recurrent depression. J Affect Disord 2020; 273:106-112. [PMID: 32421590 PMCID: PMC7116332 DOI: 10.1016/j.jad.2020.04.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/23/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Greater diversity in the experience of negative and positive emotions - emodiversity - is associated with better mental health outcomes in the general population (Quoidbach et al. 2014). However, conceptual accounts of depression suggest this might differ in clinical depression. In this study, the diversity of negative and positive emotion experiences as remembered by a recurrently depressed sample and a never-depressed control group were compared. METHODS Emodiversity was assessed using a life structure card sort task which allowed for the assessment of memory for emotional experience over the life course. Depressed (n=34) and non-depressed (n=34) participants completed the card sort task, from which emodiversity metrics were calculated for negative and positive emotion experience. RESULTS Depressed individuals showed recollections of enhanced emodiversity across negative emotion but reduced emodiversity across positive emotion, relative to never-depressed individuals. LIMITATIONS This study involved a relatively small sample size. DISCUSSION This study indicates that greater diversity of negative emotion experience, which has been interpreted as a protective factor against depressed mood in community samples (Quoidbach et al., 2014), instead characterises the remembered experience of recurrent clinical depression. The finding that positive emodiversity is adaptive in depression suggests that therapeutic outcomes may be improved by facilitating exposure to a diverse range of positive emotions. These findings indicate that the relationship between emotion diversity and mental health is more complex than hitherto assumed.
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Affiliation(s)
- Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Black Dog Institute, UNSW Sydney, Australia
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Emily Hammond
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Emma Hill
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Ann-Marie Golden
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Lauren Breakwell
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Rajini Ramana
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Richard Moore
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK.
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Hart-Smith L, Moulds ML. Abstract processing of a positive memory is associated with recalling positive memories from an observer perspective. Memory 2020; 28:576-581. [PMID: 32249707 DOI: 10.1080/09658211.2020.1749284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ruminative processing and recalling memories from an observer perspective represent two cognitive processes with adverse consequences in depression. However, no study to date has investigated the interrelationship of abstract processing, observer perspective and depression symptoms in the context of recalling personal emotional (positive, negative) memories, nor imagining emotional future events. An unselected online sample (N = 342) of participants was randomly allocated to one of four conditions: to recall a memory of a positive or negative event, or to imagine a future positive or negative event. Participants rated the vantage perspective from which they recalled or imagined the event, and the extent to which they engaged in abstract processing about it. For positive memories, a positive correlation emerged between abstract processing of the memory and observer recall; this relationship remained significant when depression symptoms were controlled. Abstract processing and vantage perspective were unrelated in the remaining three conditions. Whilst our findings await replication with a clinical sample to confirm generalisability to depressed individuals, they underscore the importance of investigating cognitive processes that influence positive memory recall and provide preliminary evidence that abstract processing of a positive memory is related to recalling the memory from an observer perspective.
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Affiliation(s)
- Ly Hart-Smith
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
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Hallford DJ, Barry TJ, Austin DW, Raes F, Takano K, Klein B. Impairments in episodic future thinking for positive events and anticipatory pleasure in major depression. J Affect Disord 2020; 260:536-543. [PMID: 31539690 DOI: 10.1016/j.jad.2019.09.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 09/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Characteristic of the cardinal symptom of anhedonia, people with clinical depression report lower levels of anticipatory pleasure. However, the psychological mechanisms underlying these deficits are poorly understood. This is the first study to assess whether, and to what extent, phenomenological characteristics of episodic future thinking for positive future events are associated with anticipatory pleasure among depressed individuals. METHODS Individuals with a Major Depressive Episode (MDE; N = 117) and without (N = 47) completed ratings scales for depressive symptoms and trait anticipatory and consummatory pleasure. They then provided descriptions of personally-relevant positive future events and rated them for phenomenological characteristics and state anticipatory pleasure. RESULTS Between-groups analysis showed that those with MDE reported lower trait anticipatory and consummatory pleasure. They also simulated future events with less specificity, less detail/vividness, less use of mental imagery, less use of first-person perspective, less plausibility/perceived likelihood of occurring, and reported less associated state anticipatory pleasure. In regression analyses in the depressed group, lower scores for detail/vividness, mental imagery, and personal significance all uniquely predicted lower state anticipatory pleasure. LIMITATIONS Cognitive functioning was not assessed, which may help clarify deficits that underpin these findings. History of previous depressive episodes in the comparison group were not assessed, which may mean the observed between-group effects are underestimated. CONCLUSIONS This study provides further evidence of deficits in episodic future thinking and anticipatory pleasure in depressed individuals. It also establishes links between particular characteristics of episodic future thinking and state anticipatory pleasure, and indicates cognitive targets that may be amenable to intervention in order to reduce anhedonia.
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Affiliation(s)
- D J Hallford
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Melbourne, Victoria, 3220, Australia.
| | - T J Barry
- Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - D W Austin
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Melbourne, Victoria, 3220, Australia
| | - F Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Leuven, Box 3712, 3000, Belgium
| | - K Takano
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, München, 80539, Germany
| | - B Klein
- School of Health and Life Sciences, Federation University, University Dr, Mount Helen, VIC, 3350, Australia
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Suslow T, Bodenschatz CM, Kersting A, Quirin M, Günther V. Implicit affectivity in clinically depressed patients during acute illness and recovery. BMC Psychiatry 2019; 19:376. [PMID: 31783824 PMCID: PMC6884816 DOI: 10.1186/s12888-019-2365-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical depression is characterized by high levels of negative affect (NA) and attenuated positive affect (PA). Psychological and pharmacological treatments have been shown to reduce NA and to enhance PA in depressed patients. Following dual-process models, two types of affect can be distinguished: explicit (or self-reported) affect, which is formed by conscious reflections, and implicit affect, which relates to automatic affective reactions. The present study was conducted to examine, for the first time, both implicit and explicit affectivity in patients suffering from acute depression. Moreover, changes in patients' implicit and explicit affectivity were investigated over the course of inpatient treatment. METHODS Thirty-nine patients suffering from major depression and 39 healthy individuals participated in the study. Implicit affectivity was assessed using the Implicit Positive and Negative Affect Test. The explicit state and trait affectivity were measured by the Positive and Negative Affect Schedule. The level of depressive symptoms was assessed with the Beck Depression Inventory. Tests were administered to patients after admission and after 7 weeks of therapy, whereas healthy controls were investigated only once. We examined whether either comorbidity or antidepressant medication has an effect on affectivity. RESULTS Patients with acute depression had lower implicit and explicit PA scores and higher implicit and explicit NA scores than the healthy controls. After treatment, patients' level of depression decreased significantly. At posttreatment, patients exhibited heightened implicit and explicit PA and diminished explicit trait NA. Independent of antidepressant medication and comorbidity, no significant change in implicit NA was observed over the course of treatment. Implicit NA was correlated with explicit NA in acute depression but not during recovery. CONCLUSIONS Acute depression appears to be characterized by decreased implicit and explicit PA and increased implicit and explicit NA. After 7 weeks of treatment, depressed patients' implicit and explicit PA increased, and explicit trait NA decreased. No decrease in implicit NA and explicit state NA occurred over the course of treatment. Finally, it seems that in the state of acute depression, the interplay between the automatic and reflective systems could be increased for negative affectivity.
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Affiliation(s)
- Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany. .,LIFE Leipzig Research Centre for Civilisation Diseases, University of Leipzig, 04103, Leipzig, Germany.
| | - Charlott Maria Bodenschatz
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Anette Kersting
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany ,0000 0001 2230 9752grid.9647.cLIFE Leipzig Research Centre for Civilisation Diseases, University of Leipzig, 04103 Leipzig, Germany
| | - Markus Quirin
- 0000000123222966grid.6936.aDepartment of Psychology, Technical University München, 80333 München, Germany ,0000 0004 1771 2629grid.462770.0PFH Göttingen, 37073 Göttingen, Germany
| | - Vivien Günther
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany ,0000 0001 2230 9752grid.9647.cLIFE Leipzig Research Centre for Civilisation Diseases, University of Leipzig, 04103 Leipzig, Germany
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42
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Song R, Sun N, Song X. The Efficacy of Psychological Capital Intervention (PCI) for Depression From the Perspective of Positive Psychology: A Pilot Study. Front Psychol 2019; 10:1816. [PMID: 31447745 PMCID: PMC6692487 DOI: 10.3389/fpsyg.2019.01816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Extensive psychological interventions primarily target the negative symptoms of depression and the deficits in positive resources have been systematically neglected. So far, little attention has been devoted to psychological capital (PsyCap) intervention from the perspective of developing positive resources. The aim of the present pilot study was to evaluate the efficacy of psychological capital intervention (PCI) for depression in a randomized controlled trial. A total of 56 patients were randomized to either care as usual (CAU) for normal medication or psychological capital intervention (PCI) group, where the normal medication was supplemented with the PCI. Participants were assessed at pre- and post-treatment, as well as 6-month follow-up, on measures of depressive symptoms and PsyCap. The PCI group displayed significantly larger improvements in PsyCap and larger reductions in depression symptoms from pre- to post treatment compared to control group. Improvements were sustained over the 6-month follow-up period. Targeting the positive resources intervention in the PCI may be effective against the treatment of depression.
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Affiliation(s)
- Ruijun Song
- School of Politics and Law, Shaoyang University, Shaoyang, China
- School of Psychology, Shandong Normal University, Jinan, China
| | - Nana Sun
- Department of Education, Luliang University, Luliang, China
| | - Xuhong Song
- Department of Medical Psychology, Shanxi Medical University, Taiyuan, China
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Dunn BD, Widnall E, Reed N, Owens C, Campbell J, Kuyken W. Bringing light into darkness: A multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behav Res Ther 2019; 120:103418. [PMID: 31310929 DOI: 10.1016/j.brat.2019.103418] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
Two core features of depression are elevations in negative valence system (NVS) functioning and reductions in positive valence system (PVS) functioning. Existing psychological treatments have focused on the NVS and neglected the PVS, which may contribute to sub-optimal outcomes. The present mixed methods multiple randomised baseline case series preliminarily evaluates Augmented Depression Therapy (ADepT), a novel depression treatment targeting PVS and NVS disturbance, that aims both to reduce depression and enhance wellbeing. Eleven clinically depressed participants were recruited. Intensive time series analyses showed that 7/11 participants improved on both wellbeing and depression. Reliable and clinically significant improvement was observed for 9/11 participants on at least one of these outcomes (and also across a range of other PVS and NVS outcomes). Group level analyses showed significant pre to post change on all outcomes. Benchmarking analyses indicated these effect sizes were at least comparable (and for some PVS outcomes superior) to existing treatments. Gains were largely sustained over one-year follow-up. Qualitative interviews indicated ADepT was feasible and acceptable. These findings provide preliminary support for ADepT as a novel depression treatment. Further evaluation, directly comparing ADepT to existing treatments using randomised controlled trial designs, is now required.
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Affiliation(s)
| | | | - Nigel Reed
- Mood Disorders Centre, University of Exeter, UK
| | | | - John Campbell
- College of Medicine and Health, University of Exeter, UK
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44
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Papousek I, Rominger C, Weiss EM, Perchtold CM, Fink A, Feyaerts K. Humor creation during efforts to find humorous cognitive reappraisals of threatening situations. CURRENT PSYCHOLOGY 2019; 42:16176-16190. [PMID: 37554948 PMCID: PMC10404570 DOI: 10.1007/s12144-019-00296-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This interdisciplinary study examined the structure of humor creation in the specific context of efforts to positively reappraise stressful situations for effective coping. In a sample of n = 101 participants, a performance test was used to assess the quantity (fluency, number of generated ideas that qualified as humor) and quality (rated funniness) of humor creation in cognitive reappraisal. Linguistic mechanisms were identified and quantified using cognitive-linguistic methods of corpus analysis, and their employment was correlated with humor production performance on the level of the individual. Almost all individuals were able to come up with reappraisal ideas that qualified as humorous. Depressive symptoms, a negative mood state, and high perceptions of threat did not compromise the participants' capability to create humor. Individuals who were more serious-minded as a trait produced ideas that were rated as less funny, but their basic ability to create humor was unaffected. Metonymy (a contiguity-based principle of meaning extension) emerged as by far the most prominent semantic mechanism in the creation of humorous re-interpretations. Furthermore, its use was related to good humor creation performance in terms of quantity and quality, which is in line with its assumed importance in the extension of meaning in general and the creation of humor in particular. Further effective linguistic mechanisms and conceptual phenomena were identified. The empirical data may be valuable for the development of interventions involving the creation of humorous ideas for cognitive reappraisal.
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Affiliation(s)
- Ilona Papousek
- Institute of Psychology, University of Graz, Graz, Austria
| | | | | | | | - Andreas Fink
- Institute of Psychology, University of Graz, Graz, Austria
| | - Kurt Feyaerts
- Department of Linguistics, University of Leuven, Leuven, Belgium
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45
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Winer ES, Jordan DG, Collins AC. Conceptualizing anhedonias and implications for depression treatments. Psychol Res Behav Manag 2019; 12:325-335. [PMID: 31191054 PMCID: PMC6521843 DOI: 10.2147/prbm.s159260] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Anhedonia has been implicated as a core symptom of depression and schizophrenia, and studying anhedonia has yielded a wide array of important findings aiding the understanding and identification of psychological disorders. However, anhedonia is a complex and multifaceted construct; indeed, the term anhedonia has been defined in psychological and psychiatric research as many different concepts, a number of which are theoretically and methodologically independent of one another. In this review alone, we discuss research that separates social aspects of anhedonia from the physical contexts of anhedonia, with the former emphasizing interpersonal relationships as important to anhedonic symptoms, and the latter emphasizing biological and brain-related impairment as potential causes of chronic anhedonia states. We highlight research that distinguishes between interest in (wanting) or experience of (liking) potential pleasure as definitions of anhedonia and also disambiguate methodologically and theoretically distinct ways of assessing 1) trait-level dispositional tendencies, 2) state-level cross-sectional assessments, and 3) symptom-based recent changes from baseline, all of which have been used to indicate anhedonia. Lastly, we describe cutting-edge translations of basic anhedonia research into treatment and discuss how different conceptualizations of anhedonia, guided by recent theoretical and methodological advances, have begun to usher in a science of anhedonia that is consistent with increasingly personalized assessment and treatment. We conclude with a note for future research, emphasizing that continued application of theoretically based operationalizations of anhedonia and sound design are paramount to continue the recent progress toward meaningful and specific use of the anhedonia construct in clinical research.
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Affiliation(s)
- E Samuel Winer
- Department of Psychology, Mississippi State University, Starkville, MS 39762, USA,
| | - D Gage Jordan
- Department of Psychology, Mississippi State University, Starkville, MS 39762, USA,
| | - Amanda C Collins
- Department of Psychology, Mississippi State University, Starkville, MS 39762, USA,
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46
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Dunn BD, Widnall E, Reed N, Taylor R, Owens C, Spencer A, Kraag G, Kok G, Geschwind N, Wright K, Moberly NJ, Moulds ML, MacLeod AK, Handley R, Richards D, Campbell J, Kuyken W. Evaluating Augmented Depression Therapy (ADepT): study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2019; 5:63. [PMID: 31061718 PMCID: PMC6486988 DOI: 10.1186/s40814-019-0438-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Anhedonia (a loss of interest or pleasure) is a core symptom of depression which predicts a poor prognosis but has been neglected by existing treatments. Augmented Depression Therapy (ADepT) has been co-designed with service users to better target anhedonia alongside other features of depression. This mixed methods pilot trial aims to establish proof of concept for ADepT and to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost-effectiveness of ADepT, compared to an evidence-based mainstream therapy (Cognitive Behavioural Therapy; CBT) in the acute treatment of depression, the prevention of subsequent depressive relapse, and the enhancement of wellbeing. METHODS We aim to recruit 80 depressed participants and randomise them 1:1 to receive ADepT (15 weekly acute and 5 booster sessions in following year) or CBT (20 weekly acute sessions). Clinical and health economic assessments will take place at intake and at 6-, 12-, and 18-month follow-up. Reductions in PHQ-9 depression severity and increases in WEMWBS wellbeing at 6-month assessment (when acute treatment should be completed) are the co-primary outcomes. Quantitative and qualitative process evaluation will assess mechanism of action, implementation issues, and contextual moderating factors. To evaluate proof of concept, intake-post effect sizes and the proportion of individuals showing reliable and clinically significant change on outcome measures in each arm at each follow-up will be reported. To evaluate feasibility and acceptability, we will examine recruitment, retention, treatment completion, and data completeness rates and feedback from patients and therapists about their experience of study participation and therapy. Additionally, we will establish the cost of delivery of ADepT. DISCUSSION We will proceed to definitive trial if any concerns about the safety, acceptability, feasibility, and proof of concept of ADepT and trial procedures can be rectified, and we recruit, retain, and collect follow-up data on at least 60% of the target sample. TRIAL REGISTRATION ISCRTN85278228, registered 27/03/2017.
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Affiliation(s)
| | - Emily Widnall
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Nigel Reed
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Rod Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Christabel Owens
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Spencer
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gerda Kraag
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Gerjo Kok
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim Wright
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | | | - Michelle L. Moulds
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Andrew K. MacLeod
- Department of Psychology, Royal Holloway University of London, London, UK
| | | | - David Richards
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Campbell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
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47
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Geschwind N, Arntz A, Bannink F, Peeters F. Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy. Behav Res Ther 2019; 116:119-130. [PMID: 30897464 DOI: 10.1016/j.brat.2019.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/28/2023]
Abstract
Previous research suggests that a stronger focus on positive emotions and positive mental health may improve efficacy of Cognitive Behavior Therapy (CBT). Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT (P-CBT; CBT in a solution-focused framework, amplified with optional positive psychology exercises) versus traditional, problem-focused CBT (T-CBT). Forty-nine patients with major depressive disorder (recruited in an outpatient mental health care facility specialized in mood disorders) received two treatment blocks of eight sessions each (cross-over design, order randomized). Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first, but significantly more in P-CBT compared to T-CBT during the second treatment block. Rate of improvement on the less-frequently measured secondary outcomes was not significantly different. However, P-CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Effect sizes for the combined treatment were large (pre-post Cohen's d = 2.71 for participants ending with P-CBT, and 1.85 for participants ending with T-CBT). Positive affect, optimism, subjective happiness and mental health reached normative population averages after treatment. Overall, findings suggest that explicitly focusing on positive emotions efficiently counters depressive symptoms.
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Affiliation(s)
- Nicole Geschwind
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands; Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University of Amsterdam, the Netherlands
| | - Fredrike Bannink
- Owner Therapy, Training, Coaching and Mediation Practice Amsterdam, the Netherlands
| | - Frenk Peeters
- Department of Psychiatry and Psychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
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48
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Bastin M, Nelis S, Raes F, Vasey MW, Bijttebier P. Party Pooper or Life of the Party: Dampening and Enhancing of Positive Affect in a Peer Context. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:399-414. [PMID: 28391490 DOI: 10.1007/s10802-017-0296-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Dampening and enhancing responses to positive affect have been linked to depressive symptoms. The main aim of the present study was to examine such responses in an interpersonal peer context and to examine their relation with depressive symptoms. A community sample of 665 seventh-graders (52.0% girls, Mage = 12.7 years) took part in the study. Using a newly developed questionnaire, the Co-Dampening and Co-Enhancing Questionnaire (CoDEQ), a two-factor model distinguishing co-dampening and co-enhancing was validated. Relations with general depressive symptoms, anhedonic symptoms, and friendship quality were investigated. The direction of relations was examined over a 1-year interval using cross-lagged analyses. Cross-sectional results revealed that higher levels of co-dampening and lower levels of co-enhancing were associated with more depressive and anhedonic symptoms, while controlling for co-rumination levels. For anhedonic symptoms, this pattern also held over and above intrapersonal dampening and enhancing. Friendship quality was related to higher concurrent levels of co-enhancing and lower levels of co-dampening. The longitudinal results pointed towards a scar model, in that both depressive and anhedonic symptoms predicted relative increases in co-dampening over time; however, this did not hold in a model in which dampening and enhancing were included as control variables.
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Affiliation(s)
- Margot Bastin
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3717, B-3000, Leuven, Belgium.
| | - Sabine Nelis
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3717, B-3000, Leuven, Belgium.
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3717, B-3000, Leuven, Belgium
| | - Michael W Vasey
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA
| | - Patricia Bijttebier
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3717, B-3000, Leuven, Belgium
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49
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The Integrative Positive Psychological Intervention for Depression (IPPI-D). JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2019. [DOI: 10.1007/s10879-018-9412-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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50
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Mira A, Bretón-López J, Enrique Á, Castilla D, García-Palacios A, Baños R, Botella C. Exploring the Incorporation of a Positive Psychology Component in a Cognitive Behavioral Internet-Based Program for Depressive Symptoms. Results Throughout the Intervention Process. Front Psychol 2018; 9:2360. [PMID: 30555384 PMCID: PMC6281749 DOI: 10.3389/fpsyg.2018.02360] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/10/2018] [Indexed: 12/12/2022] Open
Abstract
Traditionally, evidence-based treatments for depression have focused on negative symptoms. Different authors describe the need to include positive affect as a major target of treatment. Positive psychology aims to fill this gap. Reaching everyone in need is also important, and Internet-based interventions can help in this task. The present study is a secondary analysis derived from a randomized controlled trial aimed to test the efficacy of an Internet-based intervention for patients with depressive symptoms. This intervention consisted of an 8-module Internet-based program that combined four modules based on cognitive-behavioral therapy strategies and four modules based on positive psychology strategies. The main goal of this secondary analysis is to report the data collected after each module from the participants who completed the intervention, explore the changes throughout the intervention process, and examine the changes observed in the different variables before versus after the introduction of the positive psychology component. A total of 103 patients completed the intervention. At pre-, post-intervention, and post-module evaluations, they completed positive and negative affect, depression, and anxiety measures. Negative affect and anxiety decreased significantly during the implementation of the cognitive-behavioral therapy and positive psychology modules. However, depression and positive affect improved only after the introduction of the positive psychology modules. This is the first study to explore, throughout the intervention process (module by module), the incorporation of a positive psychology component in an Internet-based program. Results suggest that positive psychology techniques might have an impact on clinical symptomatology, and they emphasize the need to include these techniques to achieve a more profound change in positive functioning measures. Clinical Trial Registration: NCT02148354 (http://ClinicalTrials.gov/ct2/show/NCT02148354).
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Affiliation(s)
- Adriana Mira
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain.,Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Juana Bretón-López
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Ángel Enrique
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | - Diana Castilla
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain.,Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Azucena García-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
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