CBT and positive psychology interventions for clinical depression promote healthy attentional biases: An eye-tracking study

The Role of Positivity on Depressive Symptoms in Women Seeking Help for Intimate Partner Violence

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.

A WeChat-based self-compassion training to improve the treatment adherence of patients with schizophrenia in China: Protocol for a randomized controlled trial

Background

At present, adherence to antipsychotic treatment is often poor, leading to the recurrence of symptoms. This increases the likelihood of the patient experiencing disability and thus increases the disease burden for the patient, their family, and society as a whole. However, to date, there is no clear evidence regarding the effect of medication adherence interventions on outcomes for patients with schizophrenia. Moreover, the traditional intervention methods are limited by manpower and resources in low- and middle-income countries. Recent studies have demonstrated that increasing a patient’s level of self-compassion may improve their treatment adherence. Online mental health care interventions have advantages in terms of feasibility and acceptability for patients with schizophrenia. In this regard, a WeChat-based self-compassion training protocol to improve patient treatment adherence was designed in this study and will be evaluated in the future to determine its impact on patients with schizophrenia.

Methods

The protocol for the randomized controlled trial (RCT) is based on the SPIRIT 2013 statement. This parallel RCT will aim to recruit 392 patients with schizophrenia who will be randomized at a 1:1 ratio into a 3-week intervention or control group. Both groups will receive routine care. The intervention group will also receive WeChat-based self-compassion training, which requires participants to complete three tasks every day, including a reading task, a meditation task, and a self-compassion journal task. The control group will receive WeChat-based psychological health education, which will only require participants to read positive articles about psychological health every day. Medication adherence, self-compassion, stigma, and social support will be measured at baseline (T0), immediately after the intervention (T1), and 3 weeks after the intervention (T2). Program feasibility will be evaluated throughout the course of the study, and acceptability will be measured immediately after the intervention (T1).

Expected results:

The intervention described here will address the barriers to accessing mental health care for people with schizophrenia, including patients’ desire for independent management, difficulty accessing providers, and concerns about privacy and stigma. The current study provides guidance for clinical nurses to carry out psychological intervention, with the ultimate aim of addressing the problems associated with a shortage of psychological professionals in low- and middle-income countries.

Promoting gaze toward the eyes of emotional faces in individuals with high autistic traits using group cognitive behavioral therapy: An eye-tracking study

BACKGROUND

Individuals with subclinical autistic traits exhibit a pattern of eye avoidance similar to that of typical autism. Our study aimed to test the efficacy of group cognitive behavioral therapy (G-CBT) in promoting gaze toward the eye area of facial expressions, specifically orienting to emotional faces, in individuals with high autistic traits (high AT).

METHODS

Twenty-six high AT individuals and 30 low AT individuals participated. High AT individuals were assigned to eight sessions of G-CBT intervention. Eye-tracking measurements were acquired before and after treatment.

RESULTS

We observed the following: (a) the eye avoidance in high AT individuals was prominent for all facial expressions in relative to low AT individuals; (b) G-CBT primarily improved gaze toward the eyes of happy and fearful faces but not for neutral face expressions in high AT individuals; (c) after 8 sessions of G-CBT, the fixation time on the eyes of emotional faces improved significantly. For happy faces, the fixation time on the eyes of faces was markedly increased in epochs between 500 ms and 1000 ms after the face onset; for fearful faces, the improvement in participants existed between about 1000 ms and 1500 ms after the face appeared.

LIMITATION

Our results may not be generalized to other patients with ASD.

CONCLUSIONS

Our findings demonstrate that G-CBT significantly promotes gaze toward the eyes of emotional faces in high AT individuals. These results are encouraging, and suggest that the emotional face processing in autism spectrum disorder (ASD) might stand to benefit from similar psychotherapeutic treatment.

Systematic review of the effects of evidence-based psychotherapies on neurocognitive functioning in mood disorders

OBJECTIVE

Neurocognitive impairment is considered a core feature of mood disorders. Research has shown that neurocognitive impairment often persists beyond mood symptom resolution and can have significant deleterious effects on interpersonal relationships, academic achievement, occupational functioning and independent living. As such, neurocognitive impairment has become an important target for intervention. In this systematic review, we aimed to examine the extant literature to ascertain whether current standard evidence-based psychotherapies can improve neurocognitive functioning in mood disorders.

METHOD

Studies examining changes in neurocognitive functioning following evidence-based psychotherapy were identified using MEDLINE, PsycINFO and Web of Science databases. Given the heterogeneity of study procedures, treatment protocols and patient samples, a narrative rather than meta-analytic review technique was employed.

RESULTS

Nineteen studies (21 articles) met inclusion criteria. There was preliminary evidence of improved executive functioning following evidence-based psychotherapy for Major Depressive Disorder and Bipolar Disorder. There was also some signal of reduced negative biases in emotional information processing following psychotherapy in depression. Due to methodological variability across studies however, it was difficult to draw clear conclusions.

CONCLUSION

Findings from the current review suggest that evidence-based psychotherapies may influence some aspects of neurocognitive functioning in mood disorders. This continues to be an ongoing area of importance and warrants further research.

Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program

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-I_Clin) 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-I_Clin 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-I_Clin is a potential tool to prevent and intervene in emotional disorders in young adults and could complement other traditional CBM procedures or clinical interventions.

Me looking at you, looking at me: The stare-in-the-crowd effect and autism spectrum disorder

INTRODUCTION

The stare-in-the-crowd (SITC) effect describes the ability to detect self-directed gaze in a crowd. Given the importance of gaze detection in initiating and maintaining social interactions, there is a need to better characterize the SITC effect.

METHODS

Autistic and neurotypical young adults were presented with four SITC conditions. Eye tracking outcomes and arousal were compared by diagnosis and condition using repeated measures analysis of variance. Hierarchical regression was used to explore behavioral measures.

RESULTS

Significant interaction of diagnosis and condition was found for eye tracking outcomes. Overall, autistic participants exhibited less looking than neurotypical participants. Interest area dwell time, fixation count, and second fixation duration were significantly higher for conditions with shifting gaze, as well as conditions with more self-directed gaze across participants. Two hierarchical regression models of gaze behaviors with advanced theory of mind as a predictor were significant.

DISCUSSION

Autistic individuals respond to various gaze conditions in similar patterns to neurotypical individuals, but to a lesser extent. These findings offer important targets for social interventions.

Cognitive Control, Cognitive Biases and Emotion Regulation in Depression: A New Proposal for an Integrative Interplay Model

Research traditions on cognition and depression focus on relatively unconnected aspects of cognitive functioning. On one hand, the neuropsychological perspective has concentrated on cognitive control difficulties as a prominent feature of this condition. On the other hand, the clinical psychology perspective has focused on cognitive biases and repetitive negative patterns of thinking (i.e., rumination) for emotional information. A review of the literature from both fields reveals that difficulties are more evident for mood-congruent materials, suggesting that cognitive control difficulties interact with cognitive biases to hinder cognitive switching, working memory updating, and inhibition of irrelevant information. Connecting research from these two traditions, we propose a novel integrative cognitive model of depression in which the interplay between mood-congruent cognitive control difficulties, cognitive biases, and rumination may ultimately lead to ineffective emotion-regulation strategies to downregulate negative mood and upregulate positive mood.

An eye-tracking study of interpersonal threat sensitivity and adverse childhood experiences in borderline personality disorder

BACKGROUND

Previous eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD). From an etiological point of view, such interpersonal threat hypersensitivity might be explained by a biological vulnerability along with a history of early life adversities. The objective of the current study was to investigate interpersonal threat hypersensitivity and its association with adverse childhood experiences (ACE) in patients with BPD employing eye-tracking technology.

METHODS

We examined a sample of 46 unmedicated, adult female patients with BPD and 25 healthy female volunteers, matched on age and intelligence, with a well-established emotion classification paradigm with angry, fearful, happy, and neutral facial expressions. ACE were assessed retrospectively with the Childhood Trauma Questionnaire.

RESULTS

Patients as compared to healthy volunteers reflexively directed their gaze more quickly towards the eyes of emotional and neutral faces and did not adapt their fixation patterns according to the facial expression presented. Misclassifying emotional and neutral faces as angry correlated positively with the patients' self-reported ACE.

CONCLUSIONS

Building on and extending earlier findings, our results are likely to suggest a visual hypervigilance towards the eyes of emotional and neutral facial expressions and a childhood trauma-related anger bias in patients with BPD. Given the lack of a clinical control group, the question whether these findings are specific for BPD has to remain open. Thus, further research is needed to elucidate the specificity of altered visual attention allocation and the role of ACE in anger recognition in patients with BPD.

Attentional biases in dysphoria when happy and sad faces are simultaneously presented

BACKGROUND AND OBJECTIVE

Difficulties to engage attention to positive stimuli and to disengage attention from negative stimuli are typically found in depression. Yet, most of the evidence supporting these attentional biases comes from experimental paradigms in which emotional information (e.g., happy or sad faces) is simultaneously presented with neutral information. Few studies have explored attentional biases when emotional stimuli of different valence are presented simultaneously. The aim of the present study was to assess visual scan patterns of non-dysphoric and dysphoric participants when emotional information is presented simultaneously.

METHOD

Using an eye-tracker methodology, the gradient relation between attentional biases and depression scores as well as differences between groups in their attentional performance were assessed in non-dysphoric participants (N = 84) and dysphoric participants (N = 58). Three different pairs of faces were used: happy-neutral, neutral-sad, and happy-sad.

RESULTS

First, we found that simultaneous presentation of emotional information (i.e., happy vs. negative faces) reduces the magnitude of attentional biases towards positive information. Second, we also found a significant negative relation between attentional biases towards positive information and depression scores. Finally, compared to non-dysphoric participants, dysphoric individuals marginally spent less time attending positive information in both happy-neutral and happy-sad trials.

LIMITATIONS

The cross-sectional nature of our study does not allow us to make inferences about causality. Further, only one type of simultaneous emotional faces presentation (i.e., happy-sad) was used.

CONCLUSIONS

These results support the need for further research on the processing of competing emotional stimuli in depression.

Predicting optimal interventions for clinical depression: Moderators of outcomes in a positive psychological intervention vs. cognitive-behavioral therapy

Identifying differences in the clinical response to specific interventions is an important challenge in the field of Clinical Psychology. This is especially true in the treatment of depression where many treatments appear to have comparable outcomes. In a controlled trial, we compared a positive psychology group intervention, the Integrative Positive Psychological Intervention for Depression (IPPI-D; n = 62) to a cognitive-behavioral therapy group intervention (CBT; n = 66) for depression. No statistically or clinically-significant differences between the treatments were found, but a slight advantage was observed, on average, for IPPI-D. The aim of the present study was to identify and combine moderators of the differential efficacy of these two psychological interventions for clinical depression. For this purpose, a secondary analysis using the Personalized Advantage Index (PAI) was performed to identify the intervention predicted to produce the better outcome for each patient. Six of the 21 potential moderators were found to predict differential efficacy between the treatments. IPPI-D was predicted to be the optimal treatment for 73% of the sample. Baseline features that characterized these individuals were: mental and physical comorbidity, prior antidepressant medication, higher levels of negative thoughts, and higher personal growth. The 27% who were predicted to achieve better outcomes in CBT than in IPPI-D tended to have these baseline features: no comorbidities, no prior antidepressant medication, lower levels of negative thoughts, and lower personal growth.

Acceptance and Commitment Therapy Preceded by Attention Bias Modification on Residual Symptoms in Depression: A 12-Month Follow-Up

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants with a history of depression, currently in remission (N = 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N = 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse.

A failure to show the efficacy of a dot-probe attentional training in dysphoria: Evidence from an eye-tracking study

OBJECTIVE

This study examines whether a 4-day dot-probe attentional training to orient attention toward positive words could lead participants with dysphoria to change selective attention to emotional faces. It was also explored whether this positive attentional bias training could lead to a decrease in depressive symptoms.

METHODS

Participants were randomly assigned to Positive Training Group (PTG) and No Training Group (NTG). PTG was composed of 16 subjects, whereas NTG was composed of 15 subjects. All participants were women with a mean age of 22.87 (SD = 3.21).

RESULTS

Results showed that dysphoric participants in the PTG did not show changes in attentional patterns to emotional faces. Furthermore, depressive symptoms did not significantly change after the 4-session training.

CONCLUSIONS

These results suggest that cognitive training procedures based on dot-probe paradigms are probably not adequate to modify attentional patterns in individuals with depressive symptoms. The theoretical and practical implications are discussed.