Perception of social functioning in dysphoria

Using Mobile Phones to Examine and Enhance Perceptions of Control in Mildly Depressed and Nondepressed Volunteers: Intervention Study

BACKGROUND

Perceived control is strongly linked to healthy outcomes, mental healthiness, and psychological well-being. This is particularly important when people have little control over things that are happening to them. Perceived control studies have been performed extensively in laboratory settings and show that perceived control can be increased by experimental manipulations. Although these studies suggest that it may be possible to improve people's mental health by increasing their perceived control, there is very little evidence to date to suggest that perceived control can also be influenced in the real world.

OBJECTIVE

The first aim of this study was to test for evidence of a link between noncontrol situations and psychological well-being in the real world using a mobile phone app. The second and arguably more important aim of the study was to test whether a simple instructional intervention on the nature of alternative causes would enhance people's perceptions of their own control in these noncontrol situations.

METHODS

We implemented a behavioral action-outcome contingency judgment task using a mobile phone app. An opportunity sample of 106 healthy volunteers scoring low (n=56, no depression) or high (n=50, mild depression) on a depression scale participated. They were given no control over the occurrence of a low- or high-frequency stimulus that was embedded in everyday phone interactions during a typical day lasting 8 hours. The intervention involved instructions that either described a consistent alternative cause against which to assess their own control, or dynamic alternative causes of the outcome. Throughout the day, participants rated their own control over the stimulus using a quantitative judgment scale.

RESULTS

Participants with no evidence of depression overestimated their control, whereas those who were most depressed were more accurate in their control ratings. Instructions given to all participants about the nature of alternative causes significantly affected the pattern of perceived control ratings. Instructions describing discrete alternative causes enhanced perceived control for all participants, whereas dynamic alternative causes were linked to less perceived control.

CONCLUSIONS

Perceptions of external causes are important to perceived control and can be used to enhance people's perceptions. Theoretically motivated interventions can be used to enhance perceived control using mobile phone apps. This is the first study to do so in a real-world setting.

[Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder]

OBJECTIVE

Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder.

METHOD

We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending").

RESULTS

We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed.

CONCLUSION

The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.

Altered self-report of empathic responding in patients with bipolar disorder

Despite evidence of impairments in social cognition in patients with bipolar disorder (BD), systematic investigations of empathic responding in this population have not been conducted. The objectives of the current study were to investigate empathic responding in patients with BD in varying states of illness and to determine whether course of illness variables and symptom severity predicted responding. Twenty well-characterized patients with BD and 20 matched healthy control subjects completed the Interpersonal Reactivity Index (IRI) and the Social Adjustment Scale Self-Report (SAS-SR), self-report measures of cognitive and emotional empathy and of psychosocial functioning, respectively. Patients with BD reported significantly reduced levels of cognitive empathy ('Perspective Taking') and higher levels of personal distress in response to others' negative experiences than did controls. Altered affective empathic abilities correlated significantly with reduced psychosocial functioning in family, social and occupational domains and with increased symptom severity. This study provides preliminary evidence of alterations in empathic responding in patients with BD. Alterations in the ability to adopt the perspective of others may contribute to the difficulties in social communication inherent in this patient population. Additional studies, involving larger samples, are required to determine the contribution of social cognitive performance to impaired social functioning in BD.

Depressive symptoms and bias in perceived social competence among young adults

We examined associations between depressive symptoms and young adults' self-perceptions of social competence to explore whether higher symptoms are associated with self-evaluations that are more accurate (i.e., depressive realism), negatively biased (i.e., cognitive distortion), or less accurate (i.e., self-verification perspective). In 133 young adults, depressive symptoms and discrepancies between self- and peer ratings of social competence were assessed. Results demonstrated a linear relationship between depressive symptoms and self-peer discrepancies, such that higher symptoms were associated with underestimation of the self and low symptom levels were linked with overestimation of the self relative to peer evaluations. These findings suggest negative bias in dysphorics' self-perceptions, supporting cognitive distortion models, as well as positive bias in self-perceptions of those with low depressive symptoms.

Specificity of interpretation and judgemental biases in social phobia versus depression

OBJECTIVES

A body of studies shows that social phobia is characterized by content specific interpretation and judgmental biases. That is, they show bias in social situations but not in non-social situations. Comorbid depression, one of the major comorbid disorders in social phobia, might account for these biases in social phobia since depression also is characterized by cognitive distortions in social situations. This study hypothesized that, despite comorbid depression, patients with social phobia would suffer from contentspecific biases.

DESIGN

Participants filled out the Interpretation and Judgmental Questionnaire (IJQ) to assess interpretation bias (using open-ended responses and forced-interpretations) and judgmental bias in social and non-social situations.

METHOD

Four groups participated: social phobic patients with high (N=38) and low (N=47) depressive symptoms, depressed patients (N=22) and normal controls (N=33).

RESULTS

We found both social phobic groups to interpret social situations more negatively and judge social situations as more threatening than non-social situations relative to depressed patients and normal controls. As expected, depressive symptoms related to increased general interpretation and judgmental biases across social and non-social situations. In contrast to expectations, we did not find these patterns for the open-ended measure of interpretation bias.

CONCLUSIONS

The content-specific biases for social situations distinguished social phobic patients from depressive patients. This speaks for the importance of establishing the primary diagnosis in patients with mixed depression and social anxiety complaints.

Social skills deficits associated with depression

This article reviews the empirical evidence of impaired social skills associated with depression. Conceptualizations of social skills are examined followed by evidence from self-report, observer-rating, and behavioral assessments of depressed people's social skills. Evidence of social skills deficits in children with depression and in people with bipolar disorder is also examined. The effectiveness of social skills training as a treatment of depression is evaluated. Three different theoretical relationships between disrupted social skills and depression are described and evaluated, including poor social skills as a cause of depression, depression as a cause of poor social skills, and poor social skills as a vulnerability factor in the development of depression. Currently, there is some evidence to support each of these conceptualizations, as the relationship between poor social skills and depression can take a variety of forms.