Responses to Positive Affect: A Self-Report Measure of Rumination and Dampening

Predicting which intervention works better for whom: Moderators of treatment effect of Mindfulness-Based Cognitive Therapy and Positive Psychology Intervention in patients with bipolar disorder

BACKGROUND

This study aimed to identify moderators of treatment effect (i.e. depressive symptoms and well-being) of Mindfulness-Based Cognitive Therapy (MBCT) and Positive Psychology Intervention (PPI) in patients with bipolar disorder.

METHODS

Data were drawn from two multicenter randomized controlled trials investigating effectiveness of MBCT vs treatment as usual (TAU; n = 144) and PPI vs TAU (n = 97) in bipolar disorder. Outcomes were assessed at baseline, posttreatment, and 12 months after baseline. Data were analyzed using separate linear regression models, comparing the pooled MBCT or PPI outcomes to TAU, and comparing MBCT to PPI.

RESULTS

The exploratory analyses not corrected for multiple comparisons showed a number of variables that were associated with stronger response to the interventions, including higher baseline anxiety, lower well-being, and lower levels of self-focused positive rumination, well-being, and self-compassion, and variables associated with a stronger response to either MBCT (higher levels of depression and anxiety and being married) or PPI (being male). After correcting for multiple testing, depressive symptoms appeared to be the most robust variable associated with better response to MBCT than PPI.

LIMITATIONS

The RCTs handled slightly different enrollment criteria and outcome measures.

CONCLUSIONS

The most robust finding is that patients with more severe symptomatology seem to benefit more from MBCT than PPI.

CLINICAL IMPLICATIONS

This is a first step to improve personalized assignment of third-wave CBT interventions for patients with bipolar disorder. However, before definite treatment assignment criteria can be formulated and implemented in clinical practice, these findings should be replicated.

Recalling and anticipating positive events to improve the positive affect and mental health of adolescents: A cluster randomized controlled trial in secondary schools

This cluster randomized controlled trial examined the effectiveness of Positive Events Training (PET), a combined group training aimed at simultaneously improving positive autobiographical memory (AM) and episodic future thinking (EFT) among adolescents (12-16 years). Delivered as a universal school-based program, PET was compared with an active (creative writing) control group (CREAT). Effects on resilience, wellbeing, positive emotions, emotional response styles towards positive emotions (savoring, dampening), anhedonia, depressive symptoms, and multiple AM and EFT indices were examined. Adolescents (NPET = 95, NCREAT = 93) completed self-report scales at baseline, post-training and two-month follow-up. Multilevel models revealed that PET led to significant improvements in certain AM and EFT skills. Moreover, a decrease in anhedonia was observed at post-training. However, this effect did not withstand correction for multiple testing. Absence of changes in the other outcomes should be interpreted within the context of the universal school-based approach and the potential limited scope for detectable changes. Exploratory analyses suggest the importance of further investigating PET's potential in addressing positive affect dysregulations in indicated samples, and exploring perceived likelihood of generated future events and dampening as potential underlying mechanisms. Study limitations and future directions to maximize the demonstrated potential of PET are discussed.

Nature lifts when feeling low: Daily high and low awe nature clips decrease repetitive negative thinking and dampening and increase subjective happiness in adults

Exposure to nature can enhance mental well-being, making nature-based interventions promising for the treatment and prevention of mental health problems like depression. Given the decreased self-focus and sense of self-diminishment associated with awe, the present study investigated the impact of exposure to awe-evoking nature on two key risk and maintenance factors of depression-repetitive negative thinking (RNT) and dampening of positive feelings-and on subjective happiness. In a randomized controlled trial, we tested the effects of exposure to awe-evoking nature clips through a 1-week intervention, consisting of watching a 1-min clip on a daily basis of either awe-evoking (n high awe = 108) or more mundane nature scenes (n low awe = 105). Before, immediately after (post-intervention) and 1 week after the intervention (follow-up), participants completed self-report scales probing RNT, dampening, and subjective happiness. Results indicated significant decreases in these outcomes at post-intervention and follow-up in both groups. We discuss study limitations, touch upon future research ideas, and reflect upon the role of nature for clinical applications.

Experiential processing increases positive affect and decreases dampening appraisals during autobiographical memory recall in an anhedonic sample

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.

Savoring changes novel positive mindset targets of GAD treatment: Optimism, prioritizing positivity, kill-joy thinking, and worry mediation

This study analyzed effects of savoring on unstudied positive mindset targets of generalized anxiety disorder (GAD) treatment (ClinicalTrials.gov: NCT05040061). 85 students with GAD were randomly assigned to one of two ecological momentary interventions (EMIs) on smartphone for seven days. The SkillJoy EMI promoted practices for savoring positive emotions. An active control EMI mirrored SkillJoy, yet did not include savoring or positive emotion. Optimism, worry, kill-joy thinking (lessening positive emotion with cognition), and prioritization of positive emotion activities and goals were assessed at pre-trial, eighth-day, post-trial, and 30th-day follow-up. Savoring was assessed pre-trial and fifth-day mid-trial. Longitudinal linear mixed models and simple slope analyses examined change between and within conditions. Bias-corrected bootstrapping path analysis examined mediation of worry change by increased savoring. SkillJoy led to significantly greater increases in both optimism and prioritizing positivity than the control from pre-trial to post-trial and pre-trial to follow-up. Both interventions significantly reduced kill-joy thinking at both timepoints with Skilljoy leading to marginally greater change at post-trial. Pre- to mid-trial increases in savoring mediated the relationships between treatment condition and reductions in worry at both post-trial and follow-up.

An integrative analysis of potential mechanisms of reduced positive affect in daily life in depression: an ESM study

Decreased levels of positive affect (PA) are a hallmark of depression. Current models propose as potential main mechanisms a dysfunctional use of emotion regulation (ER) strategies (i.e. dampening, positive rumination), and a maladaptive activation of pro-hedonic goals. However, the role of these mechanisms in PA in daily life remains understudied. We used a 10-day ESM design to assess how these mechanisms influence each other and contribute to depressive symptomatology-related low momentary PA in 139 individuals. Higher depressive symptoms were associated with lower PA, pro-hedonic goals, more frequent use of positive rumination, and higher use of dampening. Further, experiencing higher levels of PA predicted lower following time point use of dampening in individuals with higher symptoms. Finally, using positive rumination was more beneficial (i.e. predicted higher PA increases one moment later) for individuals with higher symptomatology. Our findings suggest that moment-to-moment changes in PA daily life are affected by, and have an effect on, both pro-hedonic goals and the use of dampening and positive rumination, highlighting specific cognitive-affective mechanisms that should be considered when designing interventions aimed at improving low PA characterising depression symptomatology.

Unpacking affect maintenance and its association with depressive symptoms: integrating positive and negative affects

ABSTRACTDepression is associated with increased maintenance of negative affect (NA) and reduced - blunted and short-lived - maintenance of positive affect (PA). Studies have focused on factors associated with the maintenance of NA, specifically, the emotion regulation strategy of brooding and the capacity to hold negative affective experiences in working memory (WM). Despite its theoretical importance, less attention has been given to factors associated with the maintenance of PA in depression. This study aims to synthesise factors playing a role in the maintenance of both NA and PA. Specifically, we used self-reported assessment of PA and NA regulation and performance-based measures of NA and PA processing in WM to predict depressive symptoms severity. Participants (N = 219) completed the Affective Maintenance Task (AMT, Mikels et al., 2008), which provided performance-based measures of PA and NA maintenance, and filled out questionnaires assessing brooding, positive rumination and depressive severity. Brooding, positive rumination and AMT-based measures of positive (but not negative) affective information processing were independently associated with depressive symptoms. We highlight the unique contributions of PA processing, as well as of self-reported emotion regulation strategies in understanding depression maintenance.

The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue

In this special series, new research on the Contrast Avoidance Model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.

Understanding mechanisms of depression prevention: study protocol of a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing as intervention techniques for reducing perseverative cognition in remitted depressed individuals

BACKGROUND

Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders, and involves high relapse rates in which persistent negative thinking and rumination (i.e., perseverative cognition [PC]) play an important role. Positive fantasizing and mindfulness are common evidence-based psychological interventions that have been shown to effectively reduce PC and subsequent depressive relapse. How the interventions cause changes in PC over time, is unknown, but likely differ between the two. Whereas fantasizing may change the valence of thought content, mindfulness may operate through disengaging from automatic thought patterns. Comparing mechanisms of both interventions in a clinical sample and a non-clinical sample can give insight into the effectivity of interventions for different individuals. The current study aims to 1) test whether momentary psychological and psychophysiological indices of PC are differentially affected by positive fantasizing versus mindfulness-based interventions, 2) test whether the mechanisms of change by which fantasizing and mindfulness affect PC differ between remitted MDD versus never-depressed (ND) individuals, and 3) explore potential moderators of the main effects of the two interventions (i.e., what works for whom).

METHODS

In this cross-over trial of fantasizing versus mindfulness interventions, we will include 50 remitted MDD and 50 ND individuals. Before the start of the measurements, participants complete several individual characteristics. Daily-life diary measures of thoughts and feelings (using an experience sampling method), behavioural measures of spontaneous thoughts (using the Sustained Attention to Response Task), actigraphy, physiological measures (impedance cardiography, electrocardiography, and electroencephalogram), and measures of depressive mood (self-report questionnaires) are performed during the week before (pre-) the interventions and the week during (peri-) the interventions. After a wash-out of at least one month, pre- and peri-intervention measures for the second intervention are repeated.

DISCUSSION

This is the first study integrating self-reports, behavioural-, and physiological measures capturing dynamics at multiple time scales to examine the differential mechanisms of change in PC by psychological interventions in individuals remitted from multiple MDD episodes and ND individuals. Unravelling how therapeutic techniques affect PC in remitted individuals might generate insights that allows development of personalised targeted relapse prevention interventions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06145984, November 16, 2023.

Effectiveness of behavioral activation and mindfulness in increasing reward sensitivity and reducing depressive symptoms - A randomized controlled trial

Reward insensitivity is a potential key mechanism regarding the maintenance of depression. However, there is a lack of research examining and comparing the effectiveness of different psychological interventions in modifying reward insensitivity. This four-arm randomized controlled trial (RCT) investigated a two-week online intervention. After screening for eligibility, a total of 336 participants were randomized, and 224 participated per-protocol. Participants were assigned to either a) behavioral activation, b) mindfulness and gratitude, c) a combination of both, or d) a waitlist control condition. They received videos and implemented daily exercises. Reward sensitivity and depressive symptoms served as primary outcomes. Behavioral activation and mindfulness significantly improved depressive symptoms and reward sensitivity. However, the effects of behavioral activation were not superior. The combination treatment versus the waiting group was insignificant regarding reward insensitivity. Explorative analyses revealed that all intervention groups reduced anhedonia substantially. Our findings imply that brief online interventions with behavioral activation and mindfulness-based approaches can impact reward insensitivity, while effects for a combination were less clear. Nonetheless, our results do not allow us to infer the differential effectiveness of the interventions. There is a clear need for treatments better targeting maintaining factors of depression, such as reward insensitivity. Clinical trial registration number: NCT05402150.

Psychometric properties of the Persian version of the cognitive emotion regulation questionnaire-short (CERQ-P-short): Reliability, validity, factor structure, treatment sensitivity, and measurement invariance

AIMS

This study aimed to examine the psychometric properties of a widely-used measure of emotion regulation, the short version of the Cognitive Emotion Regulation Questionnaire (CERQ-short), in the Persian language (CERQ-P-short) among Iranian populations.

METHODS

The CERQ-P-short was administered to 1825 participants (female = 974) including 436 adolescents, 834 adults from the general population, 45 patients each with generalized anxiety and obsessive-compulsive disorders, an additional 30 patients each with generalized anxiety and obsessive-compulsive disorders receiving treatment, 45 patients with substance use disorders (SUDs) and an additional 360 adult psychiatric patients. We tested reliability, factor structure, measurement invariance, convergent and discriminant validity, and treatment sensitivity (i.e., intervention response) by age, sex, and diagnostic group. The Depression Anxiety Stress Scale-21 was also administered.

RESULTS

Cronbach's alpha coefficient and test-retest coefficients suggested good reliability. Fit indices suggested that the 9-factor CERQ-P-Short model was good across groups. The CERQ-P-Short showed good measurement invariance in all four models (configural, metric, scalar, and strict) in all groups. Both adaptive and maladaptive cognitive emotion-regulation strategies demonstrated convergent and discriminant validity. Finally, treatment sensitivity of the CERQ-P-Short scale before and after the completion of treatment sessions was suggested for patients with generalized anxiety and obsessive-compulsive disorders.

CONCLUSIONS

While the present study has some limitations, it represents a significant contribution because it supports CERQ-P-Short scales usefulness, validity, and reliability in the general population and among psychiatric patients. The results of the current study can be beneficial to the both clinicians and researchers.

Parents' depressive symptoms and reflective functioning predict parents' proficiency in relational savoring and children's physiological regulation

This study examined parental depression and parental reflective functioning (PRF) as predictors of parental proficiency in relational savoring (RS), the association between RS proficiency and a marker of children's physiological self-regulation, respiratory sinus arrhythmia (RSA), during a stressor, and indirect effects of parental depression and PRF on children's RSA via parents' RS. At Time 1 (T1), parents of 8- to 12-year-old children (N = 139) reported on their depressive symptoms and completed a parenting interview, coded for PRF. After 1.5 years (Time 2; T2), parents savored a positive relational memory that involved their children, which was coded for savoring proficiency. Children's RSA was measured during a stressful task (a series of impossible puzzles). Depressive symptoms (inversely) and PRF (positively) were associated with RS proficiency. Higher parental RS proficiency was associated with children's higher mean levels of RSA during the stressor. Indirect effects models supported that T2 RS proficiency mediated the negative association between parental T1 depressive symptoms and children's T2 RSA, and between T1 PRF and children's T2 RSA. We discuss these findings in terms of implications for parents' emotion regulation, children's emotion regulation, children's mental health, and intervention.

Neural reward responsiveness and daily positive affect functioning in adolescent girls

Deficits in reward processing have been implicated in the development of many forms of psychopathology, especially major depressive disorder (MDD). One facet of reward processing, known as reward responsivity, has been associated with the development and maintenance of depression across development. The reward positivity (RewP) is an event-related potential derived from electroencephalogram (EEG), which is thought to reflect reward responsivity. An attenuated RewP has been observed in both currently depressed individuals and youth at risk for depression, suggesting it may represent a biomarker of depression. Despite this, little is known about how the RewP translates to behavior and affect in the real world. In the current study, we examined how the RewP relates to real world emotional functioning, measured using ecological momentary assessment (EMA). Thirty-eight female adolescents (ages 11-16, Mage = 13.9 years) participated in the study; approximately half of the sample were considered high risk due to maternal lifetime history of MDD. Adolescents completed a monetary reward task while EEG was recorded, followed by a 10-day period of EMA assessing daily affect and emotion regulation strategy use following positive events. Results revealed that the RewP was positively associated with subjective reports of positive, but not negative, daily affect. Results also revealed that the RewP was positively associated with focusing on positive feelings following a positive event (e.g., savoring). Findings from this preliminary study highlight how neural responses to reward in the lab relate to daily life emotional functioning, supporting the RewP as an ecologically valid marker of positive affect functioning among youth.

A network analytic investigation of avoidance, dampening, and devaluation of positivity

BACKGROUND AND OBJECTIVES

Reward Devaluation Theory suggests that devaluation of positivity may be integral in understanding depression (Winer & Salem, 2016). Specifically, the anticipatory (e.g., fear of happiness) and responsive (e.g., dampening) behaviors related to the processing of positivity may play a role in the development and maintenance of depression.

METHODS

The goal of this study was to examine the potential overlap between measures that operationalize positivity avoidance, two Fear of Happiness Scales (Gilbert et al., 2012; Joshanloo, 2013), as well as positivity dampening, measured via the dampening subscale of the Responses to Positive Affect Questionnaire (Feldman et al., 2008). Network and community analyses were employed to examine the extent to which the items of these measures clustered into their parent measures and investigate the dynamic interactions between items.

RESULTS

The results of the community analysis revealed that the three self-report measures overall clustered into their parent measures, except for the Gilbert et al. (2012) Fear of Happiness Scale, which clustered into two separate communities. The most influential nodes represented the concept that good feelings are often followed by negative outcomes. Additionally, nodes related to the theme of fear of letting oneself become happy emerged as the strongest bridge nodes.

LIMITATIONS

One limitation of this study is the use of a cross-sectional design; thus, causality cannot be inferred, but the results can guide future longitudinal network designs.

CONCLUSIONS

These findings demonstrate how anticipatory avoidance and responsive dampening may influence depression, thus providing evidence for unique targets for treatment.

A multicomponent positive psychology intervention for euthymic patients with bipolar disorder to improve mental well-being and personal recovery: A pragmatic randomized controlled trial

OBJECTIVE

Mental well-being and personal recovery are important treatment targets for patients with bipolar disorder (BD). The goal of this study was to evaluate the effectiveness of an 8-week group multicomponent positive psychology intervention (PPI) for euthymic patients with BD as an adjunct to treatment as usual (TAU) compared to TAU alone.

METHODS

Patients with BD were randomized to receive TAU (n = 43) or the PPI in addition to TAU (n = 54). The primary outcome was well being measured with the Mental Health Continuum-Short Form. Personal recovery was measured with the Questionnaire about the Process of Recovery. Data were collected at baseline, mid-treatment, post-treatment and 6- and 12-month follow-up. Life chart interviews were conducted at 12 months to retrospectively assess recurrence of depression and mania.

RESULTS

Significant group-by-time interaction effects for well-being and personal recovery were found favouring the PPI. At post-treatment, between-group differences were significant for well-being (d = 0.77) and personal recovery (d = 0.76). Between-group effects for well-being were still significant at 6-month follow-up (d = 0.72). Effects on well-being and personal recovery within the intervention group were sustained until 12-month follow-up. Survival analyses showed no significant differences in time to recurrence.

CONCLUSIONS

The multicomponent PPI evaluated in this study is effective in improving mental well-being and personal recovery in euthymic patients with BD and would therefore be a valuable addition to the current treatment of euthymic BD patients. The fact that the study was carried out in a pragmatic RCT demonstrates that this intervention can be applied in a real-world clinical setting.

Subjective and neural reactivity during savoring and rumination

Repetitive thinking about negative emotions or events is strongly associated with worse mental health, whereas repetitive positive thought is generally believed to be beneficial. This observation is at odds with the idea that all forms of repetitive thinking share underlying neural mechanisms. To resolve this apparent discrepancy, the present study examined relationships between subjective affect and neural mechanisms during periods of sustained processing of positive (savoring) and negative (rumination) emotion. We also examined potential common moderators of savoring and rumination including memory specificity and sleep quality. Results indicated that individuals who experience high positive affect during savoring also are likely to experience more intense negative affect during rumination. fMRI-derived brain activity revealed common mechanisms of rumination and savoring. Memory specificity had common effects on neural correlates of rumination and savoring; sleep quality was not associated with mechanisms of savoring or rumination. These results suggest that repetitive engagement with positive and negative affect is similar both subjectively and mechanistically. Clinical interventions for rumination may benefit from capitalizing on preserved capacity for savoring.

Correlation between emotion dysregulation and mood symptoms of bipolar disorder: A systematic review and meta-analysis

BACKGROUND

Emotion dysregulation (ED) is a transdiagnostic construct characterized by difficulties regulating intense emotions. People with bipolar disorder (BD) are more likely to show ED and use maladaptive emotion regulation strategies than adaptive ones. However, little is known about whether ED in BD is a trait or it is rather an epiphenomenon of mood symptoms.

METHODS

We conducted a systematic review and meta-analysis of the evidence across major literature databases reporting correlations between measures of emotion regulation (overall ED and different emotion regulation strategies) and measures of depressive and (hypo)manic symptoms in BD from inception until April 12th, 2022.

RESULTS

Fourteen studies involving 1371 individuals with BD were included in the qualitative synthesis, of which 11 reported quantitative information and were included in the meta-analysis. ED and maladaptive strategies were significantly higher during periods with more severe mood symptoms, especially depressive ones, while adaptive strategies were lower.

CONCLUSION

ED significantly correlates with BD symptomatology, and it mainly occurs during mood alterations. ED may be a target for specific psychotherapeutic and pharmacological treatments, according to precision psychiatry. However, further studies are needed, including patients with mood episodes and longitudinal design, to provide more robust evidence and explore the causal direction of the associations.

Reducing the stickiness of negative memory retrieval through positive memory training in adolescents

BACKGROUND AND OBJECTIVES

Individuals at risk for depression exhibit a decreased ability to disengage from negative memory retrieval during times of mental distress, partly because they have difficulty retrieving positive memories to repair sad mood. In this study, we tested whether this persistent tendency for negative memory retrieval could be reduced in adolescents through repeated practice to retrieve positive autobiographical memories, namely Positive Memory Specificity Training (PMST). Further, we examined the impact of this intervention on secondary outcomes, including depressive symptoms, emotion regulation strategies, and fear of positive emotions.

METHODS

Adolescents (n = 68) between 16 and 18 years old were randomly allocated to either PMST or bogus control training. Persistent negative memory retrieval was assessed following the training using a behavioral decision-making task (Emotional Reversal Learning Task). Additionally, participants completed self-report measurements (e.g., depressive symptoms) before and two weeks after the training.

RESULTS

We found preliminary supportive evidence for a significant training effect such that adolescents following PMST showed less persistence in negative memory retrieval compared to those in the control group. Only for anhedonia a significant training effect was found, indicating a possible adverse effect of the intervention.

LIMITATIONS

The primary outcome was assessed only at post-intervention to prevent a potential learning effect due to repeated measurements. We cannot exclude the possibility that baseline individual differences contaminated our results. To examine possible adverse effects of PMST, larger sample are needed.

CONCLUSIONS

PMST may help to reduce persistent negative memory retrieval in adolescents. Recommendations for future studies are addressed.

Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.

Study protocol for a randomized controlled trial of the RASPERA project: recalling and anticipating specific positive events to boost resilience in adolescents

Background

Many stress-related mental health problems, like depression and anxiety, emerge during adolescence, with some recent studies suggesting numbers are increasing. One possible way to reduce adolescents' vulnerability to stress-related mental health problems is to increase their resilience by training them in recalling specific positive memories and anticipating specific positive future events. Therefore, an innovative combi-training (called Positive Events Training; PET) was developed, focusing on the enhancement of the specificity of both past and future positive autobiographical events in adolescents. Its effects on adolescents' resilience and mental wellbeing will be examined.

Methods

A cluster randomized controlled trial with a 2 (condition) × 3 (time-point) factorial design was conducted. Classes of adolescents were randomized to either a PET program (intervention) or a CREAtive writing Training (CREAT) program (active control). Both trainings consisted of four sessions of 50 min (one session, weekly, for four consecutive weeks) and were delivered in schools. Before (pre-training, T1), immediately after (post-training, T2), and 2 months after the training (follow-up, T3), participants completed a series of self-report questionnaires. Primary outcomes are resilience and mental wellbeing. Secondary outcomes are positive affect, positive affect regulation and anhedonia. CONSORT criteria for conducting and reporting RCTs will be used.

Ethics and dissemination

Ethical approval was obtained from the Social and Societal Ethics Committee (SMEC) and the study has been preregistered on Open Science Framework (OSF) and ClinicalTrials.gov (Trial registration number: NCT05757180). We plan to develop a free, online, web-based self-directed PET protocol for teachers if the study provides evidence for the effectiveness of the PET program in increasing adolescents' resilience and mental wellbeing, so teachers can deliver the program to future students without the need of professional external trainers.

Examining Differences in Emotion Dysregulation Between Emerging Adult Alcohol-Only Users, Abstainers, and Simultaneous Users

Objective

Simultaneous use of alcohol and cannabis is associated with more negative consequences than use of either substance alone. Research suggests that emotion dysregulation is linked to alcohol, cannabis, and polysubstance use. However, no previous research has examined whether emotion dysregulation scores differ among individuals without past month substance use (abstainers), individuals who report past-month alcohol use only (no past month cannabis or simultaneous use; alcohol-only users), and individuals who engage in past-month simultaneous alcohol and cannabis use (simultaneous users). Our aim was to examine differences in overall levels of emotion dysregulation and emotion dysregulation subscales between these groups.

Methods

The sample included 468 college students. Participants completed an online survey assessing demographics, emotion dysregulation, average number of drinks per week, days of monthly cannabis use, and simultaneous use of alcohol and cannabis.

Results

A one-way ANOVA showed significant differences in emotion dysregulation between alcohol-only users, abstainers, and simultaneous users. A Bonferroni post hoc analysis revealed significant differences in emotion dysregulation for simultaneous users (p = .004) compared to alcohol-only users and abstainers. A series of ANOVAs were run to examine emotion dysregulation subscale scores and significant differences were found for impulse control difficulties (p = .003) and limited access to emotion regulation strategies (p = .005) for simultaneous users compared to alcohol-only users and abstainers, and for non-acceptance of emotional responses (p = .018) for simultaneous users compared to and alcohol-only users.

Conclusion

These findings indicate that simultaneous users have higher levels of emotion dysregulation, higher levels of impulse control difficulties, greater non-acceptance of emotions, and greater lack of access to emotion regulation strategies compared to abstainers and alcohol-only users.

Embracing the Emotion in Emotional Intelligence Measurement: Insights from Emotion Theory and Research

Emotional intelligence (EI) has gained significant popularity as a scientific construct over the past three decades, yet its conceptualization and measurement still face limitations. Applied EI research often overlooks its components, treating it as a global characteristic, and there are few widely used performance-based tests for assessing ability EI. The present paper proposes avenues for advancing ability EI measurement by connecting the main EI components to models and theories from the emotion science literature and related fields. For emotion understanding and emotion recognition, we discuss the implications of basic emotion theory, dimensional models, and appraisal models of emotion for creating stimuli, scenarios, and response options. For the regulation and management of one's own and others' emotions, we discuss how the process model of emotion regulation and its extensions to interpersonal processes can inform the creation of situational judgment items. In addition, we emphasize the importance of incorporating context, cross-cultural variability, and attentional and motivational factors into future models and measures of ability EI. We hope this article will foster exchange among scholars in the fields of ability EI, basic emotion science, social cognition, and emotion regulation, leading to an enhanced understanding of the individual differences in successful emotional functioning and communication.

Development and validation of a Manic Thought Inventory

OBJECTIVE

This article describes the development and psychometric evaluation of the Manic Thought Inventory (MTI), a patient-driven self-report inventory to assess the presence of typical (hypo)manic cognitions.

METHODS

The initial item pool was generated by patients with bipolar disorder (BD) type I and assessed for suitability by five psychiatrists specialized in treating BD. Study 1 describes the item analysis and exploratory factor structure of the MTI in a sample of 251 patients with BD type I. In study 2, the factor structure was validated with confirmatory factor analysis, and convergent and divergent validity were assessed in an independent sample of 201 patients with BD type I.

RESULTS

Study 1 resulted in a 50-item version of the MTI measuring one underlying factor. Study 2 confirmed the essentially unidimensional underlying construct in a 47-item version of the MTI. Internal consistency of the 47-item version of the MTI was excellent (α = 0.97). The MTI showed moderate to large positive correlations with other measures related to mania. It was not correlated with measures of depression.

CONCLUSION

The MTI showed good psychometric properties and can be useful in research and clinical practice. Patients could use the MTI to select items that they recognize as being characteristic of their (hypo)manic episodes. By monitoring and challenging these items, the MTI could augment current psychological interventions for BD.

A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT

BACKGROUND

Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes.

METHODS

The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires.

RESULTS

A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males.

CONCLUSIONS

The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.

The effect of parenting behaviours on adolescents' rumination: a systematic review of longitudinal studies

Rumination is an emotional regulation mechanism strongly associated with the development and maintenance of internalising psychopathology in adolescence and adulthood. Parenting behaviours (PBs) play a pivotal role in the development of rumination in children and adolescents. Nonetheless, the specific PBs that can either protect against or increase the risk of rumination development remain poorly understood. This systematic review aimed to explore the (1) temporal associations between PBs and adolescents' rumination and (2) potential moderators influencing these associations. We conducted a comprehensive search across Web of Science, Scopus, PubMed, Academic Search Complete and Eric databases, adhering to PRISMA reporting guidelines. Out of 1,868 abstracts screened, 182 articles underwent full-text examination, with nine meeting the inclusion criteria for the systematic review. Overall, the studies indicated that PBs characterised by criticism, rejection and control were positively associated with the development of rumination in adolescents, whilst PBs marked by authoritative practises exhibited a negative association with rumination. Gender, temperament, environmental sensitivity and pubertal timing emerged as significant moderators in the effects of PBs on rumination. However, conclusions were limited due to the studies' methodological heterogeneity. Future studies on PBs and rumination should address various dimensions of PBs and different moderators to identify factors that can modify the development of rumination across adolescence. Findings may inform family-based prevention programmes to promote emotion regulation in adolescents as a protective factor against internalising psychopathology across adulthood.

Mindfulness-based cognitive therapy v. treatment as usual in people with bipolar disorder: A multicentre, randomised controlled trial

Background

Mindfulness-based cognitive therapy (MBCT) seems a promising intervention for bipolar disorder (BD), but there is a lack of randomised controlled trials (RCT) investigating this. The purpose of this multicentre, evaluator blinded RCT was to investigate the added value of MBCT to treatment as usual (TAU) in BD up to 15 months follow-up (NCT03507647).

Methods

A total of 144 participants with BD type I and II were randomised to MBCT + TAU (n = 72) and TAU (n = 72). Primary outcome was current depressive symptoms. Secondary outcomes were current (hypo)manic and anxiety symptoms, recurrence rates, rumination, dampening of positive affect, functional impairment, mindfulness skills, self-compassion, and positive mental health. Potential moderators of treatment outcome were examined.

Results

MBCT + TAU was not more efficacious than TAU in reducing current depressive symptoms at post-treatment (95% CI [−7.0 to 1.8], p = 0.303, d = 0.24) or follow-up (95% CI [−2.2 to 6.3], p = 0.037, d = 0.13). At post-treatment, MBCT + TAU was more effective than TAU in improving mindfulness skills. At follow-up, TAU was more effective than MBCT + TAU in reducing trait anxiety and improving mindfulness skills and positive mental health. Exploratory analysis revealed that participants with higher depressive symptoms and functional impairment at baseline benefitted more from MBCT + TAU than TAU.

Conclusions

In these participants with highly recurrent BD, MBCT may be a treatment option in addition to TAU for those who suffer from moderate to severe levels of depression and functional impairment.

Trial registration

ClinicalTrials.gov, NCT03507647. Registered the 25 April 2018, https://www.clinicaltrials.gov/ct2/show/NCT01126827 .

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

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.

Hooked on a memory: How rumination about past positive events might contribute to grandiose ideas?

OBJECTIVES

Dwelling about positive experiences has been found to be positively related to mania and grandiose ideas. Nevertheless, besides some important limitations, past research has also neglected the nature (or characteristics) of memories individuals dwell on, and that might be specifically associated with grandiose ideas. Thus, the present study aimed to replicate previous studies while considering the role of specificity and the importance of memory used to increase grandiose feelings.

METHOD

In total, 219 participants were included and, after completing the memory induction, were randomized to either the rumination condition or the distraction condition. They also completed different questionnaires assessing positive rumination and grandiose ideas.

RESULTS

Overall, rumination, compared to the distraction condition, led to the maintenance of grandiose ideas and positive affect from T2 to T3. Regression analysis showed that the specificity of memory was associated with grandiose ideas at T2, which predicted grandiose ideas at T3.

CONCLUSIONS

Our results confirm rumination's causal role in forming grandiose ideas. We also found that autobiographical memory and, more specifically, the capacity to recall past positive experiences coupled with repeatedly thinking about them might constitute a fundamental pathway leading to the persistence of such beliefs. The use of a non-clinical sample limits the results and needs replication in clinical samples.

Circadian, Reward, and Emotion Systems in Teens prospective longitudinal study: protocol overview of an integrative reward-circadian rhythm model of first onset of bipolar spectrum disorder in adolescence

BACKGROUND

Bipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence.

METHODS

This NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13-16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1-6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period.

DISCUSSION

This study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the "self-focused" type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one's daily activities, not only limited to those related to "self". A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today's context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the "Flow Model of Rumination (FMR)", which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human-device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.

Fear of Happiness Predicts Concurrent but not Prospective Depressive Symptoms in Adolescents

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.

‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions

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.

Pathways to Depressive Symptoms in a Digital Environment: The Role of Trait Affectivity and Mediation of Media Response Styles in Adolescence

Trait negative affectivity and trait extraversion/positive affectivity are predictive of both responses to affect and depressive symptoms in adolescence. Furthermore, differences in the use of responses to affect are associated with different levels of depressive symptoms. Despite the central role of media content in adolescents' daily lives, responses to affect have not yet been extended to affect in this media content. It is thus unclear whether trait affectivity is predictive of responses to affective media content, and whether such media response styles are predictive of depressive symptoms. A 3-wave longitudinal panel study with 3-month intervals among 318 adolescents (Mage = 16.5 years, SDage = 1.11, 72.5% boys) investigated the mediating role of media response styles in associations between trait affectivity and depressive symptoms. Trait negative affectivity predicted media rumination and media dampening, yet only media rumination predicted greater levels of depressive symptoms over time. Trait positive affectivity was associated with concurrent media distraction and media-enhancing. The media response styles did not mediate the associations between trait affectivity and depressive symptoms over time. These findings suggest that individuals higher in trait negative affectivity tend to engage in maladaptive emotion regulation strategies during sad media content consumption, whereas adolescents higher in trait positive affectivity turn to more adaptive strategies during sad or happy media content consumption. Yet, media response styles are not robustly associated with depressive symptoms over time.

Role of positive emotion regulation strategies in the association between childhood trauma and posttraumatic stress disorder among trauma-exposed individuals who use substances

BACKGROUND

The co-occurrence of childhood trauma and posttraumatic stress disorder (PTSD) is highly prevalent and clinically significant. Existing research emphasizes the role of emotion regulation in the relation between childhood trauma and PTSD. Yet, research in this area has almost exclusively examined the influence of strategies aimed at regulating negative emotions, such as anger and sadness.

OBJECTIVE

To extend existing research, the current study examined underlying roles of strategies for regulating positive emotions (i.e., self- and emotion-focused positive rumination and positive dampening) in the association between childhood trauma severity and PTSD symptoms.

PARTICIPANTS AND SETTING

Participants were 320 trauma-exposed community individuals who reported past 30-day substance use (Mage = 35.78, 50.3% men, 81.6% white).

METHOD

Analyses examined whether childhood trauma severity was indirectly related to PTSD symptoms through self-focused positive rumination, emotion-focused positive rumination, and positive dampening.

RESULTS

Positive dampening, but not positive self- and emotion-focused positive rumination, indirectly explained associations between childhood trauma severity and PTSD symptoms (B = .17, SE = .03, 95% CI [.12, .24]).

CONCLUSIONS

These findings highlight the potential utility of targeting positive dampening in the treatment of PTSD symptoms among individuals who use substances with a history of childhood trauma.

Worry and rumination enhance a positive emotional contrast based on the framework of the Contrast Avoidance Model

The Contrast Avoidance Model (CAM) suggests that worry increases negative affect and decreases positive affect. CAM also suggests that in response to a positive event, higher worry enhances the probability of experiencing greater decreased negative affect and increased positive affect (positive emotional contrasts; PECs). Consequently, worrying may be reinforced by repeated PECs. However, no study has tested whether rumination enhances PECs. Also, emotional specificity in these processes has not been considered. Therefore, we tested whether both rumination and worry enhanced PECs related to specific emotions. After resting baseline, participants with pure generalized anxiety disorder (GAD group, n = 91), pure depression symptoms (depression group, n = 91), and non-GAD and non-depressed healthy controls (HCs, n = 93) engaged with randomly assigned induction tasks (either worry, rumination, or relaxation), and then watched an amusement video. Regardless of group, both worry and rumination increased sadness and fear and decreased amusement more than relaxation from baseline. However, worry increased fear more than rumination, and rumination increased sadness more than worry. Although all inductions led to PECs during the video, worry enhanced fear PECs more than rumination, and rumination enhanced sadnessPECs more than worry. The GAD group who worried experienced the most salient PEC of amusement relative to other groups.

"Don't [ruminate], be happy": A cognitive perspective linking depression and anhedonia

Anhedonia, a lack of pleasure in things an individual once enjoyed, and rumination, the process of perseverative and repetitive attention to specific thoughts, are hallmark features of depression. Though these both contribute to the same debilitating disorder, they have often been studied independently and through different theoretical lenses (e.g., biological vs. cognitive). Cognitive theories and research on rumination have largely focused on understanding negative affect in depression with much less focus on the etiology and maintenance of anhedonia. In this paper, we argue that by examining the relation between cognitive constructs and deficits in positive affect, we may better understand anhedonia in depression thereby improving prevention and intervention efforts. We review the extant literature on cognitive deficits in depression and discuss how these dysfunctions may not only lead to sustained negative affect but, importantly, interfere with an ability to attend to social and environmental cues that could restore positive affect. Specifically, we discuss how rumination is associated to deficits in working memory and propose that these deficits in working memory may contribute to anhedonia in depression. We further argue that analytical approaches such as computational modeling are needed to study these questions and, finally, discuss implications for treatment.

Differential patterns of default mode network activity associated with negative and positive rumination in bipolar disorder

BACKGROUND

Patients with bipolar disorder (BD) engage in both negative and positive rumination, defined as maladaptive self-focused thinking, and this tendency predicts depressive and manic episodes, respectively. Prior research in patients with major depression implicates regions of the default mode network (DMN) consistent with the self-focused nature of rumination. Little is known about the neural correlates of rumination in bipolar disorder.

METHODS

Fifteen euthymic patients with BD (twelve with Type I) and 17 healthy controls (HC) performed negative and positive rumination induction tasks, as well as a distraction task, followed by a self-related trait judgment task while undergoing functional magnetic resonance imaging (fMRI). Participants also underwent resting state scans. We examined functional connectivity at rest and during the induction tasks, as well as task-based activation during the trait judgment task, in core regions of the DMN.

RESULTS

Compared to HC, patients with BD showed greater functional connectivity between the posterior cingulate cortex (PCC) and medial prefrontal cortex (MPFC) at rest and during positive rumination, compared to distraction. They also showed greater activity in the PCC and MPFC during processing of positive traits, following positive rumination. At rest and during negative rumination compared to distraction, patients with BD showed greater functional connectivity between the PCC and inferior parietal lobule than HC.

CONCLUSIONS

These findings demonstrate that negative and positive rumination are subserved by different patterns of connectivity within the DMN in BD. Additionally, the PCC and MPFC are key regions involved in the processing of positive self-relevant traits following positive rumination.

Correlates of repetitive negative thinking in postnatal first time mothers

BACKGROUND

Despite the well-established role of repetitive negative thinking (RNT) in the prediction and maintenance of depression and anxiety, only minimal research to date has investigated RNT in the context of postnatal psychological adjustment.

OBJECTIVE

We examined the relationships between RNT, associated maladaptive cognitive processes, infant responsiveness and psychopathology in a sample of first-time mothers (N = 235) with babies under 12 months.

METHODS

Participants completed an online battery of measures that indexed RNT, dampening of positive affect, metacognitive beliefs about RNT, infant responsiveness, depression and anxiety symptoms.

RESULTS

As predicted, RNT was correlated with depression. Controlling for depression, RNT was associated with anxiety, dampening positive affect and positive beliefs about RNT. RNT was inversely related to maternal responsiveness, but this relationship was accounted for by depression.

CONCLUSIONS

Consistent with findings in the broader literature, RNT was associated with depression, anxiety and other unhelpful cognitive processes in the postnatal period, as well as with poor infant responsiveness. Whilst cross-sectional and preliminary, these data suggest there may be potential clinical utility in targeting RNT in first-time mothers.

The effects of walking in nature on negative and positive affect in adult psychiatric outpatients with major depressive disorder: A randomized-controlled study

BACKGROUND

While walking in nature has been shown to improve affect in adults from the community to a greater extent than walking in urban settings, it is unknown whether such benefits apply to individuals suffering from depression. Using a parallel group design, this randomized controlled trial examined the effects of a single walk in nature versus urban settings on negative and positive affect in adult psychiatric outpatients diagnosed with major depressive disorder (MDD).

METHOD

Participants recruited from a psychiatric outpatient clinic for adults with MDD were randomly assigned to a nature or urban walk condition. Thirty-seven adults (mean age = 49 years) completed a single 60-minute walk. Negative and positive affect were assessed using The Positive and Negative Affect Schedule or PANAS at 6 time points: before the walk, halfway during the walk, immediately post-walk, at home before bedtime, 24 h post-walk, and 48 h post-walk.

RESULTS

Controlling for baseline levels of affect before the walk, individuals who walked in nature experienced overall lower levels of negative affect, F(1, 35.039) = 4.239, p = .047, compared to those who walked in urban settings. Positive affect did not differ across walk conditions.

LIMITATIONS

The generalizability of results are limited by the small sample size and the presence of more female than male participants.

CONCLUSIONS

Walking in nature might be a useful strategy to improve negative affect in adults with MDD. Future research should investigate different ways to integrate the beneficial effects of nature exposure into existing treatment plans for psychiatric outpatients with MDD.

Correlates of Dampening and Savoring in Generalized Anxiety Disorder

Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants (N = 233) completed questionnaires online.

In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed.

Differential Antecedents and Consequences of Affective and Cognitive Ruminations

Adopting the information processing perspective, the current study aims to investigate the differential effects of affective and cognitive ruminations on individuals' affective states and learning behavior, and to further explore their differential mediating roles in transmitting effects of challenge and hindrance stressors on affect and behavior. A two-wave survey, in which stressors and ruminations were measured in the first wave and affective states and learning behavior were measured in the second, was conducted to obtain responses from 410 employees. As expected, affective and cognitive ruminations were differently associated with challenge stressors (i.e., cognitive job insecurity) and hindrance stressors (i.e., interpersonal conflict), and yielded different effects in terms of positive affect, negative affect, and learning behavior. Specifically, the results showed that: (a) cognitive job insecurity was significantly and positively related to cognitive rumination, while interpersonal conflict was significantly and positively related to affective rumination; (b) affective and cognitive ruminations were significantly associated with positive or negative affect, but in the exact opposite direction; (c) cognitive rumination, but not affective rumination, was significantly related to learning behavior; and (d) cognitive rumination mediated the effect of cognitive job insecurity on positive affect and learning behavior, while affective rumination mediated the effect of interpersonal conflict on negative affect. The current study contributes to the literature on rumination by introducing a new perspective, and sheds new light on the understanding of how and why affective and cognitive ruminations may lead to different affective states and behaviors.

The thrill of victory: Savoring positive affect, psychophysiological reward processing, and symptoms of depression

Depression is characterized by a pattern of maladaptive emotion regulation. Recently, researchers have begun to focus on associations between depression and two positive affect regulation strategies: savoring and dampening. Savoring, or upregulation of positive affect, is positively associated with well-being and negatively associated with depression, whereas dampening, or downregulation of positive affect, is positively associated with depression, anhedonia, and negative affect. To date, no research has examined whether savoring or dampening can affect neurophysiological reactivity to reward, which previous research has shown is associated with symptoms of depression. Here, we examined associations between psychophysiological reward processing-primarily captured by the Reward Positivity (RewP), an event-related potential (ERP) deflection elicited by feedback indicating reward (vs. nonreward)-positive affect regulation strategies, and symptoms of depression. One hundred undergraduates completed questionnaires assessing affect, emotion regulation, and depressive symptoms and completed a computerized guessing task, once before and again after being randomly assigned to emotion-regulation strategy conditions. Results indicate that (a) the relationship between RewP amplitude and depressive symptoms may, in part, depend upon positive affect regulation strategies and (b) the RewP elicited by reward appears sensitive to a savoring intervention. These findings suggest that mitigating depressive symptoms in emerging adults may depend on both top-down (i.e., savoring) and bottom-up (i.e., RewP) forms of positive affect regulation and have important implications for clinical prevention and intervention efforts for depressive symptoms and disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of mindfulness-based cognitive therapy on rumination and a task-based measure of intrusive thoughts in patients with bipolar disorder

Background

Preliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.

Methods

The study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing.

Results

Compared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R² = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f² = 0.19)) and negative intrusive thoughts on the BFT (R² = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f² = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts.

Conclusions

MBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40345-022-00269-1.

Beneficial effects of sleep extension on daily emotion in short-sleeping young adults: An experience sampling study

OBJECTIVES

Short sleep duration has been linked to disrupted emotional experiences and poor emotion regulation. Extending sleep opportunity might therefore offer a means to improve emotion functioning. This study used experience sampling to examine the effect of sleep extension on daily emotion experiences and emotion regulation.

PARTICIPANTS

Participants were young adults (n = 72), aged 18-24 years who reported consistently sleeping less than 7 hours in a 24-hour period in the past 2 weeks.

DESIGN AND SETTING

For 14 consecutive days, participants completed experience sampling questions related to sleep, emotion, and emotion regulation via a smartphone application. Procedures were identical for all participants for the first 7 days ("baseline" assessments).

INTERVENTION

From days 8-14, participants were randomly assigned to either a "sleep extension" condition, in which they were instructed to increase their sleep opportunity by 90 minutes or a "sleep as usual" condition.

MEASUREMENTS

Duration and quality of the previous night's sleep were reported each morning and daytime experiences of positive and negative emotion and emotion regulation were measured at pseudorandom timepoints 6 times a day.

RESULTS

Multilevel modeling demonstrated that participants in the sleep extension condition reported significantly longer sleep times and improved sleep quality, as well as higher positive and lower negative daily emotion, compared to those in the sleep as usual condition.

CONCLUSION

A brief experimental paradigm to extend sleep length has the potential to improve sleep quality and to a minor extent mood, among young adults with short sleep.

Dampening of positive affect and depression: A meta-analysis of cross-sectional and longitudinal relationships

Dampening responses to positive affect have been posited to confer vulnerability to depression, but longitudinal studies have not consistently shown dampening tendencies to predict follow-up depression. The cross-sectional, longitudinal, and cross-lagged relationships between dampening and depression were determined using meta-analytic methods. A systematic literature search of the PsycINFO and PubMed databases supplemented by Google Scholar yielded 60 samples suitable for inclusion in the cross-sectional analyses and 12 samples meeting criteria for the longitudinal analyses. In the first meta-analytic study to examine the relationship between dampening and depression, we found dampening to be associated with depression both cross-sectionally (r = .45) and prospectively (r = 0.34). Crucially, dampening at baseline remained a significant predictor of follow-up depression even after controlling for baseline levels of depression in cross-lagged analyses (β = .09). A bidirectional effect was also found, with baseline levels of depression predicting follow-up tendencies to engage in dampening (r = 0.36). This relationship was again diminished but remained significant after controlling for initial levels of dampening (β = .14). These results suggest that dampening responses to positive affect are a risk factor for the development of depression and highlight the importance of targeting dampening cognitions in treatment.

Neural basis of positive and negative emotion regulation in remitted depression

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RRMDD patients show deviant uninstructed neural emotion regulation.

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This is reflected in residual problems in daily strategy use.

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RRMDD patients are capable to engage frontolimbic areas upon instructed reappraisal.

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Neural regulation capacity is related to inadequate rumination.

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Positive, next to negative, affect is highly relevant for understanding vulnerability.

The recurrent nature of Major Depressive Disorder (MDD) necessitates a better understanding of mechanisms facilitating relapse. MDD has often been associated with abnormal emotion regulation, underpinned by aberrant interactions between the prefrontal cortex and subcortical areas. We assessed whether neural regulation abnormalities remain after remission and relate to emotion regulation problems in daily life.

At the baseline measurement of a randomized controlled trial, an emotion regulation task was performed during fMRI scanning by 46 remitted recurrent (rrMDD) patients and 24 healthy controls. We assessed both fMRI peak activity and the temporal dynamics of the neural response during passive attendance and explicit regulation of positive and negative emotions. Furthermore, we assessed regulation strategy use in daily life using questionnaires, and attentional biases using a modified attentional dot-probe task.

RrMDD patients showed lower activation and different temporal dynamics in occipital, parietal, and prefrontal brain regions during passive attendance of emotional material compared to healthy controls. During explicit downregulation of negative emotions, no group differences were found. However, during explicit upregulation of positive emotions, rrMDD patients showed a different neural response over time in the insula. Behaviourally, rrMDD patients were characterized by dysfunctional regulation strategies in daily life. Within rrMDD patients, rumination was associated with activation within a limbic- prefrontal network.

After remission, immediate emotional processing seems unaffected, but regulatory abnormalities remain, especially uninstructed and in daily life. Abnormal insula activation during positive upregulation suggests decreased monitoring of positive emotions. The relation between inadequate rumination and brain activity during emotion regulation suggests that regulation of both positive and negative affect is important in understanding neurocognitive underpinnings of resilience.

A five-factor model of perseverative thought

Like diagnostic status, clinically relevant thought remains overwhelmingly conceptualized in terms of discrete categories (e.g., worry, rumination, obsessions). However, definitions can vary widely. The area of perseverative thought (or clinically relevant thought more broadly) would benefit substantially from a consensus-based, empirically grounded taxonomy similar to the Hierarchical Taxonomy of Psychopathology (Kotov et al., 2017) or the Big Five for personality. This article addresses three major barriers to establishing such a taxonomy: (a) a lack of research explicitly comparing categorical (subtype) versus dimensional models, (b) primary reliance on between-person measures rather than modeling at the level of the thought (within person), and (c) insufficient emphasis on replication and refinement. Participants included an unselected crowdsourced sample (790 observations from 286 participants) and an independent anxious-depressed replication sample (808 observations from 277 participants). Participants made dimensional ratings for three idiographic clinically relevant thoughts on a range of features. Multilevel latent class analysis and multilevel exploratory factor analysis were applied to identify and extract natural patterns of covariation among features at the level of the thought, controlling for person-level tendencies. A consistent five-dimension solution emerged across both samples and reliably outperformed the best-fitting categorical solution in terms of fit, replicability, and explanatory power. Identified dimensions were dyscontrol, self-focus, valence, interpersonal, and uncertainty. Findings support a five-factor latent structure of perseverative thought. Theoretical, empirical, and clinical implications and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).