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Myklebost SB, Heltne A, Hammar Å, Nordgreen T. Efficacy of an internet-delivered cognitive enhancement intervention for subjective residual cognitive deficits in remitted major depressive disorder: A randomized crossover trial. J Affect Disord 2024; 364:87-95. [PMID: 39142571 DOI: 10.1016/j.jad.2024.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/28/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Cognitive deficits such as difficulties with attention, memory, and executive functions are frequently reported during remission from depression and relates to adverse functioning in daily life and risk of relapse. There is therefore a need for interventions targeting cognitive deficits after depression. However, few randomized controlled trials have investigated the efficacy of interventions targeting subjective residual cognitive deficits in adults remitted from depression. METHODS This randomized crossover trial aimed to investigate the efficacy of an internet-delivered cognitive enhancement intervention on subjective residual cognitive deficits. Forty-four formerly depressed adults (89 % female;mean age = 39 years) were included. Twenty-three participants received the intervention, and 21 participants were assigned to a waitlist control group. The waitlist control group received the intervention after seven weeks. Analyses of follow-up assessment after six months were conducted for the combined sample. RESULTS Significant differences were found between the intervention and waitlist control group in subjective cognitive functioning (d = 1.83) and rumination (d = 1.65). There was a difference in symptoms of depression between the groups (d = 1.22), whereas symptoms of depression increased in the waitlist control, but not in the intervention group. Fewer participants in the waitlist control group (43 %), compared to the intervention group (78 %) showed reliable improvement in self-reported cognitive deficits after receiving the intervention. LIMITATIONS Findings should be interpreted with caution due to the small sample, and lack of an active control group. CONCLUSIONS Internet-delivered cognitive enhancement interventions may improve subjective cognitive deficits. Waiting time to receive cognitive enhancement interventions may worsen symptoms and treatment response.
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Affiliation(s)
- Sunniva Brurok Myklebost
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Norway.
| | - Aleksander Heltne
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Norway; Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden; Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Sweden
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
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Zetsche U, Neumann P, Bürkner PC, Renneberg B, Koster EHW, Hoorelbeke K. Computerized cognitive control training to reduce rumination in major depression: A randomized controlled trial. Behav Res Ther 2024; 177:104521. [PMID: 38615373 DOI: 10.1016/j.brat.2024.104521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/12/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Rumination is a major risk factor for the onset and recurrence of depressive episodes and has been associated with deficits in updating working memory content. This randomized controlled trial examines whether training updating-specific cognitive control processes reduces daily ruminative thoughts in clinically depressed individuals. METHODS Sixty-five individuals with a current major depressive episode were randomized to 10 sessions of either cognitive control training (N = 31) or placebo training (N = 34). The frequency and negativity of individuals' daily ruminative thoughts were assessed for seven days before training, after training, and at a 3-month follow-up using experience sampling methodology. Secondary outcomes were depressive symptoms, depressed mood, and level of disability. RESULTS Cognitive control training led to stronger improvements in the trained task than placebo training. However, cognitive control training did not lead to greater reductions in the frequency or negativity of daily ruminative thoughts than placebo training. There were no training-specific effects on participants' depressive symptoms or level of disability. CONCLUSIONS The robustness of the present null-findings, combined with the methodological strengths of the study, suggest that training currently depressed individuals to update emotional content in working memory does not affect the frequency or negativity of their daily ruminative thoughts.
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Affiliation(s)
- Ulrike Zetsche
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
| | - Pauline Neumann
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | | | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, University Ghent, Belgium
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, University Ghent, Belgium
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3
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Bomyea J, Feng S, Moore RC, Simmons AN, Thomas ML. Change in Resting-State Functional Connectivity Following Working Memory Training in Individuals With Repetitive Negative Thinking. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00119-8. [PMID: 38705463 DOI: 10.1016/j.bpsc.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Repetitive negative thinking (RNT) symptoms, which are characterized by pervasive, uncontrollable negative thoughts, are common in individuals with mood, anxiety, and traumatic stress disorders. Inability to regulate the contents of working memory is a hypothesized etiological factor in RNT, which suggests that training to improve working memory may be beneficial. This study examined the effects of working memory training on resting-state functional connectivity (rsFC) in individuals with elevated RNT and whether such changes would be associated with clinical improvement. METHODS We conducted a secondary analysis of pre-post resting-state data collected as part of a randomized controlled trial (NCT04912089) of working memory training interventions (n = 42) compared with a waitlist control group (n = 23). We hypothesized that individuals who completed training would show increased rsFC between the 2 key intrinsic connectivity networks-the default mode network (posterior cingulate cortex) and the frontoparietal network (dorsolateral prefrontal cortex). We explored whether the magnitude of rsFC change was associated with change in RNT symptom severity. RESULTS rsFC increased between the posterior cingulate cortex and regions including the frontal and parietal cortex in the training group compared with the waitlist group. Increased connectivity between the posterior cingulate cortex and superior frontal cortex was associated with RNT symptom reduction. CONCLUSIONS These data provide evidence that working memory training can modulate neural circuitry at rest in individuals with RNT. Results are consistent with accounts of working memory training effects on large-scale neurocircuitry changes and suggest that these changes may contribute to clinical promise of this type of intervention on transdiagnostic RNT symptoms.
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Affiliation(s)
- Jessica Bomyea
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California.
| | - Shirley Feng
- Department of Psychiatry, University of California San Diego, San Diego, California; Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Alan N Simmons
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, San Diego, California
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, Colorado
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4
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Wen H, Wu M, Wang Z, Gao B, Zheng Y. Aberrant effort-based reward dynamics in anhedonia. Cereb Cortex 2024; 34:bhae193. [PMID: 38741268 DOI: 10.1093/cercor/bhae193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Anhedonia is a transdiagnostic symptom and associated with a spectrum of reward deficits among which the motivational dysfunction is poorly understood. Previous studies have established the abnormal cost-benefit trade-off as a contributor to motivational deficits in anhedonia and its relevant psychiatric diseases. However, it remains elusive how the anhedonic neural dynamics underlying reward processing are modulated by effort expenditure. Using an effort-based monetary incentive delay task, the current event-related potential study examined the neural dynamics underlying the effort-reward interplay in anhedonia using a nonclinical sample who scored high or low on an anhedonia questionnaire. We found that effort prospectively decreased reward effect on the contingent variation negativity and the target-P3 but retrospectively enhanced outcome effect on the feedback-P3 following effort expenditure. Compared to the low-anhedonia group, the high-anhedonia group displayed a diminished effort effect on the target-P3 during effort expenditure and an increased effort-enhancement effect for neutral trials during the feedback-P3 period following effort expenditure. Our findings suggest that anhedonia is associated with an inefficient control and motivation allocation along the efforted-based reward dynamics from effort preparation to effort production.
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Affiliation(s)
- Hailing Wen
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Menglin Wu
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Zhao Wang
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Bo Gao
- Department of Psychology, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian 116044, China
| | - Ya Zheng
- Department of Psychology, Guangzhou University, 230 Wai Huan Xi Road, Guangzhou Higher Education Mega Center, Guangzhou 510006, China
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5
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Nusslock R, Alloy LB, Brody GH, Miller GE. Annual Research Review: Neuroimmune network model of depression: a developmental perspective. J Child Psychol Psychiatry 2024; 65:538-567. [PMID: 38426610 PMCID: PMC11090270 DOI: 10.1111/jcpp.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Depression is a serious public health problem, and adolescence is an 'age of risk' for the onset of Major Depressive Disorder. Recently, we and others have proposed neuroimmune network models that highlight bidirectional communication between the brain and the immune system in both mental and physical health, including depression. These models draw on research indicating that the cellular actors (particularly monocytes) and signaling molecules (particularly cytokines) that orchestrate inflammation in the periphery can directly modulate the structure and function of the brain. In the brain, inflammatory activity heightens sensitivity to threats in the cortico-amygdala circuit, lowers sensitivity to rewards in the cortico-striatal circuit, and alters executive control and emotion regulation in the prefrontal cortex. When dysregulated, and particularly under conditions of chronic stress, inflammation can generate feelings of dysphoria, distress, and anhedonia. This is proposed to initiate unhealthy, self-medicating behaviors (e.g. substance use, poor diet) to manage the dysphoria, which further heighten inflammation. Over time, dysregulation in these brain circuits and the inflammatory response may compound each other to form a positive feedback loop, whereby dysregulation in one organ system exacerbates the other. We and others suggest that this neuroimmune dysregulation is a dynamic joint vulnerability for depression, particularly during adolescence. We have three goals for the present paper. First, we extend neuroimmune network models of mental and physical health to generate a developmental framework of risk for the onset of depression during adolescence. Second, we examine how a neuroimmune network perspective can help explain the high rates of comorbidity between depression and other psychiatric disorders across development, and multimorbidity between depression and stress-related medical illnesses. Finally, we consider how identifying neuroimmune pathways to depression can facilitate a 'next generation' of behavioral and biological interventions that target neuroimmune signaling to treat, and ideally prevent, depression in youth and adolescents.
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Affiliation(s)
- Robin Nusslock
- Department of Psychology, Northwestern University, Evanston IL, USA
- Institute for Policy Research, Northwestern University, Evanston IL, USA
| | - Lauren B. Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA. USA
| | - Gene H. Brody
- Center for Family Research, University of Georgia, Athens GA, USA
| | - Gregory E. Miller
- Department of Psychology, Northwestern University, Evanston IL, USA
- Institute for Policy Research, Northwestern University, Evanston IL, USA
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Vander Zwalmen Y, Liebaert E, Hoorelbeke K, de Mévergnies CN, Baeken C, Verhaeghe N, Koster EHW. Treatment Response Following Adaptive PASAT Training for Depression Vulnerability: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2024; 34:232-249. [PMID: 36853526 DOI: 10.1007/s11065-023-09581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/27/2022] [Indexed: 03/01/2023]
Abstract
In recent years, cognitive control training (CCT) has gained momentum as an intervention to remediate cognitive impairments and decrease depressive symptoms. One promising operationalization to train cognitive control is the adaptive Paced Auditory Serial Addition Task (aPASAT). In this systematic review and meta-analysis of aPASAT training, the efficacy of the intervention and potential moderators were examined. The PsycINFO, MEDLINE, Embase, Web of Science and Cochrane Library electronic databases were searched for studies examining aPASAT training for depressive symptomatology or rumination. Nineteen studies (n = 1255) were included, comprising of depressed patients, remitted depressed patients, at-risk, and healthy participants. We found small significant effects directly after training for both depressive symptomatology and rumination, with similar effect sizes at follow-up. Subgroup analyses suggest a significantly higher mean effect of aPASAT training in non-healthy populations for rumination immediately following training, but not for depressive symptomatology. The amount of training sessions did not moderate effects of CCT. aPASAT has a small but significant effect on depressive symptoms, with direct effects immediately after training, as well as sustained long-term effects. It is currently unclear how many sessions are required for sustained effects due to heterogeneity in training dosage and absence of sufficient trials. Our results suggest that aPASAT training may be most effective for at-risk, remitted- and clinically depressed populations. The effect sizes resulting from this meta-analysis could be used to adequately power future research, which could investigate a dose-response relationship and examine potential treatment gains when combining CCT with other antidepressant interventions.
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Affiliation(s)
- Yannick Vander Zwalmen
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium.
| | - Eveline Liebaert
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Constance Nève de Mévergnies
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Group Social and Economic Policy and Social Inclusion, HIVA, KU Leuven, Leuven, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Patriarca GC, Rey Y, Yeguez CE, Buitron V, McMakin DL, Pettit JW. Attentional Control Accounts for the Association Between Anxiety Sensitivity and Sleep Efficiency in Clinic-Referred Youth. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01631-9. [PMID: 38036742 PMCID: PMC11143078 DOI: 10.1007/s10578-023-01631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.
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Affiliation(s)
- Guadalupe C Patriarca
- Department of Psychology, Center for Children and Families, Florida International University, AHC 1 Room 140, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Yasmin Rey
- Department of Psychology, Center for Children and Families, Florida International University, AHC 1 Room 140, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Carlos E Yeguez
- Department of Psychology, Center for Children and Families, Florida International University, AHC 1 Room 140, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Dana L McMakin
- Department of Psychology, Center for Children and Families, Florida International University, AHC 1 Room 140, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Jeremy W Pettit
- Department of Psychology, Center for Children and Families, Florida International University, AHC 1 Room 140, 11200 SW 8th Street, Miami, FL, 33199, USA.
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8
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Murphy OW, Hoy KE, Wong D, Bailey NW, Fitzgerald PB, Segrave RA. Effects of transcranial direct current stimulation and transcranial random noise stimulation on working memory and task-related EEG in major depressive disorder. Brain Cogn 2023; 173:106105. [PMID: 37963422 DOI: 10.1016/j.bandc.2023.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To compare effects of transcranial direct current stimulation (tDCS) and transcranial random noise stimulation with a direct-current offset (tRNS + DC-offset) on working memory (WM) performance and task-related electroencephalography (EEG) in individuals with Major Depressive Disorder (MDD). METHODS Using a sham-controlled, parallel-groups design, 49 participants with MDD received either anodal tDCS (N = 16), high-frequency tRNS + DC-offset (N = 16), or sham stimulation (N = 17) to the left dorsolateral prefrontal cortex (DLPFC) for 20-minutes. The Sternberg WM task was completed with concurrent EEG recording before and at 5- and 25-minutes post-stimulation. Event-related synchronisation/desynchronisation (ERS/ERD) was calculated for theta, upper alpha, and gamma oscillations during WM encoding and maintenance. RESULTS tDCS significantly increased parieto-occipital upper alpha ERS/ERD during WM maintenance, observed on EEG recorded 5- and 25-minutes post-stimulation. tRNS + DC-offset did not significantly alter WM-related oscillatory activity when compared to sham stimulation. Neither tDCS nor tRNS + DC-offset improved WM performance to a significantly greater degree than sham stimulation. CONCLUSIONS Although tDCS induced persistent effects on WM-related oscillatory activity, neither tDCS nor tRNS + DC-offset enhanced WM performance in MDD. SIGNIFICANCE This reflects the first sham-controlled comparison of tDCS and tRNS + DC-offset in MDD. These findings directly contrast with evidence of tRNS-induced enhancements in WM in healthy individuals.
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Affiliation(s)
- O W Murphy
- Central Clinical School, Monash University, Clayton, VIC, Australia; Bionics Institute, East Melbourne, VIC, Australia.
| | - K E Hoy
- Central Clinical School, Monash University, Clayton, VIC, Australia; Bionics Institute, East Melbourne, VIC, Australia
| | - D Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - N W Bailey
- Central Clinical School, Monash University, Clayton, VIC, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - P B Fitzgerald
- Monarch Research Institute Monarch Mental Health Group, Sydney, NSW, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - R A Segrave
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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9
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Kashyap H, Mehta UM, Reddy RP, Bharath RD. Role of Cognitive Control in Psychotherapy: An Integrated Review. Indian J Psychol Med 2023; 45:462-470. [PMID: 37772131 PMCID: PMC10523513 DOI: 10.1177/02537176221128611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background Cognitive control (CC), including shifting, updating, and inhibiting functions, may play an integral role in various aspects of psychotherapy; however, research on this is limited. This review aims to link the disparate lines of evidence on CC as they relate to psychotherapy processes, techniques, and outcomes. Methods A systematic search of the literature on neuropsychological domains relating to psychotherapy in adults with anxiety/depression yielded 18 eligible studies. The review also uses a narrative format to explore other potential links between CC and psychotherapy that are underinvestigated, and highlights the need for research and application to evidence-based practice of psychotherapy. Results and conclusions Findings suggest that CC may predict psychotherapy outcomes and also improve as a function of psychotherapy. Analog sample studies suggest a possible link between CC and techniques for regulation of cognition and emotion, such as reappraisal, mindfulness, and cognitive restructuring. CC may also play an integral role in the regulation of behavior. Study of CC in the context of psychotherapy may potentially explain individual differences in psychotherapy outcomes and mechanisms of action of various psychotherapy techniques and processes. Such an understanding may have possible implications for "best fit" matching clients to therapies and modifying psychological interventions to account for poorer CC abilities. CC may be enhanced through training and further research is warranted on the impact of such training in facilitating better long-term psychotherapy outcomes.
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Affiliation(s)
- Himani Kashyap
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Urvakhsh Meherwan Mehta
- Dept. of Psychiatry, National Institute of
Mental Health And Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Rose Dawn Bharath
- Dept. of Neuroimaging and Interventional
Radiology, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
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Nève de Mévergnies C, Verhaeghe N, Koster EHW, Baeken C, Vander Zwalmen Y, Hoorelbeke K. Health Economic Evaluation of Cognitive Control Training for Depression: Key Considerations. JMIR Ment Health 2023; 10:e44679. [PMID: 37594847 PMCID: PMC10474514 DOI: 10.2196/44679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/22/2023] [Accepted: 06/10/2023] [Indexed: 08/19/2023] Open
Abstract
Depression is a serious and burdensome psychiatric illness that contributes heavily to health expenditures. These costs are partly related to the observation that depression is often not limited to a single episode but can recur or follow a chronic pathway. In terms of risk factors, it is acknowledged that cognitive impairments play a crucial role in vulnerability to depression. Within this context, cognitive control training (CCT) has shown its effectiveness in reducing the risk for recurrence of depression. CCT is low cost intensive and can be provided as a web-based intervention, which makes it easy to disseminate. Despite increasing interest in the field, studies examining the cost-effectiveness of CCT in the context of depression are largely missing. Health economic evaluation (HEE) allows to inform decision makers with evidence-based insights about how to spend limited available (financial) resources in the most efficient way. HEE studies constitute a crucial step in the implementation of a new intervention in clinical practice. Approaching preventive measures for depression such as CCT from an HEE perspective is informative to health policy, fostering optimal use of health expenditures. The aim of this paper was to inform and guide researchers during the phase of designing HEE studies in the context of CCT for depression. A clear view of CCT's cost-effectiveness is paramount for its clinical implementation.
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Affiliation(s)
- Constance Nève de Mévergnies
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital Brussel (UZBrussel), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Yannick Vander Zwalmen
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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11
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Dalhuisen I, Schutte C, Bramson B, Roelofs K, van Eijndhoven P, Tendolkar I. Studying additive effects of combining rTMS with cognitive control training: a pilot investigation. Front Hum Neurosci 2023; 17:1201344. [PMID: 37584029 PMCID: PMC10423931 DOI: 10.3389/fnhum.2023.1201344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) on the dorsolateral prefrontal cortex (DLPFC) is an effective treatment for depression that has been proposed to work via the enhancement of cognitive control. Cognitive control training (CCT) can also alleviate depression by relying on DLPFC activation. As the additive effects of rTMS and CCT are unclear, we set out to conduct a within-subject pilot study in healthy controls. Methods Seventeen participants received two sessions of individualized resting-state connectivity-guided high-frequency rTMS, while randomly performing CCT or a control task. After each session, a negative mood was induced. Results We found effects on mood and cognitive control after rTMS + CCT as well as rTMS + control, which were indiscriminative between conditions. Based on the statistical evidence for the absence of an additive effect of CCT, we did not perform a full study. Conclusion Our results demonstrate no differential effects of single sessions combining rTMS and CCT in a healthy population, even with the methodological improvement of individualized neuronavigation. The improvement in cognitive control seen in both conditions could indicate that a simple cognitive task is sufficient when studying additive rTMS effects. Future studies should focus on augmenting the effects of various cognitive tasks and compare the present interventions with rTMS or cognitive tasks alone.
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Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Céline Schutte
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bob Bramson
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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Jahn N, Sinke C, Kayali Ö, Krug S, Leichter E, Peschel S, Müller T, Burak A, Krüger THC, Kahl KG, Heitland I. Neural correlates of the attention training technique as used in metacognitive therapy – A randomized sham-controlled fMRI study in healthy volunteers. Front Psychol 2023; 14:1084022. [PMID: 36993887 PMCID: PMC10040584 DOI: 10.3389/fpsyg.2023.1084022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
IntroductionThe Attention Training Technique (ATT) developed as part of metacognitive therapy is a psychotherapeutic treatment method used to enhance top-down attentional flexibility and control. This study investigated potential neurocognitive changes due to ATT and its underlying neural mechanisms using pre-to-post functional magnetic resonance imaging (fMRI).Materials and methodsFifty-four healthy participants were subjected to a randomized, sham-controlled attention training and evaluated using a neurocognitive test battery that partly took place in an fMRI environment. Participants received two doses ATT or sham ATT daily for 1 week. On day eight, all subjects completed the neurocognitive test battery again.ResultsAfter the training, the ATT group showed a significant improvement in reaction times regarding attentional disengagement compared to the sham ATT group. fMRI data showed decreased levels of activation in the anterior cingulate cortex (ACC) when comparing the ATT group to the sham ATT group during attentional disengagement post intervention. No ATT > sham ATT effects were found regarding selective auditory attention, working memory performance and inhibitory control.DiscussionThese findings putatively indicate that ATT facilitates faster attention allocation and increased attentional flexibility in healthy subjects. The fMRI results suggest this ATT-dependent improvement is accompanied by reduced ACC activity, indicating a more flexible attentional state.
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Affiliation(s)
- Niklas Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Christopher Sinke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hanover, Germany
| | - Özlem Kayali
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Svenja Krug
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Erik Leichter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Stephanie Peschel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Torben Müller
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alev Burak
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Tillmann H. C. Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hanover, Germany
- Center for Systems Neuroscience, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- *Correspondence: Ivo Heitland,
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Mokhtari S, Mokhtari A, Bakizadeh F, Moradi A, Shalbafan M. Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with Major Depressive Disorder: a systematic review and meta-analysis of randomized controlled clinical trials. BMC Psychiatry 2023; 23:77. [PMID: 36707847 PMCID: PMC9883940 DOI: 10.1186/s12888-023-04554-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Nearly 40% of patients with Major Depressive Disorder (MDD) have been found to experience cognitive impairment in at least one domain. Cognitive impairment associated with MDD is disproportionately represented in patients that have not fully returned to psychosocial functioning. As awareness regarding cognitive dysfunction in MDD patients grows, so does the interest in developing newer treatments that specifically address these deficits. METHOD In the present study, we conduct a systematic review of controlled randomized clinical trials that used cognitive training and remediation interventions for improving cognitive functions and reducing symptom severity in adult patients with MDD. We selected studies published before March 2022 using search databases including PubMed, ScienceDirect, Scopus, and Google scholar. For conducting the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated. RESULTS The database search resulted in identifying 756 studies of interest, which ultimately 15 studies with 410 participants in the cognitive rehabilitation group and 339 participants in the control group were included. The meta-analysis of the data extracted from these studies, shows a moderate and significant effect on the executive function (d = 0.59 (95% CI, 0.25 to 0.93) p-value = 0.001, I2 = 15.2%), verbal learning (d = 0.45 (95% CI, 0.12 to 0.78) p-value = 0.007, I2 = 0.00%), and working memory (d = 0.41 (95% CI, 0.18 to 0.64) p-value < 0.001, I2 = 33%) of MDD patients. Although, there were no significant difference between intervention and control group in attention (d = 0.32 (95% CI, -0.01 to 0.66) p-value = 0.058, I2 = 0.00%) or depressive symptoms. CONCLUSION This systematic review and meta-analysis indicate that cognitive rehabilitation is an effective intervention for the executive function, verbal learning, and working memory of MDD patients. Due to the importance of these neuropsychological deficits in day-to-day life and the core symptoms of MDD, cognitive rehabilitation should be considered an important part of treating MDD. Further research in this area and concentrated on these particular deficits is warranted.
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Affiliation(s)
- Saba Mokhtari
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asieh Mokhtari
- School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Bakizadeh
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Alireza Moradi
- Department of Clinical Psychology, Kharrazmi University, Tehran, Iran
- Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran.
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14
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Aksu S, Hasırcı Bayır BR, Sayman C, Soyata AZ, Boz G, Karamürsel S. Working memory ımprovement after transcranial direct current stimulation paired with working memory training ın diabetic peripheral neuropathy. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-14. [PMID: 36630270 DOI: 10.1080/23279095.2022.2164717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Association of cognitive deficits and diabetic peripheral neuropathy (DPN) is frequent. Working memory (WM) deficits result in impairment of daily activities, diminished functionality, and treatment compliance. Mounting evidence suggests that transcranial Direct Current Stimulation (tDCS) with concurrent working memory training (WMT) ameliorates cognitive deficits. Emboldening results of tDCS were shown in DPN. The study aimed to evaluate the efficacy of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) coupled with cathodal right DLPFC with concurrent WMT in DPN for the first time. The present randomized triple-blind parallel-group sham-controlled study evaluated the efficacy of 5 sessions of tDCS over the DLPFC concurrent with WMT in 28 individuals with painful DPN on cognitive (primary) and pain-related, psychiatric outcome measures before, immediately after, and 1-month after treatment protocol. tDCS enhanced the efficacy of WMT on working memory and yielded lower anxiety levels than sham tDCS but efficacy was not superior to sham on other cognitive domains, pain severity, quality of life, and depression. tDCS with concurrent WMT enhanced WM and ameliorated anxiety in DPN without affecting other cognitive and pain-related outcomes. Further research scrutinizing the short/long-term efficacy with larger samples is accredited.
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Affiliation(s)
- Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Türkiye
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Buse Rahime Hasırcı Bayır
- Department of Neurology, Health Sciences University, Haydarpaşa Numune Education and Research Hospital, Istanbul, Türkiye
| | - Ceyhun Sayman
- Translational Neurodevelopmental Neuroscience Phd Programme, Institute of Health Science, Istanbul University, Istanbul, Türkiye
| | - Ahmet Zihni Soyata
- Psychiatry Outpatient Clinic, Başakşehir State Hospital, İstanbul, Turkey
| | - Gökalp Boz
- Department of Psychology, Istanbul University, Istanbul, Türkiye
| | - Sacit Karamürsel
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Department of Physiology, School of Medicine, Koc University, Istanbul, Türkiye
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Fink M, Pasche S, Schmidt K, Tewes M, Schuler M, Mülley BW, Schadendorf D, Scherbaum N, Kowalski A, Skoda EM, Teufel M. Neurofeedback Treatment Affects Affective Symptoms, But Not Perceived Cognitive Impairment in Cancer Patients: Results of an Explorative Randomized Controlled Trial. Integr Cancer Ther 2023; 22:15347354221149950. [PMID: 36691908 PMCID: PMC9893099 DOI: 10.1177/15347354221149950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 11/06/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND EEG biofeedback (NF) is an established therapy to enable individuals to influence their own cognitive-emotional state by addressing changes in brainwaves. Psycho-oncological approaches of NF in cancer patients are rare and effects are hardly studied. OBJECTIVE The aim of this explorative, randomized controlled trial was to test the effectiveness of an alpha and theta NF training protocol, compared to mindfulness based therapy as an established psycho-oncological treatment. METHODS Of initially 62 screened patients, 56 were included (inclusion criteria were cancer independent of tumor stage, age >18 years, German speaking; exclusion criteria suicidal ideation, brain tumor). Randomization and stratification (tumor stage) was conducted by a computer system. Participants got 10 sessions over 5 weeks, in (a) an NF intervention (n = 21; 13 female, 8 male; MAge = 52.95(10 519); range = 31 to 73 years)) or (b) a mindfulness group therapy as control condition (CG; n = 21; ie, 15 female, 6 male; MAge = 50.33(8708); range = 32 to 67 years)). Outcome parameters included self-reported cognitive impairment (PCI) as primary outcome, and secondary outcomes of emotional distress (DT, PHQ-8, GAD-7), fatigue (MFI-20), rumination (RSQ), quality of life (QoL, EORTC-30 QoL), self-efficacy (GSE), and changes in EEG alpha, and theta-beta band performance in the NF condition. RESULTS No changes in cognitive impairment were found (P = .079), neither in NF nor CG. High affective distress was evident, with 70.7% showing elevated distress and 34.1% showing severe depressive symptoms. Affective symptoms of distress (P ≤ .01), depression (P ≤ .05) and generalized anxiety (P ≤ .05) decreased significantly over time. No differences between NF and CG were found. There was a significant increase of the alpha band (P ≤ .05; N = 15) over the NF sessions. Self-efficacy predicted QoL increase in NF with P ≤ .001 and an explained variance of 48.2%. CONCLUSION This is the first study to investigate NF technique with regard to basic mechanisms of effectiveness in a sample of cancer patients, compared to an established psycho-oncological intervention in this field. Though there were no changes in cognitive impairment, present data show that NF improves affective symptoms comparably to mindfulness-based therapy and even more pronounced in QoL and self-efficacy.Trial registration: ID: DRKS00015773.
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Affiliation(s)
| | | | | | - Mitra Tewes
- University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- University of Duisburg-Essen, Essen, Germany
- Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Bernhard W. Mülley
- University of Duisburg-Essen, Essen, Germany
- University of Wuppertal, Wuppertal, Germany
| | - Dirk Schadendorf
- University of Duisburg-Essen, Essen, Germany
- University Hospital Essen, Essen, Germany
| | | | - Axel Kowalski
- NeuroFit GmbH, Krefeld, Germany
- IB University of Applied Health and Social Sciences, Berlin, Germany
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16
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Kong Z, Zhu X, Chang S, Bao Y, Ma Y, Yu W, Zhu R, Sun Q, Sun W, Deng J, Sun H. Somatic symptoms mediate the association between subclinical anxiety and depressive symptoms and its neuroimaging mechanisms. BMC Psychiatry 2022; 22:835. [PMID: 36581819 PMCID: PMC9798660 DOI: 10.1186/s12888-022-04488-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Subclinical anxiety, depressive and somatic symptoms appear closely related. However, it remains unclear whether somatic symptoms mediate the association between subclinical anxiety and depressive symptoms and what the underlying neuroimaging mechanisms are for the mediating effect. METHODS Data of healthy participants (n = 466) and participants in remission of major depressive disorder (n = 53) were obtained from the Human Connectome Project. The Achenbach Adult Self-Report was adopted to assess anxiety, depressive and somatic symptoms. All participants completed four runs of resting-state functional magnetic resonance imaging. Mediation analyses were utilized to explore the interactions among these symptoms and their neuroimaging mechanisms. RESULTS Somatic symptoms partially mediated the association between subclinical anxiety and depressive symptoms in healthy participants (anxiety→somatic→depression: effect: 0.2785, Boot 95% CI: 0.0958-0.3729; depression→somatic→anxiety: effect: 0.0753, Boot 95% CI: 0.0232-0.1314) and participants in remission of MDD (anxiety→somatic→depression: effect: 0.2948, Boot 95% CI: 0.0357-0.7382; depression→somatic→anxiety: effect: 0.0984, Boot 95% CI: 0.0007-0.2438). Resting-state functional connectivity (FC) between the right medial superior frontal gyrus and the left thalamus and somatic symptoms as chain mediators partially mediated the effect of subclinical depressive symptoms on subclinical anxiety symptoms in healthy participants (effect: 0.0020, Boot 95% CI: 0.0003-0.0043). The mean strength of common FCs of subclinical depressive and somatic symptoms, somatic symptoms, and the mean strength of common FCs of subclinical anxiety and somatic symptoms as chain mediators partially mediated the effect of subclinical depressive symptoms on subclinical anxiety symptoms in remission of MDD (effect: 0.0437, Boot 95% CI: 0.0024-0.1190). These common FCs mainly involved the insula, precentral gyri, postcentral gyri and cingulate gyri. Furthermore, FC between the triangular part of the left inferior frontal gyrus and the left postcentral gyrus was positively associated with subclinical anxiety, depressive and somatic symptoms in remission of MDD (FDR-corrected p < 0.01). CONCLUSIONS Somatic symptoms partially mediate the interaction between subclinical anxiety and depressive symptoms. FCs involving the right medial superior frontal gyrus, left thalamus, triangular part of left inferior frontal gyrus, bilateral insula, precentral gyri, postcentral gyri and cingulate gyri maybe underlie the mediating effect of somatic symptoms.
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Affiliation(s)
- Zhifei Kong
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Ximei Zhu
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Suhua Chang
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Yanping Bao
- grid.11135.370000 0001 2256 9319National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319School of Public Health, Peking University, Beijing, 100191 China
| | - Yundong Ma
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Wenwen Yu
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Ran Zhu
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Qiqing Sun
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Wei Sun
- grid.459847.30000 0004 1798 0615Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Jiahui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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Hoorelbeke K, Vander Zwalmen Y, Hagen BI, Stubberud J, Koster EHW. Connecting residual depressive symptoms to self-reported executive functioning: A network analytical approach. J Psychiatr Res 2022; 155:75-84. [PMID: 35995017 DOI: 10.1016/j.jpsychires.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/05/2022] [Accepted: 08/05/2022] [Indexed: 10/31/2022]
Abstract
Persisting executive functioning (EF) impairments following remission from depression form an important source of disability in daily life. However, little is known regarding how specific aspects of EF relate to residual depressive symptomatology. Using network analysis, the current study investigates unique associations between cognitive-, affective-, and somatic depressive symptoms (Beck Depression Inventory 2nd edition, BDI-II) and self-reported EF (Behavior Rating Inventory of Executive Function - Adult version, BRIEF-A) in a sample of 161 remitted depressed individuals. We identified three clusters of closely connected nodes, corresponding with the Metacognition- and Behavioral Regulation Index of the BRIEF-A, and one cluster consisting of cognitive, affective-, and somatic depressive symptomatology. Among the clusters consisting of EF domains, working memory and shifting difficulties emerged as bridging nodes. Depressive cognition most strongly connected the cluster of depressive symptoms with the EF clusters. Depressive symptom dimensions demonstrated both shared and unique associations with EF domains. Each depressive symptom dimension was directly related to emotional control impairments. In addition, multiple associations were observed between depressive symptomatology and complaints at the level of working memory, shifting, and planning/organizing. Depressive affect was uniquely related to difficulties initiating activity. The current findings provide insights into the relationship between perceived difficulties in EF and residual depressive symptomatology. EF domains were differentially related to depressive symptom dimensions, suggesting the need for further research into the role of EF following remission from depression.
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Affiliation(s)
- Kristof Hoorelbeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Yannick Vander Zwalmen
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Bjørn Ingulfsvann Hagen
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Social Education, Faculty of Health Sciences, UiT - the Arctic University of Norway, Harstad, Norway
| | - Jan Stubberud
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Ernst H W Koster
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Weller S, Schroeder PA, Plewnia C. Gamification improves antidepressant effects of cognitive control training-A pilot trial. Front Digit Health 2022; 4:994484. [PMID: 36339520 PMCID: PMC9635856 DOI: 10.3389/fdgth.2022.994484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Computerised cognitive trainings have been put forward to improve control over negatively biased information processing and associated depressive symptomatology. Yet, disease-related impairments of motivation and endurance, as well as insufficient accessibility hinder use of this promising therapeutic opportunity. Here, we developed an app (de:)press© ) that utilizes a cognitive control training (paced auditory serial addition task) enriched with gamification and information elements. We compared a six-week training with de:)press© to a non-gamified version (active control group). METHODS Thirty-two depressed participants were included. Each received either de:)press© or the non-gamified version and was instructed to train three times per week for two weeks. Afterwards (four weeks) they were free to train at their own discretion. Depression severity was assessed during training and two follow-up sessions. Primary endpoint was defined as difference between groups [change of Montgomery-Åsberg Depression Rating Scale (MADRS)] four weeks after end of training. RESULTS Depression severity decreased in both groups. At primary endpoint, MADRS scores were significantly lower in the de:)press© -group compared to the control group. No differences were observed at three months' follow-up. Intervention usability was consistently rated positively. Participants who had trained with de:)press© maintained the recommended training frequency without further prompting. Besides transient fatigue or frustration, no adverse effects were observed. CONCLUSION This pilot demonstrates that gamification and information elements can substantially increase cognitive control training efficacy in alleviating depressive symptoms. Moreover, it provides first evidence for the feasibility and efficacy of de:)press© as an add-on intervention to treat depression. CLINICAL TRIAL REGISTRATION The study is registered under ClinicalTrials.gov, identifier: NCT04400162.
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Affiliation(s)
- Simone Weller
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Tuebingen, Germany
| | | | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Tuebingen, Germany,Correspondence: Christian Plewnia
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Schweizer S, Auer T, Hitchcock C, Lee-Carbon L, Rodrigues E, Dalgleish T. Affective Control Training (AffeCT) reduces negative affect in depressed individuals. J Affect Disord 2022; 313:167-176. [PMID: 35792299 DOI: 10.1016/j.jad.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Depression is the leading cause of disability worldwide, with prevalence rates rising. Despite the scale of the problem, available pharmacological and psychological interventions only have limited efficacy. The National Institute of Health's Science of Behaviour Change framework proposes to address this issue by capitalising on insights from basic science to identify mechanisms that can be targeted by novel interventions. The current study evaluated the potential of a computerized programme aimed at improving affective control, a mechanistic target involved in both risk and maintenance of depression. In a first phase the cognitive profiles of 48 depressed individuals (mean age: 39 years, 75 % female) were compared to cognitive functioning in 16 never-depressed individuals (mean age: 31 years, 56 % female). The sole index of functioning that differed between diagnostic groups was reaction time across negative and positively valanced trials on an affective Stroop task (d = 0.58). This index was then used to evaluate an affective control training (AffeCT) against a placebo training. Results showed no significant changes on tasks that showed no differences with never-depressed individuals in Phase I. However, compared to placebo training, AffeCT led to significantly greater improvement in the target index, affective Stroop performance (d = 1.17). Importantly, AffeCT led to greater reductions in negative affect as measured by the Positive Affect and Negative Affect Schedule compared to the placebo training (d = 0.98). This proof-of-concept study shows promising benefits of AffeCT on depressed individuals' affect, but not depressive symptoms. It further supports the utility of the Science of Behaviour Change framework, highlighting the need for determining meaningful assays of target mechanisms when evaluating novel interventions.
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Affiliation(s)
- Susanne Schweizer
- University of Cambridge, Department of Psychology, Cambridge, UK; University of New South Wales, School of Psychology, Sydney, Australia.
| | - Tibor Auer
- University of Surrey, School of Psychology, Guildford, UK
| | - Caitlin Hitchcock
- University of Cambridge, Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK; University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Australia
| | - Leonie Lee-Carbon
- University of Cambridge, Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Evangeline Rodrigues
- University of Cambridge, Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Tim Dalgleish
- University of Cambridge, Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Draheim C, Pak R, Draheim AA, Engle RW. The role of attention control in complex real-world tasks. Psychon Bull Rev 2022; 29:1143-1197. [PMID: 35167106 PMCID: PMC8853083 DOI: 10.3758/s13423-021-02052-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/15/2022]
Abstract
Working memory capacity is an important psychological construct, and many real-world phenomena are strongly associated with individual differences in working memory functioning. Although working memory and attention are intertwined, several studies have recently shown that individual differences in the general ability to control attention is more strongly predictive of human behavior than working memory capacity. In this review, we argue that researchers would therefore generally be better suited to studying the role of attention control rather than memory-based abilities in explaining real-world behavior and performance in humans. The review begins with a discussion of relevant literature on the nature and measurement of both working memory capacity and attention control, including recent developments in the study of individual differences of attention control. We then selectively review existing literature on the role of both working memory and attention in various applied settings and explain, in each case, why a switch in emphasis to attention control is warranted. Topics covered include psychological testing, cognitive training, education, sports, police decision-making, human factors, and disorders within clinical psychology. The review concludes with general recommendations and best practices for researchers interested in conducting studies of individual differences in attention control.
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Affiliation(s)
- Christopher Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA.
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Richard Pak
- Department of Psychology, Clemson University, Clemson, SC, USA
| | - Amanda A Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA
| | - Randall W Engle
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
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21
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Coetzer R, Ramos SDS. A neurobehavioral therapy approach to the rehabilitation and support of persons with brain injury: Practice-based evidence from a UK charitable rehabilitation provider. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:902702. [PMID: 36188937 PMCID: PMC9397663 DOI: 10.3389/fresc.2022.902702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022]
Abstract
BackgroundThe treatment and rehabilitation for people with acquired brain injury is continually evolving, with increasing recognition of the importance of approaches that adopt a multi-disciplinary biopsychosocial perspective focused on improving adjustment, social participation, and wellbeing. However, there is significant variability as to how such approaches are delivered, across the various stages of recovery, rehabilitation settings, and within different healthcare systems.ObjectiveThis paper had three aims. The first was to describe the neurobehavioral therapy (NBT) approach to brain injury rehabilitation adopted in our charitable organization. The second aim was to report how the NBT approach evolved in response to changes in referral patterns, and patient needs within a broader, longer-term clinical pathway. The third aim was to assess the effectiveness of the NBT approach by analyzing outcome data.MethodsRetrospective analyses of standardized outcome data were completed to investigate the effectiveness of our approach. Case vignettes are provided to illustrate the key components of the approach.ResultsOutcome data suggested that the approach is effective in delivering positive outcomes for patients. Furthermore, the data show differences in presentation between three clinical streams (restoration, compensation, and scaffolding) within the NBT approach.ConclusionsThis paper describes the adaption of the ‘traditional' neurobehavioral approach to brain injury rehabilitation into a model of delivery that can benefit a more diverse range of people living with the heterogenous and long-term consequences of brain injury.
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Affiliation(s)
- Rudi Coetzer
- Clinical Department, The Disabilities Trust, Wakefield, United Kingdom
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
- Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom
- *Correspondence: Rudi Coetzer ;
| | - Sara da Silva Ramos
- Clinical Department, The Disabilities Trust, Wakefield, United Kingdom
- Faculty of Health and Medical Science, University of Surrey, Guildford, United Kingdom
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22
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Vander Zwalmen Y, Hoorelbeke K, Liebaert E, Nève de Mévergnies C, Koster EHW. Cognitive remediation for depression vulnerability: Current challenges and new directions. Front Psychol 2022; 13:903446. [PMID: 35936259 PMCID: PMC9352853 DOI: 10.3389/fpsyg.2022.903446] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
It is increasingly acknowledged that cognitive impairment can play an important role in depression vulnerability. Therefore, cognitive remediation strategies, and cognitive control training (CCT) procedures have gained attention in recent years as possible interventions for depression. Recent studies suggest a small to medium effect on indicators of depression vulnerability. Despite initial evidence for the efficacy and effectiveness of CCT, several central questions remain. In this paper we consider the key challenges for the clinical implementation of CCT, including exploration of (1) potential working mechanisms and related to this, moderators of training effects, (2) necessary conditions under which CCT could be optimally administered, such as dose requirements and training schedules, and (3) how CCT could interact with or augment existing treatments of depression. Revisiting the CCT literature, we also reflect upon the possibilities to evolve toward a stratified medicine approach, in which individual differences could be taken into account and used to optimize prevention of depression.
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Affiliation(s)
- Yannick Vander Zwalmen
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- *Correspondence: Yannick Vander Zwalmen,
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eveline Liebaert
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
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23
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Rogiers R, Baeken C, Watkins ER, van den Abbeele D, Remue J, de Raedt R, Lemmens GMD. A Psychoeducational CBT-based Group Intervention ("Drop It") for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes. Int J Group Psychother 2022; 72:257-292. [PMID: 38446560 DOI: 10.1080/00207284.2022.2066535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive negative thinking (RNT)-such as worry and rumination-is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled "Drop It" that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT.
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24
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Keefe RSE, Cañadas E, Farlow D, Etkin A. Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults. Am J Psychiatry 2022; 179:482-489. [PMID: 35410496 DOI: 10.1176/appi.ajp.21020125] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated AKL-T03, an investigational digital intervention delivered through a video game-based interface, designed to target the fronto-parietal network to enhance functional domains for attentional control. AKL-T03 was tested in adult patients with major depressive disorder and a demonstrated cognitive impairment at baseline. METHODS Adults ages 25-55 years on a stable antidepressant medication regimen with residual mild to moderate depression and an objective impairment in cognition (as measured using the symbol coding test) were enrolled in a double-blind randomized controlled study. Participants were randomized either to AKL-T03 or to an expectation-matched digital control intervention. Participants were assessed at baseline and after completion of their 6-week at-home intervention. The primary outcome measure was improvement in sustained attention, as measured by the Test of Variables of Attention (TOVA). RESULTS AKL-T03 (N=37) showed a statistically significant medium-effect-size improvement in sustained attention compared with the control intervention on the TOVA primary outcome (N=37) (partial eta-squared=0.11). Additionally, a composite score derived from all cognitive measures demonstrated significant improvement with AKL-T03 over the control intervention. Individual secondary and exploratory endpoints did not demonstrate statistically significant between-group differences. No serious adverse events were reported, and two patients (5.5%) in the AKL-T03 group reported an intervention-related adverse event (headache). CONCLUSIONS Treatment with AKL-T03 resulted in significant improvement in sustained attention, as well as in cognitive functioning as a whole, compared with a control intervention. AKL-T03 is a safe digital intervention that is effective in the treatment of cognitive impairment associated with major depression. Further research will be needed to understand the clinical consequences of this treatment-induced change.
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Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Elena Cañadas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Deborah Farlow
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
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25
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Crum J, Ronca F, Herbert G, Funk S, Carmona E, Hakim U, Jones I, Hamer M, Hirsch J, Hamilton A, Tachtsidis I, Burgess PW. Decreased Exercise-Induced Changes in Prefrontal Cortex Hemodynamics Are Associated With Depressive Symptoms. FRONTIERS IN NEUROERGONOMICS 2022; 3:806485. [PMID: 38235451 PMCID: PMC10790946 DOI: 10.3389/fnrgo.2022.806485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/27/2022] [Indexed: 01/19/2024]
Abstract
People with a depressed mood tend to perform poorly on executive function tasks, which require much of the prefrontal cortex (PFC), an area of the brain which has also been shown to be hypo-active in this population. Recent research has suggested that these aspects of cognition might be improved through physical activity and cognitive training. However, whether the acute effects of exercise on PFC activation during executive function tasks vary with depressive symptoms remains unclear. To investigate these effects, 106 participants were given a cardiopulmonary exercise test (CPET) and were administered a set of executive function tests directly before and after the CPET assessment. The composite effects of exercise on the PFC (all experimental blocks) showed bilateral activation changes in dorsolateral (BA46/9) and ventrolateral (BA44/45) PFC, with the greatest changes occurring in rostral PFC (BA10). The effects observed in right ventrolateral PFC varied depending on level of depressive symptoms (13% variance explained); the changes in activation were less for higher levels. There was also a positive relationship between CPET scores (VO2peak) and right rostral PFC, in that greater activation changes in right BA10 were predictive of higher levels of aerobic fitness (9% variance explained). Since acute exercise ipsilaterally affected this PFC subregion and the inferior frontal gyrus during executive function tasks, this suggests physical activity might benefit the executive functions these subregions support. And because physical fitness and depressive symptoms explained some degree of cerebral upregulation to these subregions, physical activity might more specifically facilitate the engagement of executive functions that are typically associated with hypoactivation in depressed populations. Future research might investigate this possibility in clinical populations, particularly the neural effects of physical activity used in combination with mental health interventions.
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Affiliation(s)
- James Crum
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Flaminia Ronca
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - George Herbert
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Sabina Funk
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Estela Carmona
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Uzair Hakim
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Isla Jones
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Mark Hamer
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Joy Hirsch
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
- Department of Comparative Medicine, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
- Department of Neuroscience, School of Medicine, Yale University, New Haven, CT, United States
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Paul W. Burgess
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
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26
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Nishimura H, Hasegawa A, Nishiguchi Y, Tabuchi R, Matsumoto N, Masuyama A, Oi H, Fukui H, Oikawa M, Tanno Y, Mochizuki S. Relationship between trait rumination and imbalanced working memory: Analysis at the latent variable and individual task levels. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00804-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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27
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Edwards EJ, Zec D, Campbell M, Hoorelbeke K, Koster EHW, Derakshan N, Wynne J. Cognitive control training for children with anxiety and depression: A systematic review. J Affect Disord 2022; 300:158-171. [PMID: 34983006 DOI: 10.1016/j.jad.2021.12.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.
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Affiliation(s)
| | - Dajana Zec
- School of Education, The University of Queensland, QLD 4072, Australia
| | - Marilyn Campbell
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Nazanin Derakshan
- Department of Psychological Science, Birkbeck University College of London, United Kingdom
| | - Jeffrey Wynne
- School of Education, The University of Queensland, QLD 4072, Australia
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28
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Hoorelbeke K, Vervaeke J, Siegle GJ, Baeken C, Koster EH. Individual differences associated with treatment adherence and transfer effects following gamified web-based cognitive control training for repetitive negative thinking. Internet Interv 2022; 27:100507. [PMID: 35242588 PMCID: PMC8859013 DOI: 10.1016/j.invent.2022.100507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Recent research suggests beneficial effects of cognitive control training (CCT) on repetitive negative thinking (RNT), a key risk factor for internalizing symptomatology. However, relatively little is known regarding predictors of adherence to internet-delivered CCT as well as moderators of treatment effects for this intervention. Answering these questions could improve efficiency of clinical implementation of CCT as an eHealth intervention. The current pre-registered single-arm trial set-out to address these questions using a web-based gamified CCT procedure based on the adaptive Paced Auditory Serial Addition Task. Participants (N = 382) entered the internet-based study, where we observed considerable drop-out during the assessment phase and the first training sessions. Emotional stability and resilience emerged as predictors for deciding not to commence the intervention. Drop-out throughout the course of CCT was explained by age, emotion regulation-, and personality factors. We used latent profile analysis, a probabilistic modeling approach, to identify clusters of participants (User Profiles) based on indicators of baseline cognitive- and emotional functioning, training progress, and user experience. We obtained three User Profiles, reflecting low-, moderate-, and high-risk status. Effortful control, emotion regulation, internalizing symptomatology, resilience, and emotional stability played a central role in these User Profiles. Interestingly, User Profile predicted training related cognitive gains, as well as effects of CCT on anxiety- and stress symptoms, and reappraisal. Our findings suggest that CCT is most effective for the moderate- and high-risk groups. In addition, the high-risk group would likely benefit from a more intensive training procedure or repeated administration of the training procedure over time to foster long-term retention of training related gains.
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Affiliation(s)
- Kristof Hoorelbeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Corresponding author at: Henri-Dunantlaan 2, 9000 Ghent, Belgium.
| | - Jasmien Vervaeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Imec-Mict-Ghent University, Ghent, Belgium
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chris Baeken
- Department of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium,Department of Psychiatry (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Ernst H.W. Koster
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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29
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Meuleman B, Vrijsen JN, Vanderhasselt MA, Koster EHW, Oostelbos P, Naarding P, Bolier L, Tendolkar I, Smit F, Spijker J, Becker ES. A randomized controlled trial of cognitive control training (CCT) as an add-on treatment for late-life depression: a study protocol. BMC Psychiatry 2021; 21:596. [PMID: 34837976 PMCID: PMC8626726 DOI: 10.1186/s12888-021-03597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Already a major health concern, late-life depression (LLD) is expected to form an increasing problem in the aging population. Moreover, despite current treatments, LLD is associated with a poor long-term prognosis and high rate of chronicity. Treatment provision and treatment accordingly warrant improvement, where add-on treatments might contribute to the efficacy of conventional therapies. Although it is known that impaired cognitive control contributes to LDD, it is not targeted sufficiently by current interventions. Research on cognitive control training (CCT) shows promising results on depressive symptoms, cognitive performance, and overall functioning. However, further research is needed to determine the long-term effects of CCT on LLD, its cost-effectiveness, and mechanisms of change. METHODS In the current multicenter randomized controlled trial (RCT) with a between-subjects design participants aged 60 years and over with a current LLD receiving treatment as usual (TAU) are randomized to add-on CCT or placebo training. Randomization is stratified by depression severity. Participants will receive eight online CCT or placebo sessions spread across four consecutive weeks. They will complete a post-training assessment after 1 month and three follow-up assessments scheduled three, six and 12 months after completing the training. We expect CCT and TAU to be more (cost-)effective in reducing depressive symptoms than placebo training and TAU. Additionally, we will be looking at secondary clinical, cognitive and global functioning outcomes and likely mechanisms of change (e.g., improved cognitive functioning, reduced rumination, and improved inhibition of negative stimuli). DISCUSSION The proposed RCT aims to contribute to the clinical and scientific knowledge on the long-term effects of CCT as an add-on treatment for LLD. Cost-effectiveness is particularly relevant considering the expected volume of the target demographic. The study will be a pragmatic trial with few inclusion restrictions, providing information on feasibility of web-based trainings in clinical settings. The outcomes are potentially generalizable to guidelines for treatment of LLD. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register (code: NL7639 ). Registered 3 april 2019.
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Affiliation(s)
- Bart Meuleman
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, the Netherlands.
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands.
| | - Janna N Vrijsen
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Peter Oostelbos
- Dutch Depression Association, Amersfoort, The Netherlands
- De Hartenboom, Randwijk, the Netherlands
| | - Paul Naarding
- GGNet Network for Mental Health Care, Zutphen, the Netherlands
| | - Linda Bolier
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
- Department of Epidemiology and Biostatistics, University Medical Centers Amsterdam, Location VUmc, Amsterdam, the Netherlands
- Department of Clinical Psychology, University Medical Centers Amsterdam, Location VUmc, Amsterdam, the Netherlands
| | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, the Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
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30
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Sommer A, Fallgatter AJ, Plewnia C. Investigating mechanisms of cognitive control training: neural signatures of PASAT performance in depressed patients. J Neural Transm (Vienna) 2021; 129:649-659. [PMID: 34812928 PMCID: PMC9188526 DOI: 10.1007/s00702-021-02444-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
Major depression disorder (MDD) is characterized by cognitive control (CC) dysfunctions associated with increased attention toward negative information. The paced auditory serial addition task (PASAT) has been used as a targeted training of CC and studies show promising effects on depressive symptoms. However, neural mechanisms underlying its efficacy are still unclear. Based on previous findings of feedback-locked event-related potentials in healthy subjects, we investigated neural signatures during PASAT performance in 46 depressed patients. We found significantly larger amplitudes after negative than positive feedback for the P300 and late positive potential (LPP). However, this difference was not significant for the feedback-related negativity (FRN). Moreover, no associations of valence-specific ERPs and PASAT performance nor depressive symptoms were found. This indicates that depressed patients seem unable to use neural activation in late feedback processing stages (P300, LPP) to adapt accordingly. Moreover, lack of valence-specific neural reaction in early feedback processing stages (FRN) might point toward emotional indifference in depressed patients.Trial registration number: NCT03518749 Date of registration: May 8, 2018.
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Affiliation(s)
- Anja Sommer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstraße 14, 72076, Tübingen, Germany.
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31
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Ben-Avraham R, Afek A, Berezin Cohen N, Davidov A, Van Vleet T, Jordan J, Ben Yehudah A, Gilboa Y, Nahum M. Feasibility and preliminary effectiveness of mobile cognitive control training during basic combat training in the military. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1969162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rina Ben-Avraham
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Anat Afek
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Noa Berezin Cohen
- Department of Health and Well-Being, Medical Corps, Israel Defense Forces (IDF), Israel
| | - Alex Davidov
- Medical Branch, Ground Forces, Israel Defense Forces (IDF), Israel
| | - Tom Van Vleet
- Department of Research and Development, Posit Science Corporation, San Francisco, California
| | - Josh Jordan
- Department of Psychology, Dominican University of California, San Rafael, California
| | - Ariel Ben Yehudah
- Department of Health and Well-Being, Medical Corps, Israel Defense Forces (IDF), Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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32
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Westermann K, Woud ML, Cwik JC, Graz C, Nyhuis PW, Margraf J, Blackwell SE. Feasibility of computerised positive mental imagery training as a treatment adjunct in in-patient mental health settings: randomised controlled trial. BJPsych Open 2021. [PMCID: PMC8596293 DOI: 10.1192/bjo.2021.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background
Positive affect and anhedonia are important but challenging targets for mental health treatments. Previous research indicates the potential of a computerised cognitive training paradigm involving generation of positive mental imagery, termed positive mental imagery training (PMIT), to increase positive affect and reduce anhedonia.
Aims
Our main aim was to investigate the feasibility of PMIT as a positive affect-focused, transdiagnostic adjunct to treatment as usual for patients in in-patient mental health settings.
Method
We ran an open feasibility, randomised controlled trial with three parallel arms: treatment as usual; treatment as usual plus PMIT; and treatment as usual plus an active comparator, cognitive control training. Fifty-seven patients from two different in-patient mental health treatment clinics in Germany were randomised in a 1:1:1 ratio. PMIT and cognitive control training comprised an introductory session followed by eight 15-min training sessions over 2 weeks. Clinical outcomes such as positive affect (primary outcome measure) and anhedonia were assessed at pre- and post-training, and at a further 2-week follow-up.
Results
Adherence was good and attrition was low. The patterns of results for the outcome data were not consistent with a specific effect of PMIT on positive affect, but were more consistent with a specific effect on anhedonia.
Conclusions
The results indicate feasibility and potential promise of a larger efficacy trial investigating PMIT as a treatment adjunct in in-patient mental health settings. Limitations include lack of researcher blinding, small sample size and lack of pre-specified feasibility outcomes. Anhedonia may be a more suitable primary outcome for a future larger trial.
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33
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Peckham AD, Sandler JP, Dattolico D, McHugh RK, Johnson DS, Björgvinsson T, Pizzagalli DA, Beard C. Cognitive control training for urgency: A pilot randomized controlled trial in an acute clinical sample. Behav Res Ther 2021; 146:103968. [PMID: 34562728 PMCID: PMC8555999 DOI: 10.1016/j.brat.2021.103968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Urgency - rash action in the context of strong emotion - is a facet of impulsivity closely related to many psychological disorders. Deficits in working memory and response inhibition are potential mechanisms underlying urgency, and a previous study showed that cognitive training targeting these domains is efficacious in reducing urgency. However, the feasibility and efficacy of this intervention has not yet been tested in a clinical sample or naturalistic treatment setting. To fill this gap, we conducted a pilot study of cognitive training for individuals reporting high levels of urgency in a partial hospitalization program. We evaluated this intervention in an open trial (n = 20), followed by a randomized controlled trial (n = 46) comparing cognitive training plus treatment as usual to treatment as usual. Results supported the feasibility and acceptability of cognitive training. Participants in the training group showed significant improvement on cognitive tasks, but groups did not differ in urgency. In pooled analyses combining the open trial and RCT, there was a significant reduction in distress intolerance in the training group only. Results indicate the potential benefit of cognitive training for distress intolerance, but do not support the use of cognitive training for urgency in acute clinical settings. The study conducted in the RCT phase of this manuscript is registered on ClinicalTrials.gov (NCT: NCT03527550). The full trial protocol is available on ClinicalTrials.gov.
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Affiliation(s)
- Andrew D Peckham
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Jenna P Sandler
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Brandeis University, 415 South Street, Waltham, MA, 02453, USA.
| | | | - R Kathryn McHugh
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | | | - Thröstur Björgvinsson
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Diego A Pizzagalli
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Courtney Beard
- McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
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Appel JE, Vrijsen JN, Marchetti I, Becker ES, Collard RM, van Eijndhoven P, Schene AH, Tendolkar I. The Role of Perseverative Cognition for Both Mental and Somatic Disorders in a Naturalistic Psychiatric Patient Sample. Psychosom Med 2021; 83:1058-1066. [PMID: 34419995 DOI: 10.1097/psy.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Perseverative cognition (PC) is the repeated or long-term activation of the cognitive representation of psychological stressors and is associated with prolonged stress including somatic and mental consequences. Hence, PC might represent a cognitive process linking mental and somatic pathology, but current research on this link is limited by investigating healthy samples, markers of somatic disease, and single disorders. The present study explored the importance of PC for different mental and somatic disorders in psychiatric patients. METHODS Data from 260 naturalistic psychiatric outpatients were used. Psychiatric diagnoses were based on structured clinical interviews. Somatic diseases were assessed using a well-validated questionnaire and were clustered into (cardio)vascular and immune/endocrine diseases. PC was operationalized using the Perseverative Thinking Questionnaire (PTQ). RESULTS Multiple regression complemented with relative importance analyses showed that the PTQ total and subscale scores were associated with the presence of mood disorders, addiction, and anxiety. Unexpectedly, no relatively important associations were found between the PTQ and autism spectrum disorder, attention-deficit/hyperactivity disorder, or somatic disease. CONCLUSIONS Our data complement previous work linking PC to stress-related mental disorders but question its immediate role in neurodevelopmental and somatic disorders. Targeting PC in the treatment of mood disorders and perhaps also in addiction seems promising.
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Affiliation(s)
- Judith E Appel
- From the Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour (Appel, Vrijsen, Collard, van Eijndhoven, Schene, Tendolkar), Radboud University Medical Center; Behavioural Science Institute (Appel, Becker), Radboud University; Depression Expertise Centre (Vrijsen), Pro Persona Mental Health Care, Nijmegen, the Netherlands; Department of Life Sciences (Marchetti), Psychology Unit, University of Trieste, Trieste, Italy; and LVR-Klinikum Essen (Tendolkar), Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
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Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial. Behav Res Ther 2021; 147:103991. [PMID: 34740101 DOI: 10.1016/j.brat.2021.103991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 08/23/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. METHOD The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18-60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. RESULTS Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. CONCLUSIONS Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression.
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Peckham AD. Why Don't Cognitive Training Programs Transfer to Real Life?: Three Possible Explanations and Recommendations for Future Research. THE BEHAVIOR THERAPIST 2021; 44:357-360. [PMID: 35813267 PMCID: PMC9262342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Fergus TA, Weinzimmer SA, Schneider SC, Storch EA. Associations between self-absorption and working memory capacity: A preliminary examination of a transdiagnostic process spanning across emotional disorders. J Anxiety Disord 2021; 83:102457. [PMID: 34380084 PMCID: PMC8440467 DOI: 10.1016/j.janxdis.2021.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
Considered a transdiagnostic process spanning across emotional disorders, self-absorption reflects self-focused processing that is excessive, sustained, and inflexible. Working memory capacity is critical for self-regulation, inclusive of mitigating perseverative thinking. Providing the first known examination of associations between self-absorption and working memory capacity, a negative association was expected. A sample of adults (N = 63; 70 % experiencing an anxiety or depressive disorder) completed the study protocol, which included completing a structured diagnostic interview, self-report measures, and a working memory capacity task. Self-absorption, as predicted, negatively correlated with working memory capacity, with an association found for the private, but not public, aspect of self-absorption. The association between private self-absorption and working memory capacity was not attributable to shared variance with public self-absorption or negative affectivity. Diagnostic status (anxiety disorder, depressive disorder, or either disorder) did not moderate the association. The results provide evidence that self-absorption relates to impairments in working memory capacity. Implications and future directions for how these results advance our understanding and treatment efforts of self-absorption are discussed.
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Affiliation(s)
| | - Saira A. Weinzimmer
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Sophie C. Schneider
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Eric A. Storch
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences One Baylor Plaza MS:350, Houston, TX, 77030, USA
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Ferrari GRA, Vanderhasselt MA, Rinck M, Demeyer I, De Raedt R, Beisel S, Lindenmeyer J, Becker ES. A Cognitive Control Training as Add-On Treatment to Usual Care for Depressed Inpatients. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10197-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Strobel A, Farkas A, Hoyer J, Melicherova U, Köllner V, Strobel A. Cognitive Motivation as a Resource for Affective Adjustment and Mental Health. Front Psychol 2021; 12:581681. [PMID: 34621201 PMCID: PMC8490806 DOI: 10.3389/fpsyg.2021.581681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Depressive symptoms compromise cognitive and self-regulating capacities. Overcoming associated deficits (e.g., attentional bias) demands cognitive effort and motivation. Previous studies on healthy individuals have found cognitive motivation to positively relate to self-regulation and negatively to depressive symptoms. A test of these associations in a clinical sample is lacking. Methods: We assessed cognitive motivation, self-regulation and depressive symptoms by means of well-validated questionnaires in N = 1,060 psychosomatic rehabilitation in-patients before and after treatment. Data were split and analyzed in two steps: We tested previously reported cross-sectional and longitudinal associations of all variables as well as their longitudinal changes in a first sample. Afterward, findings and derived hypotheses were replicated and tested in a second sample. Results: Analyses of both samples confirmed earlier reports on positive associations between cognitive motivation and self-regulation, and negative associations of both with depressive symptoms. While the change in all variables was predicted by their baseline scores, higher baseline cognitive motivation was found to predict stronger improvements in self-regulation, and lower baseline depression scores to predict smaller changes in cognitive motivation and self-regulation. In addition, the change in cognitive motivation partially mediated the association between the changes in depressive symptoms and self-regulation. Conclusion: Based on a large longitudinal data set, the present study expands previous findings and suggests a resource allocation model in which decreasing depressive symptoms lead to a release of capacities benefitting self-regulation directly, and indirectly via cognitive motivation.
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Affiliation(s)
- Alexander Strobel
- Differential and Personality Psychology, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Aniko Farkas
- Division of Personality Psychology and Assessment, Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
| | - Jürgen Hoyer
- Behavioural Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Ursula Melicherova
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Anja Strobel
- Division of Personality Psychology and Assessment, Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
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Cladder-Micus M, Vrijsen JN, de Putter L, de Raedt R, Spijker J, Speckens AEM, Becker ES, Koster EHW. A multi-method assessment of attentional processes in chronic, treatment-resistant depression. J Psychiatr Res 2021; 140:68-76. [PMID: 34098388 DOI: 10.1016/j.jpsychires.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/26/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
Attentional deficits as well as attentional biases towards negative material are related to major depression and might maintain chronicity. However, studies investigating attentional deficits and attentional biases in chronic, treatment-resistant depressed are lacking. The aim of the current study was to compare measures of attentional deficits and attentional bias between chronic, treatment-resistant depressed outpatients and never-depressed control participants. Attentional deficits were assessed with the attentional control scale (ACS) and the Stroop Color naming task. Attentional bias was measured with the exogenous cueing task (ECT) and an emotional Stroop task. Chronic, treatment-resistant depressed patients (n = 80) showed significantly more attentional deficits than never-depressed controls (n = 113) on the ACS and Stroop color-naming task. However, in contrast with hypotheses, no differences were found between chronic, treatment-resistant depressed patients and never-depressed individuals on the ECT or emotional Stroop task. The current findings indicate that chronic, treatment-resistant depressed patients present attentional deficits. The results however question whether this patient group shows attentional biases for negative material. Future research should include comparisons of chronic, treatment-resistant and non-chronically depressed patients. If replicated, these current results might indicate that focusing on improving attentional deficits could be a more promising target for treatment than addressing attentional biases.
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Affiliation(s)
- Mira Cladder-Micus
- Depression Expertise Centre, Pro Persona Mental Health Care, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
| | - Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, the Netherlands; Department of Psychiatry, Radboud University Medical Center, the Netherlands
| | - Laura de Putter
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Rudi de Raedt
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Jan Spijker
- Depression Expertise Centre, Pro Persona Mental Health Care, the Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Center, the Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | - Ernst H W Koster
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
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Maier MJ, Schiel JE, Rosenbaum D, Hautzinger M, Fallgatter AJ, Ehlis AC. To Regulate or Not to Regulate: Emotion Regulation in Participants With Low and High Impulsivity. Front Behav Neurosci 2021; 15:645052. [PMID: 34393732 PMCID: PMC8363082 DOI: 10.3389/fnbeh.2021.645052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Successful emotion regulation plays a key role in psychological health and well-being. This study examines (1) whether cognitive control and corresponding neural connectivity are associated with emotion regulation and (2) to what extent external instructions can improve emotion regulation in individuals with low vs. high cognitive control capacity. For this, emotion regulation capabilities and the impact of emotion regulation on a subsequent emotional Stroop task was tested in participants with low (N = 25) vs. high impulsivity (N = 32). The classification according to impulsivity is based upon the stable correlation between high impulsivity and reduced cognitive control capacity. A negative emotion inducing movie scene was presented with the instruction to either suppress or allow all emotions that arose. This was followed by an emotional Stroop task. Electromyography (EMG) over the corrugator supercilii was used to assess the effects of emotion regulation. Neurophysiological mechanisms were measured using functional near-infrared spectroscopy over frontal brain areas. While EMG activation was low in the low-impulsive group independent of instruction, high-impulsive participants showed increased EMG activity when they were not explicitly instructed to suppress arising emotions. Given the same extent of functional connectivity within frontal lobe networks, the low-impulsive participants controlled their emotions better (less EMG activation) than the high-impulsive participants. In the Stroop task, the low-impulsive subjects performed significantly better. The emotion regulation condition had no significant effect on the results. We conclude that the cognitive control network is closely associated with emotion regulation capabilities. Individuals with high cognitive control show implicit capabilities for emotion regulation. Individuals with low cognitive control require external instructions (= explicit emotion regulation) to achieve similarly low expressions of emotionality. Implications for clinical applications aiming to improve emotion regulation are discussed.
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Affiliation(s)
- Moritz Julian Maier
- Center for Responsible Research and Innovation, Fraunhofer Institute for Industrial Engineering, Berlin, Germany
| | - Julian Elias Schiel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Martin Hautzinger
- Department of Psychology, Eberhard Karls University, Tübingen, Germany
| | - Andreas Jochen Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
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42
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Becker ES, Vanderhasselt MA, Koster EHW, Vrijsen JN. “Memories Warm You Up from the Inside. But They also Tear You Apart”: Editorial for the Special Issue on Memory Training for Emotional Disorders. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Emotional Memory: Concluding Remarks to the Special Issue on Memory Training for Emotional Disorders. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roberts H, Mostazir M, Moberly NJ, Watkins ER, Adlam AL. Working memory updating training reduces state repetitive negative thinking: Proof-of-concept for a novel cognitive control training. Behav Res Ther 2021; 142:103871. [PMID: 34004447 PMCID: PMC8214071 DOI: 10.1016/j.brat.2021.103871] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
Repetitive negative thinking (RNT) is a proximal risk factor implicated in the onset and maintenance of common mental health problems such as depression and anxiety. Adolescence may be a key developmental window in which to target RNT and prevent the emergence of such disorders. Impairments in updating the contents of working memory are hypothesised to causally contribute to RNT, and some theorists have suggested these difficulties may be specific to the manipulation of negative information. The present study compared the effects of computerised adaptive working memory updating training (in which the task becomes more difficult as performance improves) to a non-adaptive control task in reducing levels of RNT. 124 healthy young people were randomised to 20 sessions of (i) working memory updating training using neutral stimuli, (ii) working memory updating training using negative stimuli, or (iii) non-adaptive working memory updating training. Adaptive working memory updating training using neutral, but not negative, stimuli resulted in significant improvements to working memory updating for negative material, as assessed using an unpractised task, and significant reductions in susceptibility to state RNT. These findings demonstrate proof-of-concept that working memory updating training has the potential to reduce susceptibility to episodes of state RNT.
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Depression treatment by tDCS-enhanced cognitive control training: A test of two stimulation intensities. Brain Stimul 2021; 14:987-989. [PMID: 34147374 DOI: 10.1016/j.brs.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 01/11/2023] Open
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Shah RV, Grennan G, Zafar-Khan M, Alim F, Dey S, Ramanathan D, Mishra J. Personalized machine learning of depressed mood using wearables. Transl Psychiatry 2021; 11:338. [PMID: 34103481 PMCID: PMC8187630 DOI: 10.1038/s41398-021-01445-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
Depression is a multifaceted illness with large interindividual variability in clinical response to treatment. In the era of digital medicine and precision therapeutics, new personalized treatment approaches are warranted for depression. Here, we use a combination of longitudinal ecological momentary assessments of depression, neurocognitive sampling synchronized with electroencephalography, and lifestyle data from wearables to generate individualized predictions of depressed mood over a 1-month time period. This study, thus, develops a systematic pipeline for N-of-1 personalized modeling of depression using multiple modalities of data. In the models, we integrate seven types of supervised machine learning (ML) approaches for each individual, including ensemble learning and regression-based methods. All models were verified using fourfold nested cross-validation. The best-fit as benchmarked by the lowest mean absolute percentage error, was obtained by a different type of ML model for each individual, demonstrating that there is no one-size-fits-all strategy. The voting regressor, which is a composite strategy across ML models, was best performing on-average across subjects. However, the individually selected best-fit models still showed significantly less error than the voting regressor performance across subjects. For each individual's best-fit personalized model, we further extracted top-feature predictors using Shapley statistics. Shapley values revealed distinct feature determinants of depression over time for each person ranging from co-morbid anxiety, to physical exercise, diet, momentary stress and breathing performance, sleep times, and neurocognition. In future, these personalized features can serve as targets for a personalized ML-guided, multimodal treatment strategy for depression.
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Affiliation(s)
- Rutvik V Shah
- Department of Psychiatry, University of California, San Diego, CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA
| | - Gillian Grennan
- Department of Psychiatry, University of California, San Diego, CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA
| | - Mariam Zafar-Khan
- Department of Psychiatry, University of California, San Diego, CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA
| | - Fahad Alim
- Department of Psychiatry, University of California, San Diego, CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA
| | - Sujit Dey
- Mobile Systems Design Lab, Dept. of Electrical and Computer Engineering, University of California, San Diego, CA, USA
| | - Dhakshin Ramanathan
- Department of Psychiatry, University of California, San Diego, CA, USA
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA, USA
| | - Jyoti Mishra
- Department of Psychiatry, University of California, San Diego, CA, USA.
- Neural Engineering and Translation Labs, University of California, San Diego, CA, USA.
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Abstract
Depression is both prevalent and costly, and many individuals do not adequately respond to existing psychopharmacological and behavioral interventions. The current article describes the use of neuroscience in augmenting behavioral interventions for depression in two primary areas: anhedonia and cognitive deficits/biases. Neuroscience research has increased our understanding of the neural bases of reward processing and regulation of positive affect, and anhedonia among depressed samples can be related to deficits in each of these domains. Treatments that specifically target reward processing and regulation of positive affect in order to reduce anhedonia represent a recent advance in the field. Depression is also associated with aberrant processes relating to working memory, autobiographical memory, attentional bias, and interpretive bias. Neuroscience findings have increasingly been leveraged to augment the efficacy of cognitive-training and bias-modification interventions in these domains. The use of neuroscience to inform the development and augmentation of behavioral interventions for depression is a promising avenue of continued research.
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Vervaeke J, Hoorelbeke K, Baeken C, Koster EHW. Online Cognitive Control Training for Remitted Depressed Individuals: A Replication and Extension Study. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10238-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zareian B, Wilson J, LeMoult J. Cognitive Control and Ruminative Responses to Stress: Understanding the Different Facets of Cognitive Control. Front Psychol 2021; 12:660062. [PMID: 34025524 PMCID: PMC8138047 DOI: 10.3389/fpsyg.2021.660062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Rumination has been linked to the onset and course of depression. Theoretical models and empirical evidence suggest that deficits controlling negative material in working memory underlie rumination. However, we do not know which component of cognitive control (inhibition, shifting, or updating) contributes most to rumination, and whether different components predict the more maladaptive (brooding) versus the more adaptive (reflection) forms of rumination. We aimed to advance theory and research by examining the contribution of different facets of cognitive control to the level and trajectory of brooding and reflection. At baseline, participants completed three cognitive tasks that assessed their inhibition, shifting, and updating biases, respectively. Next, using experience sampling methodology, participants rated their level of rumination and negative affect nine times during the 48 h after their most stressful exam. At each time point, higher levels of brooding, but not reflection, predicted higher levels of negative affect at the next time point. Furthermore, several facets of shifting and inhibition, but not updating, predicted brooding immediately after the exam and its trajectory of change over 48 h. Additionally, difficulty inhibiting neutral words predicted both brooding and reflection. These findings inform theoretical models describing the role of cognitive control in brooding and reflection.
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Affiliation(s)
- Bita Zareian
- Depression, Anxiety and Stress Lab, Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Jessica Wilson
- Depression, Anxiety and Stress Lab, Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Joelle LeMoult
- Depression, Anxiety and Stress Lab, Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
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[Towards a better recognition of cognitive disorders in internal medicine?]. Rev Med Interne 2021; 42:299-301. [PMID: 33867196 DOI: 10.1016/j.revmed.2021.03.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 01/09/2023]
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