Depressive realism: A meta-analytic review

Research Review: Why do prospective and retrospective measures of maltreatment differ? A narrative review

BACKGROUND

Childhood maltreatment contributes to a large mental health burden worldwide. Different measures of childhood maltreatment are not equivalent and may capture meaningful differences. In particular, prospective and retrospective measures of maltreatment identify different groups of individuals and are differentially associated with psychopathology. However, the reasons behind these discrepancies have not yet been comprehensively mapped.

METHODS

In this review, we draw on multi-disciplinary research and present an integrated framework to explain maltreatment measurement disagreement.

RESULTS

We identified three interrelated domains. First, methodological issues related to measurement and data collection methods. Second, the role of memory in influencing retrospective reports of maltreatment. Finally, the motivations individuals may have to disclose, withhold, or fabricate information about maltreatment.

CONCLUSIONS

A greater understanding of maltreatment measurement disagreement may point to new ways to conceptualise and assess maltreatment. Furthermore, it may help uncover mechanisms underlying maltreatment-related psychopathology and targets for novel interventions.

Risk estimation in relation to anxiety and depression for low probability negative events

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

Mild Cognitive Impairment, But Not HIV Status, is Related to Reduced Awareness of Level of Cognitive Performance Among Older Adults

OBJECTIVE

Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI).

METHODS

One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment.

RESULTS

We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant.

CONCLUSIONS

MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance.

Understanding the relationship between maternity care providers and middle-class Chinese migrant women in the Netherlands: A qualitative study

OBJECTIVE

This study aims to provide insights into the formation and the quality of the maternity care provider-woman relationship between midwives, maternity care assistants and middle-class Chinese migrant women in the Netherlands.

DESIGN

online in-depth interviews addressing interpersonal trust, women's autonomy in shared decision making and culturally sensitive care PARTICIPANTS: 46 middle-class Chinese migrant women, 13 midwives and 12 maternity care assistants in the Netherlands FINDINGS: Midwives and maternity care assistants reported challenges interpreting the needs of middle-class Chinese migrant women in care practices while Chinese migrant women experienced receiving insufficient emotional support. Midwives and maternity care assistant tended to attribute women's different preferences for care to culture which reinforced difficulties of addressing women's needs. Middle-class Chinese migrant women experienced a lack of responsive care, feelings of being overlooked, being uncomfortable to express different opinions and challenges in developing autonomy in the shared decision-making process.

CONCLUSIONS

A trusting relationship, effective communication with maternity care providers, and a culturally sensitive and safe environment could be beneficial for middle-class migrant mothers. Chinese migrant women held ambivalent attitudes towards both traditional Chinese health beliefs and Dutch maternity care values. Each individual woman adopted the practice of the "doing the month" tradition to a different extent. This indicated the need for maternity care providers to recognize women's various needs for more responsive and individualized care, especially for first-time migrant mothers to negotiate their ways through the new healthcare system.

IMPLICATIONS FOR PRACTICE

We suggest a more proactive role for maternity care providers addressing the individual's subjectivity and preferences. Our findings are relevant and applicable for maternity care professionals conducting shared decision making with middle-class and highly educated migrant women living in Western contexts.

Uncovering mnestic problems in help-seeking individuals reporting subjective cognitive complaints

In individuals with subjective cognitive impairments (SCI) the risk for the development of a neurodegenerative disease is assumed to be increased. However, it is not clear which factors contribute to the expression of SCI: Is it related to the cognitive resources already challenged, or is the psycho-affective state of more relevance? Using a novel online assessment combining self-report questionnaires and neuropsychological psychometric tests, significant predictors for the level of complaints were identified in two samples of elderly individuals: Help-seekers (HS, n = 48) consulting a memory clinic and a matched sample of non-help-seekers (nHS, n = 48). Based on the results of the online assessment, the SCI level was found to be significantly determined by the psycho-affective state (depressive mood) in the nHS group, whereas cognitive performance (cued recall) was the main predictor in the HS group. The predictive value of recall performance, however, is more-strongly expressed in memory tests which reduce the impact of compensatory strategies (face-name-association vs. word lists). Our results indicate that the problem-focused behavior of help-seeking individuals is also associated with a higher sensitivity for cognitive deficits-which can be uncovered with an appropriate psychometric test. Considering these factors, the conversion risk in individuals with SCI can probably be determined more reliably.

Affect Across the Wake-Sleep Cycle

Affective scientists traditionally have focused on periods of active wakefulness when people are responding to external stimuli or engaging in specific tasks. However, we live much of our lives immersed in experiences not related to the current environment or tasks at hand-mind-wandering (or daydreaming) during wakefulness and dreaming during sleep. Despite being disconnected from the immediate environment, our brains still generate affect during such periods. Yet, research on stimulus-independent affect has remained largely separate from affective science. Here, we suggest that one key future direction for affective science will be to expand our field of view by integrating the wealth of findings from research on mind-wandering, sleep, and dreaming to provide a more comprehensive account of affect across the wake-sleep cycle. In developing our argument, we address two key issues: affect variation across the wake-sleep cycle, and the benefits of expanding the study of affect across the full wake-sleep cycle. In considering these issues, we highlight the methodological and clinical implications for affective science.

Investigating the role of action-contingent expectancy biases in dysphoria-linked activity engagement behavioural choice

Reduced tendency to engage in potentially rewarding activities is a hallmark of depression. The present study investigated the role of future expectancy biases in depression-linked behavioural choice, in participants varying in self-reported depression symptoms (dysphoria). A novel laboratory paradigm was developed to test the hypotheses that the degree to which higher dysphoria is associated with reduced tendency to engage in a potentially rewarding activity is dependent on the presence of negative biases in the expected outcomes of activity engagement. Specifically, two types of expectancy biases were distinguished: a) the expected likelihood of a negative rather than positive outcome, and b) the expected emotional impact of either outcome. N = 176 undergraduate students with varied levels of dysphoria were given the opportunity to choose to engage in a coin-tossing game that could result in a win or loss monetary outcome in terms of charity donations, and then rated both types of expectancies. Results indicated that higher dysphoria was associated with more negative expectations concerning the likelihood of objective outcomes and the emotional impact of such outcomes, and as hypothesised, such negative expectancy biases mediated indirect associations between dysphoria and behavioural choice.

Empathic Accuracy and Shared Depressive Symptoms in Close Relationships

Empathic accuracy, the ability to accurately understand others' emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate others' emotional valence accurately over time: first, in a sample of 156 neurotypical married couples (Study 1; Total N=312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner's level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. Accurately detecting changes in others' emotional valence may underpin shared depressive symptoms.

Negative comments and social media: How cognitive biases relate to body image concerns

Body image concern (BIC) is a prevalent issue thought to be exacerbated by social media. In addition to sociocultural factors, cognitive biases may also contribute to BIC. We explore whether cognitive biases in memory for body image-related words, presented in a mock social-media context, are associated with BIC in young adult women. A sample of 150 University students was presented with a series of body image-related comments aimed at either themselves, a close friend, or a celebrity in a recognisable social media context. Afterwards, a surprise memory task was completed that assessed the participant's memory for body image-related words (item memory), their insight (metamemory), and to whom a specific word was directed (source memory). Self-referential biases were identified for both item memory and source memory. Individuals with greater BIC displayed a greater self-referential bias for correctly and incorrectly sourcing negative words to themselves compared with both friend and celebrity. A greater self-referential effect in metacognitive sensitivity was also associated with higher BIC. We provide novel evidence for a cognitive bias in sourcing negative body image-related information to the self in individuals with higher BIC. The results should inform cognitive remediation programmes aimed at treating individuals with body and eating-related disorders.

How the Cognitive Science of Belief Can Transform the Study of Mental Health

This Viewpoint highlights how new insights into belief acquisition, storage, and change can transform our understanding of psychiatric disorders.

Superiority and stigma in modern psychology and neuroscience

Bias in early psychological and neuroscientific research distorted conclusions about women and people of color. Unintentional biases persisting today in studies of older adults and people with stigmatized conditions may perpetuate stigma and hinder scientific discovery. We can combat these biases by changing how we analyze, interpret, and describe differences.

Depressive traits are associated with a reduced effect of choice on intentional binding

A sense of agency (SoA) over wilful actions is thought to be dependent on the level of choice and the nature of the outcome. In a preregistered study, we manipulated choice and valence of outcome to assess the relationship between SoA across the depression and psychosis continuum. Participants (N = 151) completed a Libet Clock task, in which they had either a free or forced choice to press one of two buttons and received either a rewarding or punishing outcome. Participants also completed questionnaires on depressive and psychosis-like traits. Rewarding outcomes increased intentional binding. The evidence favoured no effect of choice on average, but this was influenced by inter-individual differences. Individuals reporting more depressive traits had less of a difference in intentional binding between free and forced choice conditions. We show that implicit SoA is sensitive to outcome valence and the effect of choice differs across the depression continuum.

Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors

OBJECTIVE

Poor insight is a major problem in psychosis, being detrimental for treatment compliance and recovery. Previous studies have identified various correlates of insight impairment, mostly in chronic samples. The current study aimed to determine clinical, neurocognitive, metacognitive, and socio-cognitive predictors of insight in first-episode psychosis.

METHODS

Regression analyses of different insight dimensions were conducted in 190 patients with first-episode psychosis. Measures of clinical symptoms, neurocognition, metacognition, social cognition, and 'jumping to conclusions' bias were entered as predictors.

RESULTS

Delusions, disorganisation, and certain negative symptoms were associated with unawareness in various domains, while depression was associated with greater awareness of illness. Deficit in theory of mind and self-reflective processes, as well as a 'jumping to conclusions' bias, contributed to poor insight. Several neuropsychological scores also contributed to this but their contribution was no longer observed in regression analyses that included all the previously identified clinical and cognitive predictors. A measure of perseverative errors was still associated with unawareness and misattribution of symptoms.

CONCLUSION

In models that account for 28 % to 50 % of the variance, poor insight in first-episode psychosis is mainly associated with delusions and certain negative symptoms. At the cognitive level it does not appear to result from neuropsychological impairment but rather from altered reasoning bias and dysfunction in metacognitive processes. Therapeutic strategies specifically directed at these mechanisms could help improve the evolution of insight in first episode psychosis.

Interactions between attributions and beliefs at trial-by-trial level: Evidence from a novel computer game task

Inferring causes of the good and bad events that we experience is part of the process of building models of our own capabilities and of the world around us. Making such inferences can be difficult because of complex reciprocal relationships between attributions of the causes of particular events, and beliefs about the capabilities and skills that influence our role in bringing them about. Abnormal causal attributions have long been studied in connection with psychiatric disorders, notably depression and paranoia; however, the mechanisms behind attributional inferences and the way they can go awry are not fully understood. We administered a novel, challenging, game of skill to a substantial population of healthy online participants, and collected trial-by-trial time series of both their beliefs about skill and attributions about the causes of the success and failure of real experienced outcomes. We found reciprocal relationships that provide empirical confirmation of the attribution-self representation cycle theory. This highlights the dynamic nature of the processes involved in attribution, and validates a framework for developing and testing computational accounts of attribution-belief interactions.

As part of interpreting our experiences, we spontaneously make causal attributions and use them to update our beliefs about the world, ourselves and others. This has long been a topic of interest, particularly within psychiatry. Some theories assume that people have stable “attributional styles”, others focus on the changing nature of attribution-making and on the relationships between attributions and one’s beliefs about the self, suggesting that the two are mutually connected. In this area of research, people have traditionally been asked to imagine themselves experiencing various significant life events and report on how they would interpret those, or have been exposed to artificial and highly simplified situations in the lab. In this work, we introduce a new task to study relationships between causal attributions and beliefs: repeatedly playing an engaging and relatively complex game of skill. We show that we can detect mutual influences between attributions and beliefs at the level of individual wins and losses. This has implications for how everyday successes and failures impact our beliefs about ourselves and our well-being. It also could help understand how our interpretations of negative experiences can spiral out of control, affecting our mental health.

Barriers to mental health services among college students screened in student health: A latent class analysis

Background: Almost a third of college students experience significant mental health concerns, but many do not receive adequate services. This study investigated barriers to mental health services among college students screened in a student health center primary care service. Method: Students (N = 1662) presenting for primary care completed mental health screenings and a barrier measure in the student health center of a university. Latent class analysis created barrier profiles. Results: Three barrier profiles were identified (none, logistical, all barriers). Profiles related to gender (p < .001), with logistical/all barrier profiles more likely amongst female students. No significant difference found by race. Students with higher depression scores were more likely to report logistical barriers than no barriers (p < .001). Conclusion: Programs must address multiple barriers to successfully engage students in treatment. Tailored interventions, including in primary care, should assess and respond to individual barriers, not just common ones.

You Were Better Than Expected-An Experimental Study to Examine Expectation Change in a Non-clinical Sample

Background

Reduced sensitivity to rewards as well as the tendency to maintain dysfunctional expectations despite expectation-disconfirming evidence (cognitive immunization) are considered core features of various mental disorders. It is therefore important for clinical research to have paradigms that are suitable to study these phenomena. We developed a new experimental paradigm to study explicit expectation change after prior expectation induction and violation. Its validity is tested by applying the paradigm to healthy individuals.

Materials and Methods

In the main part of the study (experiment 1) we examined whether it is possible to change healthy individuals' (Sample size 56) task-specific and generalized performance expectations through expectation-disconfirming experiences. We used a high-difficulty performance task to induce initially negative expectations regarding participants' ability to successfully work on that unknown task. In the second part of the study, the difficulty of the test was lowered in one experimental condition, in order to disconfirm the negative expectations of the first part, while the other group continued with high test difficulty to confirm the negative expectations. We measured the participant's explicit performance expectations before and after completing the tests. In experiment 2 (Sample size 57), we investigated the impact of different test instructions on expectation change. Using the same paradigm as in experiment 1, we added an "immunization-inhibiting" manipulation for one group and an "immunization-enhancing" manipulation for the other group.

Results

In experiment 1, we were able to show that individuals changed their expectations according to variations of task difficulty. Adding instructions to manipulate cognitive immunization inhibited expectation change regardless of condition (experiment 2).

Conclusion

Our approach allowed us to examine the effects of implicitly acquired performance expectations on explicit, verbalized expectation change. The new experimental paradigm used in this study is suitable to induce performance expectations, and to examine expectation-change among healthy individuals (experiment 1). Instructions to enhance or inhibit cognitive immunization processes both inhibited expectation change (experiment 2). The results are discussed within the context of current models of expectation change, cognitive immunization, and reward sensitivity.

The development of optimistic expectations in young children

Optimism, a bias to overestimate positive and underestimate negative outcomes, may shape how children learn, confront challenges, and overcome setbacks. Although approximately 80% of adults are optimistic, childhood optimism is understudied. A racially and socioeconomically diverse community sample of 152 three- to six-year-old children participated in two experiments (one story-based, one numeric probability-based) that assessed expectations of event outcomes when the likelihood of the outcome occurring either matched or conflicted with the most desirable outcome. The results systematically demonstrate that children are optimistic, even more optimistic for themselves than others, and increasingly integrate probabilistic information into their predictions with age. Differences in optimism were found in children from different socioeconomic backgrounds and those with different levels of depressive symptoms. These findings provide insight into how children reason about the future and elucidate key factors that impact optimistic predictions in childhood.

The Resilience of Adolescent Girls: An Archival Diary Study of the Protective Advantages of Ordinary Adolescence in the Holocaust-Era Diaries of Anne Frank and Renia Spiegel

In view of recent calls for psychology to use more strengths-based approaches when studying the life experiences of girls, this qualitative archival diary study examined two famous Holocaust-era diaries for evidence of the resilience of adolescence in girls. Adolescent-themed passages were selected from the posthumously published diaries of Anne Frank and Renia Speigel, who kept private diaries while under grave threat and devastation of WWII and the Holocaust. To explore how the ordinary affairs of adolescent development may have contributed to their resilience, we used thematic analysis to explore the prevalence and emotional valence of four themes of adolescence: evolving social-relationships, emotional fluctuation, cognitive-identity changes, and physical changes. Adolescent-themed diary passages were predominantly positive, focused on love, joy, excitement, lust, self-efficacy, trust, contentment, and justice. Negatively valanced adolescent-themed passages described commonplace social concerns of relationship conflict, sadness, social-emotional distance, embarrassment, frustration, and jealousy. Whether positive or negative in valence, the adolescent-themed passages revealed gender-role consistent attention to relationships, alongside gender-role violating confessions of unrestrained sexuality and independence, as well. Theoretical conceptions of the resilience of adolescent girls and implications for theorists and trauma care providers are discussed.

The Role of Predictions, Their Confirmation, and Reward in Maintaining the Self-Concept

The predictive processing framework posits that people continuously use predictive principles when interacting with, learning from, and interpreting their surroundings. Here, we suggest that the same framework may help explain how people process self-relevant knowledge and maintain a stable and positive self-concept. Specifically, we recast two prominent self-relevant motivations, self-verification and self-enhancement, in predictive processing (PP) terms. We suggest that these self-relevant motivations interact with the self-concept (i.e., priors) to create strong predictions. These predictions, in turn, influence how people interpret information about themselves. In particular, we argue that these strong self-relevant predictions dictate how prediction error, the deviation from the original prediction, is processed. In contrast to many implementations of the PP framework, we suggest that predictions and priors emanating from stable constructs (such as the self-concept) cultivate belief-maintaining, rather than belief-updating, dynamics. Based on recent findings, we also postulate that evidence supporting a predicted model of the self (or interpreted as such) triggers subjective reward responses, potentially reinforcing existing beliefs. Characterizing the role of rewards in self-belief maintenance and reframing self-relevant motivations and rewards in predictive processing terms offers novel insights into how the self is maintained in neurotypical adults, as well as in pathological populations, potentially pointing to therapeutic implications.

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 pandemic: Two longitudinal studies

Objective

Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS.

Method

In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later.

Results

In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself.

Conclusions

Exaggeration of one’s personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample.

Practitioner points

Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty.

The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder.

This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism.

Theory of mind in dysphoric and non--dysphoric adults: An ERP study of true-- and false--belief reasoning

Theory of mind (ToM) - the understanding that others' behaviors are connected with internal mental states - is an important part of everyday social cognition. There is increasing behavioral evidence that ToM reasoning can be affected by mood. To gain insight into the ways sad mood may affect the underlying mechanisms of ToM reasoning, we recorded event-related brain potentials (ERPs) as dysphoric (N = 16) and non-dysphoric (N = 24) participants reasoned about a protagonist's true or false beliefs about an object's location. Results showed significant group effects on early components of the ERP - individuals in the dysphoric group showed greater amplitudes for the anterior N1 and N2/P2 components relative to those in the non-dysphoric group. Later in the ERP, non-dysphoric individuals showed evidence of neurocognitive dissociations between true and false belief. Dysphoric individuals, however, did not show evidence for these later dissociations. This evidence suggests that dysphoria may be associated with effortful reasoning about other's mental states, even when that effort is not necessary (i.e., when reasoning about true beliefs). We discuss the implications of these findings for understanding how mood affects ToM reasoning and for how especially deliberative ToM processing in dysphoria may lead to social difficulties.

Is depression associated with reduced optimistic belief updating?

When asked to evaluate their probability of experiencing a negative life event, healthy individuals update their beliefs more following good news than bad. This is referred to as optimistic belief updating. By contrast, individuals with depression update their beliefs by a similar amount, showing reduced optimism. We conducted the first independent replication of this effect and extended this work to examine whether reduced optimistic belief updating in depression also occurs for positive life events. Replicating previous research, healthy and depression groups differed in belief updating for negative events (β = 0.71, 95% CI: 0.24, 1.18). Whereas healthy participants updated their beliefs more following good news than bad, individuals experiencing depression lacked this bias. However, our findings for positive events were inconclusive. While we did not find statistical evidence that patterns of belief updating between groups varied by valence (β = -0.51, 95% CI: -1.16, 0.15), mean update scores suggested that both groups showed largely similar updating for positive life events. Our results add confidence to previous findings that depression is characterized by negative future expectations maintained by reduced updating in response to good news. However, further research is required to understand the specificity of this to negative events, and into refining methods for quantifying belief updating in clinical and non-clinical research.

Response to unexpected social inclusion: A study using the cyberball paradigm

BACKGROUND

Dysfunctional expectations are considered core characteristics of Major Depressive Disorder (MDD) and should be focused in psychotherapy. Dysfunctional expectations are especially pronounced in the interpersonal area (social expectations). In the present study, we examine the effect of unexpected social inclusion (expectation violation) on the change of generalized and specific depression-typical social expectations.

METHOD

We conducted an online study to investigate the impact of social inclusion after a period of social exclusion (unexpected social inclusion) on social expectation change (sample size 144) in a non-clinical sample. Depressive symptoms were assessed via self-reporting. Participants took part in two rounds of the online ball-game Cyberball. In the first round, all participants were socially excluded by their two co-players (acquisition of negative social expectations). In the second round, participants were either once more excluded (expectation confirmation) or included equally (expectation violation) by the same co-players. Specific and generalized social expectations were assessed after each round.

RESULTS

Specific and generalized social expectations increased following expectation violation. Even though depressive symptoms were related to lower levels of social expectations, we found that depressive symptoms did not moderate expectation change after positive expectation violations.

CONCLUSIONS

In the present experimental setup including the use of the online ball-game Cyberball, the establishment and change of social expectations can be experimentally manipulated. Under the given circumstances and in a non-clinical sample, negative expectations can be updated after unexpected positive experiences regardless of the number of depressive symptoms. The results are discussed in the context of current models of Major Depressive Disorder (MDD), expectation change, and cognitive behavioral therapy.

Association between discrepancy in objective and subjective cognitive abilities and treatment response in patients with major depressive disorder: A CAN-BIND-1 study report

BACKGROUND

Major Depressive Disorder (MDD) is characterized by objective and subjective cognitive deficits. Discrepancies between objective and subjective cognitive performance can reflect under- to over-estimations of cognitive abilities, and these discrepancies are referred to as cognitive self-appraisals. Despite evidence that low self-appraisals are associated with depression, the modifiability of self-appraisals and their association with treatment outcome remains unclear. The current study examined whether self-appraisals change following antidepressant treatment. Furthermore, we investigated the association of self-appraisals with treatment outcome.

METHODS

As part of the CAN-BIND-1 clinical trial, 154 patients with MDD completed measures of objective and subjective cognitive abilities, depressive symptoms, and functional outcomes (work productivity, psychosocial functioning, and quality of life) at baseline and post-escitalopram treatment. Self-appraisals were calculated based on discrepancies between objective and subjective cognitive abilities, with higher scores indicating overestimation of cognitive abilities.

RESULTS

Baseline self-appraisals were not predictive of treatment outcomes. However, self-appraisals increased from pre- to post-treatment. Moreover, pre-post treatment increases in self-appraisals were associated with positive treatment response and remission, decreases in depressive symptoms, and improvements in work productivity, psychosocial functioning, and quality of life.

LIMITATIONS

The pre-post intervention design precluded examining the temporal precedence of change in self-appraisals versus depressive symptoms and functional outcomes.

CONCLUSIONS

Findings are the first to demonstrate that self-appraisals are treatment-sensitive and are associated with treatment outcomes and recovery from MDD. Cognitive self-appraisals may represent a key marker of treatment response and a valuable target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.

Pavlovian occasion setting in human fear and appetitive conditioning: Effects of trait anxiety and trait depression

Contexts and discrete stimuli often hierarchically influence the association between a stimulus and outcome. This phenomenon, called occasion setting, is central to modulation-based Pavlovian learning. We conducted two experiments with humans in fear and appetitive conditioning paradigms, training stimuli in differential conditioning, feature-positive discriminations, and feature-negative discriminations. We also investigated the effects of trait anxiety and trait depression on these forms of learning. Results from both experiments showed that participants were able to successfully learn which stimuli predicted the electric shock and monetary reward outcomes. Additionally, as hypothesized, the stimuli trained as occasion setters had little-to-no effect on simple reinforced or non-reinforced stimuli, suggesting the former were indeed occasion setters. Lastly, in fear conditioning, trait anxiety was associated with increases in fear of occasion setter/conditional stimulus compounds; in appetitive conditioning, trait depression was associated with lower expectations of monetary reward for the trained negative occasion setting compound and transfer of the negative occasion setter to the simple reinforced stimulus. These results suggest that clinically anxious individuals may have enhanced fear of occasion setting compounds, and clinically depressed individuals may expect less reward with compounds involving the negative occasion setter.

Sadder and Less Gullible?—Investigating Depressive Realism Effects in Judgments of Veracity

Introduction: Depressive realism literature suggests that depressed individuals’ negative self-view is correlated with less self-serving positivity bias. Also, research suggests some social cognitive advantages for individuals with subclinical levels of depression (dysphoria), especially in identifying negative emotions. This study tested the hypothesis that individuals with dysphoric symptoms show less of a truth bias and are more accurate at detecting deception. Moreover, this effect was expected to be stronger in positive statements (I like) than in negative (I dislike) statements. Finally, a lower judgment confidence and a more accurate assessment of their lie detection ability were expected to be found in individuals with dysphoric symptoms. Methods: Two hundred-sixty-nine participants judged the veracity of 24 video statements. Analyses tested the hypotheses with three different measures of depression: the IPIP-240 Depression Subscale, the PHQ-9, and the DESC-I. Results: In contrast to the assumptions, results found no evidence that individuals with dysphoric symptoms were better at identifying false and true messages in general. While higher scores of the DESC-I were negatively correlated with accuracy in lie detection, the IPIP-240 and the PHQ-9 were found to be not significantly correlated with lie detection accuracy. While for like statements individuals with dysphoric symptoms and individuals without (measured with the DESC-I) were not different in accuracy, individuals with dysphoric symptoms had lower accuracy scores in dislike statements than individuals without. Moreover, the PHQ-9 found lower measures of judgment confidence in individuals with dysphoric symptoms compared to individuals without, while the other depression measurements showed no significant differences. Furthermore, no evidence for a more accurate assessment of lie detection ability in individuals with dysphoric symptoms was found. Discussion: Results and directions for future research are discussed.

Facial emotion recognition in major depressive disorder: A meta-analytic review

BACKGROUND

Major depressive disorder (MDD) has been associated with difficulties in social and interpersonal functioning. Deficits in emotion processing may contribute to the development and maintenance of interpersonal difficulties in MDD. Although some studies have found that MDD is associated with deficits in recognition of emotion in faces, other studies have failed to find any impairment.

METHODS

The present meta-analysis of 23 studies, with 516 dysthymic/depressed participants and 614 euthymic control participants, examined facial emotion recognition accuracy in MDD. Several potential moderators were investigated, including type of emotion, symptom severity, patient status, method of diagnosis, type of stimulus, and stimulus duration.

RESULTS

Results showed that participants with MDD in inpatient settings (Hedges' g = -0.35) and with severe levels of symptom severity (g = -0.42) were less accurate in recognizing happy facial expressions of emotion (g = -0.25) compared to participants in outpatient settings (g = -0.24) and with mild symptoms of depression (g = -0.17). Studies that presented stimuli for longer durations (g = -0.26) tended to find lower accuracy levels in dysthymic/depressed, relative to euthymic, participants.

LIMITATIONS

Limitations include a lack of studies which examined gender identity, as well as other potential moderators.

CONCLUSIONS

Results of the current study support the existence of a broad facial emotion recognition deficit in individuals suffering from unipolar depression. Clinicians should be mindful of this and other research which suggests broad-based deficits in various forms of information processing, including attention, perception, and memory in depression.

What Do People Really Think of Me? Evaluating Bias in Interpersonal Predictions Over the Course of Cognitive-Behavioral Therapy of Depression

Cognitive behavioral therapy (CBT) of depression is hypothesized to achieve its effects by correcting negative biases. However, little research has tested how biases change over the course of CBT. We focus on biases in interpersonal judgments and examine whether changes in biases occur in CBT and are associated with symptom improvements. A sample of 126 adults (60% women, mean age 31.7, 83% White) participated in CBT of depression. Observers provided ratings of patients participating in two interpersonal tasks on three occasions. Patients were asked to predict observers' ratings. In a thin slice (TS) task, observers evaluated how patients came across in a brief segment in which patients talked about themselves. In a Standard Interaction Task (SIT), observers rated the social skills patients displayed in challenging role plays. The difference between patient predictions and observer ratings provided measures of bias in these interpersonal judgments. TS and SIT bias became significantly less pessimistic and more realistic over the course of CBT. Improvements in TS bias were associated with a faster reduction in symptoms, whereas there was a non-significant trend for improvement in SIT bias being associated with faster symptom reduction. Consistent with the CBT model, negative interpersonal biases became more realistic throughout a course of CBT for depression and at least some of the changes in bias were related to therapeutic outcomes. We encourage future researchers to continue examining for whom and under which conditions correcting such biases produces the greatest benefits.

Unhealthy closets, discriminatory dwellings: The mental health benefits and costs of being open about one's sexual minority status

RATIONALE

With a concealable stigmatized identity, sexual minorities not only face discrimination but the burden of deciding when to be open about their sexuality. What are the mental health costs and benefits to openness about sexual minority status? On the one hand, openness fosters integration within the LGBTQ + community (yielding downstream benefits), but it also heightens perceptions of discrimination towards oneself and the group at large (yielding downstream costs for mental health).

OBJECTIVE

Previous research has focused on openness as reflecting either a cost or a benefit to sexual minorities' mental health, resulting in apparent conflict. We propose an integrated view of openness as leading to both costs and benefits that work in tandem to steer mental health.

METHODS

In two pre-registered studies with nearly 4000 ethnically diverse, sexual minority participants, we propose a theoretically-driven serial mediation model to test opposing mediating mechanisms that operate on subjective wellbeing and mental health. Specifically, we determine how the relationship between openness about sexual minority status fosters LGBTQ + identity importance, community integration, and perception of discrimination.

RESULTS

Being more (vs. less) open strengthens LGBTQ identity importance, facilitating integration in the LGBTQ + community, which benefits mental health. However, openness and strengthened identity importance simultaneously prompt increased perceptions of discrimination, the burden of which adversely affects mental health. Together these opposing forces explain the weak association between greater openness and mental health - an association that indicates, overall, that openness does have a net benefit for LGBTQ + individuals' mental health.

CONCLUSIONS

By identifying opposing mechanisms that underlie the relationship between openness and mental health, we have provided a more integrated perspective on the role that openness plays on sexual minorities' mental health. Openness is associated with stronger group identity importance, greater community integration, and heightened perception that the group (and self) face discrimination.

Knockout of the Serotonin Transporter in the Rat Mildly Modulates Decisional Anhedonia

Serotonin transporter gene variance has long been considered an essential factor contributing to depression. However, meta-analyses yielded inconsistent findings recently, asking for further understanding of the link between the gene and depression-related symptoms. One key feature of depression is anhedonia. While data exist on the effect of serotonin transporter gene knockout (5-HTT^-/-) in rodents on consummatory and anticipatory anhedonia, with mixed outcomes, the effect on decisional anhedonia has not been investigated thus far. Here, we tested whether 5-HTT^-/- contributes to decisional anhedonia. To this end, we established a novel touchscreen-based go/go task of visual decision-making. During the learning of stimulus discrimination, 5-HTT^+/+ rats performed more optimal decision-making compared to 5-HTT^-/- rats at the beginning, but this difference did not persist throughout the learning period. During stimulus generalization, the generalization curves were similar between both genotypes and did not alter as the learning progress. Interestingly, the response time in 5-HTT^+/+ rats increased as the session increased in general, while 5-HTT^-/- rats tended to decrease. The response time difference might indicate that 5-HTT^-/- rats altered willingness to exert cognitive effort to the categorization of generalization stimuli. These results suggest that the effect of 5-HTT ablation on decisional anhedonia is mild and interacts with learning, explaining the discrepant findings on the link between 5-HTT gene and depression.

Executive dysfunction in schizophrenia: Predictors of the discrepancy between subjective and objective measures

This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life compared to objective executive performance on neuropsychological tests. Sixty-six participants with broad schizophrenia spectrum disorders completed a comprehensive assessment of executive function. Discrepancies between performance on neuropsychological tests (objective) and an extensive self-report questionnaire (subjective) of central executive functions (inhibition, shifting and working memory) were calculated. Higher level of self-efficacy was the best predictor of experiencing fewer subjective cognitive complaints compared to objective performance, followed by higher levels of disorganized symptoms. Depressive symptoms did not predict discrepancy between subjective and objective executive function. Higher estimated IQ predicted greater subjective working memory difficulties in everyday life despite better objective performance. Results may aid clinicians in the assessment and remediation of cognitive impairment. Low self-efficacy may identify individuals who are not able to utilize their potential executive functions in daily life. Interventions aimed at fostering self-efficacy ought to be included in cognitive remediation for these individuals. Disorganized symptoms could prove useful in identifying individuals who are in need of cognitive remediation for executive dysfunction, despite that they overestimate their skills. These individuals may benefit from efforts to increase insight into cognitive dysfunction.

Metacognitive knowledge and experience across multiple cognitive domains in euthymic bipolar disorder

Background

Metacognitive knowledge (MK; general awareness of cognitive functioning) and metacognitive experience (ME; awareness of cognitive performance on a specific cognitive task) represent two facets of metacognition that are critical for daily functioning, but are understudied in bipolar disorder. This study was conducted to evaluate MK and ME across multiple cognitive domains in individuals diagnosed with bipolar disorder and unaffected volunteers, and to investigate the association between metacognition and quality of life (QoL).

Methods

Fifty-seven euthymic participants with bipolar disorder and 55 demographically similar unaffected volunteers provided prediction and postdiction ratings of cognitive task performance across multiple cognitive domains. Self-ratings were compared to objective task performance, and indices of MK and ME accuracy were generated and compared between groups. Participants rated QoL on the Quality of Life in Bipolar Disorder Scale (QoL.BD).

Results

Metacognitive inaccuracies in both MK and ME were observed in participants with bipolar disorder, but only in select cognitive domains. Furthermore, most metacognitive inaccuracies involved underestimation of cognitive ability. Metacognitive indices were minimally associated with medication variables and mood symptoms, but several indices were related to QoL.

Conclusions

Individuals with bipolar disorder demonstrate inaccuracies in rating their cognitive functioning and in rating their online cognitive task performance, but only on select cognitive functions. The tendency to underestimate performance may reflect a negative information processing bias characteristic of mood disorders. Metacognitive variables were also predictive of QoL, indicating that further understanding of cognitive self-appraisals in persons with bipolar disorder has significant clinical relevance.

A Reduced Self-Positive Belief Underpins Greater Sensitivity to Negative Evaluation in Socially Anxious Individuals

Positive self-beliefs are important for well-being, and are influenced by how others evaluate us during social interactions. Mechanistic accounts of self-beliefs have mostly relied on associative learning models. These account for choice behaviour but not for the explicit beliefs that trouble socially anxious patients. Neither do they speak to self-schemas, which underpin vulnerability according to psychological research. Here, we compared belief-based and associative computational models of social-evaluation, in individuals that varied in fear of negative evaluation (FNE), a core symptom of social anxiety. We used a novel analytic approach, 'clinically informed model-fitting', to determine the influence of FNE symptom scores on model parameters. We found that high-FNE participants learn more easily from negative feedback about themselves, manifesting in greater self-negative learning rates. Crucially, we provide evidence that this bias is underpinned by an overall reduced belief about self-positive attributes. The study population could be characterized equally well by belief-based or associative models, however large individual differences in model likelihood indicated that some individuals relied more on an associative (model-free), while others more on a belief-guided strategy. Our findings have therapeutic importance, as positive belief activation may be used to specifically modulate learning.

AUTHOR SUMMARY

Understanding how we form and maintain positive self-beliefs is crucial to understanding how things go awry in disorders such as social anxiety. The loss of positive self-belief in social anxiety, especially in inter-personal contexts, is thought to be related to how we integrate evaluative information that we receive from others. We frame this social information integration as a learning problem and ask how people learn whether someone approves of them or not. We thus elucidate why the decrease in positive evaluations manifests only for the self, but not for an unknown other, given the same information. We investigated the mechanics of this learning using a novel computational modelling approach, comparing models that treat the learning process as series of stimulusresponse associations with models that treat learning as updating of beliefs about the self (or another). We show that both models characterise the process well and that individuals higher in symptoms of social anxiety learn more from negative information specifically about the self. Crucially, we provide evidence that this originates from a reduction in the amount of positive attributes that are activated when the individual is placed in a social evaluative context.

Maternal Depression and Mother-Child Oxytocin Synchrony in Youth with Anxiety Disorders

The neuropeptide oxytocin (OT) plays a central role in the regulation of affiliative bonds and anxiety. However, the degree to which its levels are synchronized between interaction partners has not yet been assessed. Physiological synchrony assessed using other peripheral measures (e.g., heart rate, etc.) has been tied to positive outcomes for the individual and the dyad. The present study examined OT synchrony in the context of child anxiety and maternal depression by examining mother-child dyads. Mothers and their children with anxiety disorders participated in a behavioral interaction task. Changes in OT levels and mother-child OT synchrony before and after the interaction, as well as their moderation by maternal depression, were assessed. Ninety-eight youth with anxiety disorders (ages 10 to 17) and their mothers underwent psychiatric evaluation, and mothers rated their own depressive symptoms and their children's behavior problems. Salivary OT was assayed from mother and child before and after the task. Behavioral coding showed that interactions were characterized by high behavioral synchrony between mothers and their children, and both individuals displayed higher levels of positive vs. negative affect during the interactions. Mothers and their children also showed decreases in OT levels after the interaction. As hypothesized, OT synchrony increased following the task, but only dyads in which mothers showed high levels of depressive symptoms showed this increase. As hypothesized, lower levels of OT-synchrony were associated with higher levels of child internalizing symptoms. The findings suggest that positive interactions may be beneficial for youth with anxiety disorders with mothers with depression.

Reward function as an outcome predictor in youth with mood and anxiety symptoms

BACKGROUND

Adolescent depression varies considerably in its course. However, there remain no biobehavioral predictors of illness trajectory, and follow-up studies in depressed youth are sparse. Here, we sought to examine whether reward function would predict future clinical outcomes in adolescents with depressive symptoms. We utilized the reward flanker fMRI task to assess brain function during distinct reward processes of anticipation, attainment, and positive prediction error (PPE, i.e. receiving uncertain rewards).

METHODS

Subjects were 29 psychotropic-medication-free adolescents with mood and anxiety symptoms and 14 healthy controls (HC). All had psychiatric evaluations at baseline and approximately 24-month follow-up. Thirty-two participants (10 HC) had usable fMRI data. Correlation and hierarchical regression models examined baseline symptom severity measures as predictors of follow-up clinical outcomes. Whole-brain analyses examined relationships between neural reward processes and follow-up outcomes.

RESULTS

Clinically, anhedonia, but not irritability, predicted future depression and suicidal ideation. Among reward processes, only baseline neural activation during PPE correlated with follow-up depression and anhedonia severity. Specifically, activation in the left angular gyrus-a component of the default mode network-was associated with future depression, while activation in the dorsal anterior cingulate, operculum, and left insula-key salience and pain network regions-was associated with future anhedonia, even when controlling for baseline anhedonia.

LIMITATIONS

The small sample size and variable follow-up intervals limit the generalizability of conclusions.

CONCLUSIONS

This research suggests that reward dysfunction, indexed by anhedonia, may predict worse clinical trajectories in depressed youth. Adolescents presenting with significant anhedonia should be carefully monitored for illness progression.

Mechanisms Underlying Unconscious Processing and Their Alterations in Post-traumatic Stress Disorder: Neuroimaging of Zero Monetary Outcomes Contextually Framed as "No Losses" vs. "No Gains"

Although unconscious processing is a key element of mental operation, its neural correlates have not been established. Also, clinical observations suggest that unconscious processing may be involved in the pathophysiology of post-traumatic stress disorder (PTSD), but the neurobiological mechanisms underlying such impairments remain unknown. The purpose of the present study was to examine putative mechanisms underlying unconscious processing by healthy participants and to determine whether these mechanisms may be altered in PTSD patients. Twenty patients with PTSD and 27 healthy individuals were administered a validated wheel of fortune-type gambling task during functional magnetic resonance imaging (fMRI). Unconscious processing was elicited using unconscious contextual framing of the zero monetary outcomes as "no loss," "no gain" or as "neutral." Brief passive visual processing of the "no loss" vs. "no gain" contrast by healthy participants yielded bilateral frontal-, temporal- and insular cortices and striatal activations. Between-group comparison revealed smaller activity in the left anterior prefrontal-, left dorsolateral prefrontal-, right temporal- and right insular cortices and in bilateral striatum in PTSD patients with the left dorsolateral prefrontal cortex activity been more pronounced in those with greater PTSD severity. These observations implicate frontal-, temporal-, and insular cortices along with the striatum in the putative mechanisms underlying unconscious processing of the monetary outcomes. Additionally, our results support the hypothesis that PTSD is associated with primary cortical and subcortical alterations involved in the above processes and that these alterations may be related to some aspects of PTSD symptomatology.

Deficiencies in Theory of Mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature

Deficiencies in Theory of Mind (ToM) are consistently found in individuals with schizophrenia (SZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the character of these deficits and their role in the pathogenesis of mental illness remains poorly understood. This systematic review synthesizes the available secondary literature pertaining to ToM functioning in individuals with MDD, BD, or SZ, and their respective spectrum disorders in order to delineate disorder or symptom specific patterns of ToM impairment. Literature suggests that ToM deficits increase in severity along the affective-psychotic spectrum, with mild deficits in patients with MDD, and severe deficits in patients with mania or psychosis. Furthermore, ToM deficits appear to be part of a broader developmental phenotype associated with SZ and BD, as suggested by findings of attenuated impairments in ToM in remitted patients with SZ or BD, unaffected first-degree relatives of patients, and clinical high-risk groups. Future psychiatric research on ToM should aim to disentangle relationships between ToM deficits and specific symptom dimensions transdiagnostically, and employ standardized, construct-specific ToM tasks.

Asymmetries in Mutual Understanding: People With Low Status, Power, and Self-Esteem Understand Better Than They Are Understood

All too often, people who develop exceptionally astute insights into others remain mysterious to these others. Evidence for such asymmetric understanding comes from several independent domains. Striking asymmetries occur among those who differ in status and power, such that individuals with low status and power understand more than they are understood. We show that this effect extends to people who merely perceive that they have low status: individuals with low self-esteem. Whereas people with low self-esteem display insight into people with high self-esteem, people with high self-esteem fail to reciprocate. Conceptual analysis suggests that asymmetries in mutual understanding may be reduced by addressing deficits in information and motivation among perceivers. Nevertheless, several interventions have been unsuccessful, indicating that the path to symmetric understanding is a steep and thorny one. Further research is needed to develop strategies for fostering understanding of those who are most misunderstood: people with low self-esteem, low status, and low power.

Body weight and self-perception are associated with depression: Results from the National Health and Nutrition Examination Survey (NHANES) 2005-2016

BACKGROUND

Despite evidence suggesting that perceptual body image measurements are strongly associated with depression, few studies examined the association between perceptual body image and depression in adults. This study aimed to investigate the association of different measures of perceptual body image measurements with depression.

METHODS

We analyzed data of 22,735 adults participating in the National Health and Nutrition Examination Survey between 2005 and 2016. Depression was ascertained using the validated Patient Health Questionnaire (PHQ-9) and depression was defined as PHQ score ≥10. The associations of measured body mass index (BMI) and body image (i.e., self-reported BMI, BMI discordance, perceived weight, and desired weight) with depression were assessed using logistic regression.

RESULTS

Women perceiving themselves as overweight or reporting their BMI as obese had significantly higher odds of depression (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.17-1.72 and 1.29, 1.04-1.60, respectively) compared to women perceiving themselves as about the right weight or reporting their BMI as normal. The association between perceived overweight and depression was independent of measured BMI (OR 1.37, 95% CI 1.09-1.72). Men perceiving themselves as underweight had higher odds of depression (OR 1.50, 95% CI 1.06-2.11) than men perceiving themselves as about the right weight. In women, but not in men, measured obesity was associated with higher odds of depression.

LIMITATIONS

The study's cross-sectional design and missing information on comorbidities.

CONCLUSION

Weight perception (in women and men), measured BMI and BMI discordance in women are associated with depression..

Flexibility between immersion and distancing: A dynamic pattern with effect on depressive symptoms

Objective: Recent studies on immersion (first-person perspective) and distancing (third-person perspective) in psychotherapy have shown the potential of both perspectives in the treatment of depression. High levels of change were associated with transitions between immersion and distancing, suggesting that a dynamic pattern between them may result in a more adaptive view of reality. This study aimed to assess if higher flexibility between these perspectives, during clientś reflection on negative experiences in the intermediate phase, is associated with lower levels of depressive symptoms at the end of treatment. Method: We analyzed the flexibility through frequency and magnitude of transitions between immersion and distancing, in representative sessions of the intermediate phase of therapy in 17 cases with depression. Results: The results showed that the higher frequency and lower magnitude in the intermediate phase predicted lower levels of depressive symptoms at the end of treatment. Conclusion: Immersion and distancing seem to work as dynamic processes, and greater flexibility between them in intermediate phase of therapy, characterized by frequent and fast transitions between the two perspectives, may be an adaptive pattern due to its effect on post treatment depressive symptoms.

Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment

BACKGROUND

Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people.

AIMS

To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth.

METHOD

This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates.

RESULTS

With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7.

CONCLUSIONS

A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.

The Role of Negative Emotions Pre- and Post-Implementation of Graphic Health Warnings: Longitudinal Evidence from South Korea

This longitudinal study investigated the factors that determine the effectiveness of graphic health warnings (GHWs) by comparing 246 South Korean smoker's responses before and after the introduction of the country's new tobacco control policy wherein GHWs were placed on all cigarette packaging. Even though introducing GHWs did not cause immediate changes in smokers' intention to quit smoking or perception of smoking's health risk, GHWs eventually motivated smokers to quit smoking when they experienced negative emotional responses to the newly introduced graphic warnings on cigarette packaging. More importantly, this study found that positive changes in smokers' perceived risk associated with smoking due to the introduction of GHWs mediated a positive relationship between changes in smokers' negative emotions (NE) from text-only warnings to graphic warnings and changes in their intention to quit smoking during the same period. Based on these results, the authors suggest that, for GHW policy to be more effective in motivating smoking cessation, the warnings need to convey images sufficiently unpleasant to induce negative emotional responses among smokers.

Confidence, performance, and accuracy of self-assessment of social cognition: A comparison of schizophrenia patients and healthy controls

Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.