The role of negative interpretations of intrusive memories in depression

From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women

BACKGROUND

Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood.

METHODS

Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum.

RESULTS

Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period.

LIMITATIONS

Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed.

CONCLUSIONS

Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.

Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder

OBJECTIVES

Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD.

METHODS

Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts.

RESULTS

Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group.

CONCLUSION

Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.

The aversiveness of intrusiveness: Evidence from involuntary musical imagery

OBJECTIVE

Intrusive thoughts are characterized by a sense of intrusiveness of foreign entry into cognition. While not always consisting of negative content, intrusive thoughts are almost solely investigated in that context. Involuntary Musical Imagery (INMI) offers a promising alternative, as it is a type of involuntary cognition that can be used to evaluate intrusiveness without negative content.

METHODS

In Study 1, 200 participants completed self-report questionnaires to assess several aspects of intrusiveness: meta-awareness, control, repetitiveness, frequency, and subjective experience of INMI. In Study 2, 203 participants completed self-report questionnaires to explore the clinical characteristics (depression, stress, anxiety, and rumination) which might mediate the connection between INMI frequency and INMI negative experience.

RESULTS

Study 1 revealed, through exploratory factor analysis, that intrusiveness shares variance with the negative experience of INMI but not with INMI frequency. In Study 2, ruminative thinking was found to mediate the relationship between frequent INMI and the negative experience of INMI.

CONCLUSION

These results suggest that INMI might be used to investigate intrusiveness in the lab without the potential confound of negative emotions. In addition, the results suggest that neither the content nor the frequency of intrusive thoughts can solely explain why these thoughts are aversive to some but not others. Ruminative style might be the missing link to explain how and why these intrusive thoughts become aversive and obsessive. In other words, we suggest that the cause for intrusiveness lies not in the thought or repetitiveness, but in the thinker.

Specific topics, specific symptoms: linking the content of recurrent involuntary memories to mental health using computational text analysis

Researchers debate whether recurrent involuntary autobiographical memories (IAMs; memories of one's personal past retrieved unintentionally and repetitively) are pathological or ordinary. While some argue that these memories contribute to clinical disorders, recurrent IAMs are also common in everyday life. Here, we examined how the content of recurrent IAMs might distinguish between those that are maladaptive (related to worse mental health) versus benign (unrelated to mental health). Over two years, 6187 undergraduates completed online surveys about recurrent IAMs; those who experienced recurrent IAMs within the past year were asked to describe their memories, resulting in 3624 text descriptions. Using a previously validated computational approach (structural topic modeling), we identified coherent topics (e.g., "Conversations", "Experiences with family members") in recurrent IAMs. Specific topics (e.g., "Negative past relationships", "Abuse and trauma") were uniquely related to symptoms of mental health disorders (e.g., depression, PTSD), above and beyond the self-reported valence of these memories. Importantly, we also found that content in recurrent IAMs was distinct across symptom types (e.g., "Communication and miscommunication" was related to social anxiety, but not symptoms of other disorders), suggesting that while negative recurrent IAMs are transdiagnostic, their content remains unique across different types of mental health concerns. Our work shows that topics in recurrent IAMs-and their links to mental health-are identifiable, distinguishable, and quantifiable.

CBT for difficult-to-treat depression: self-regulation model

BACKGROUND

Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat.

AIM

The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT.

METHOD

The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components.

RESULTS

A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation.

CONCLUSIONS

A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going.

Longitudinal Relationship Between Mindful Awareness, Acceptance and Mental Health Problems: A Mediation Model

Mental health problems among college students are increasingly prominent. The negative effects of emotional distress on college students' mental health have been supported empirically. It is important to understand the psychological processes underlying this relationship. Using a longitudinal design, the present study aimed to reveal the explanatory mechanism of the association between dimensions of dispositional mindfulness and mental health problems among Chinese college students by testing the mediating effects of experiential avoidance and intolerance of uncertainty. A total of 907 Chinese college students (57% male; Mage = 20.33 years) were invited to complete self-report questionnaires at two time points. Mindful awareness, acceptance and mental health problems (depression, anxiety and stress) were assessed at baseline (T0). Experiential avoidance, intolerance of uncertainty and mental health problems were assessed at the 6 month follow-up (T1). Following structural equation modeling (SEM) analyses, the results show that high levels of mindful awareness and acceptance may diminish mental health problems by decreasing the levels of experiential avoidance among college students. However, only mindful acceptance diminished mental health problems through decreased intolerance of uncertainty. In addition, our study found that mindful awareness and acceptance may have different functions when working alone. Specifically, these two constructs may have different relationships with mental health. Identifying these mechanisms by which dispositional mindfulness is associated with college students' mental health over time has potential value for the prevention of potential mental health issues and timely interventions.

Obsessive-compulsive symptoms in anxiety and depressive disorders: Influence of recent and/or traumatic life events

INTRODUCTION

A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.

OBJECTIVE

This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).

METHOD

We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.

RESULTS

54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01).

CONCLUSION

The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.

Trauma-related dysfunction in the fronto-striatal reward circuit

INTRODUCTION

Reduced reactivity to pleasurable stimulation is a defining symptom of post-traumatic stress disorder (PTSD), but trauma exposure also increases the severity of many anxiety and mood disorders, including depression, social anxiety, and panic disorder, suggesting that reward system dysfunction might be pervasive in the internalizing disorders. The ventromedial prefrontal cortex (vmPFC) and ventral striatum are core components of the reward circuit and the current study assesses functional activity and connectivity in this circuit during emotional picture viewing in anxiety and mood disorder patients.

METHOD

Functional brain activity (fMRI) and functional connectivity in the fronto-striatal circuit were measured in a large sample of patients diagnosed with anxiety and mood disorders (n=155) during affective scene viewing as it varied with trauma exposure and temperament.

RESULTS

In women, but not men, blunted fronto-striatal connectivity was associated with increased posttraumatic anhedonic symptoms, whereas the amplitude of functional activity was not related to trauma exposure. In both men and women, reduced fronto-striatal connectivity was associated with decreases in temperamental positive affect. When predicting fronto-striatal connectivity, temperament and posttraumatic symptomology accounted for independent proportions of variance.

LIMITATIONS

In this civilian sample of anxiety disorder patients, men reported very little trauma-related symptomology.

CONCLUSIONS

Because dysfunctional reward processing due to trauma and temperament is pervasive across the internalizing disorder spectrum, assessing the integrity of the fronto-striatal reward circuit could provide important information in diagnostic and treatment protocols.

Post-traumatic stress disorder in train crash survivors in Italy: the role of mood spectrum dysregulations and intrusiveness

BACKGROUND

To explore relationships among post-traumatic stress disorder (PTSD), depressive spectrum symptoms, and intrusiveness in subjects who survived the crash of a train derailed carrying liquefied petroleum gas and exploded causing a fire.

METHODS

A sample of 111 subjects was enrolled in Viareggio, Italy. AMOS version 21 (IBM Corp, 2012) was utilized for a structural equation model-path analysis to model the direct and indirect links between the exposure to the traumatic event, the occurrence of depressive symptoms, and intrusiveness. Subjects were administered with the SCID-IV (Structured Clinical Interview for DSM-IV), the Questionnaire for Mood Spectrum (MOODS-SR)-Last Month version, the Trauma and Loss Spectrum Questionnaire (TALS-SR), and the Impact of Event Scale-Revised version (IES-R).

RESULTS

Sixty-six (66/111; 59.4%) subjects met SCID-IV criteria for PTSD. Indices of goodness of fit were as followed: χ2/df = 0.2 P = .6; comparative fit index = 1 and root mean square error of approximation = 0.0001. A significant path coefficient for direct effect of potential traumatic events on depressive symptoms (β = 0.25; P < .04) and from depressive symptoms to intrusiveness (β = 0.34; P < .003) was found. An indirect effect was also observed: standardized value of potential traumatic events on intrusiveness was 0.86. The mediating factor of this indirect effect path was represented by depressive symptoms. Potential traumatic events explained 6.2% of the variance of depressive symptoms; 11.8% of the variance of intrusiveness was accounted for traumatic event and depressive symptoms.

CONCLUSIONS

Path analysis led us to speculate that depression symptoms might have mediated the relationship between the exposure to potential traumatic events and intrusiveness for the onset of PTSD.

Obsessive-compulsive symptoms in anxiety and depressive disorders: Influence of recent and/or traumatic life events

INTRODUCTION

A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.

OBJECTIVE

This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).

METHOD

We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.

RESULTS

54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01).

CONCLUSION

The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.

Prevalence and predictors of posttraumatic stress disorder and depression among adolescents over 1 year after the Jiuzhaigou earthquake

BACKGROUND

On August 8, 2017, a 7-magtitude earthquake struck Jiuzhaigou County in Sichuan, China. This was the third devastating earthquake in that province. The prevalence and predictors of posttraumatic stress disorder (PTSD), depression, and comorbid PTSD/depression among adolescents were unclear after the Jiuzhaigou earthquake.

METHODS

Participants were 1241 adolescent survivors in Jiuzhaigou. Data were collected using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

In total, 46.3% of participants reported PTSD, 64.5% reported depression, and 39.2% reported comorbid PTSD/depression symptoms. Risk factors for symptoms of these disorders were being female, having been injured or trapped, and intrusive rumination. High school students were less likely to report PTSD and comorbid PTSD/depression than middle school students. Participants with family members/friends that were injured or trapped reported more PTSD and comorbid symptoms than those without this experience. Loss of property also predicted PTSD. However, deliberate rumination was a protective factor for depression.

LIMITATIONS

This study did not cover all adolescents in Jiuzhaigou and all potential predictors. As we used a cross-sectional design, this study could not assess the trajectory of PTSD, depression, and comorbid symptoms after the earthquake.

CONCLUSION

The findings are meaningful for mental health care among adolescents after natural disasters such as an earthquake.

The impact of depression and culture on responses to intrusive autobiographical memories: Cognitive appraisals, cognitive avoidance, and brooding rumination

OBJECTIVES

Those with depression ascribe more negative appraisals to intrusive autobiographical memories and use maladaptive strategies to regulate intrusive memory distress. However, it is unknown whether these patterns extend to East Asian samples. This study investigated the influence of culture and depression on intrusive remembering.

DESIGN

The study used a 2 (group: European Australian, East Asian) × 2 (depression: depressed, control) cross-sectional design, with an online intrusive memory diary.

METHODS

European Australian (n = 46) and East Asian (n = 45) participants living in Australia, with and without depression, reported two intrusive memories in real-time and completed self-report measures indexing their appraisals of the memories, and their use of cognitive avoidance and brooding rumination in response to the memories.

RESULTS

East Asian participants reported significantly greater negative, control, and responsibility appraisals than European Australian participants. Regardless of cultural group, depressed participants endorsed greater maladaptive memory appraisals and brooding compared to controls. Additionally, among East Asian participants, those with depression cognitively avoided memories significantly more than controls. When comparing the two depressed groups, East Asians reported significantly greater brooding and avoidance in response to intrusive memories than Australians.

CONCLUSIONS

The findings suggest that depression may be associated with some similar maladaptive responses to intrusive autobiographical memories across cultural groups. Clinical interventions targeting unhelpful responses may, therefore, be beneficial for those with depression, regardless of cultural background.

PRACTITIONER POINTS

Across both European Australian and East Asian cultures, depressed participants endorsed higher maladaptive intrusive memory appraisals and brooded more in response to memories. Clinical interventions targeting appraisals and emotion regulation in response to intrusive memories may be beneficial for those with depression across both cultural groups. Language and acculturation may have impacted findings, as measures were administered in English and in Australia. Replication using a cross-country design and larger sample would be beneficial to confirm findings.

The prevalence of intrusive memories in adult depression: A meta-analysis

BACKGROUND

Intrusive memories have typically been associated with post-traumatic stress disorder (PTSD) but some studies have suggested they can also occur in depression-alone.

OBJECTIVE

This meta-analysis aimed to estimate the prevalence of intrusive memories in adult depression and to explore methodological and other factors that may moderate this prevalence.

METHOD

The databases PsycINFO, PsycARTICLES, MedLine, PubMed, CINAHL and Embase were searched for relevant articles, published up to and including July 2016. Studies measuring point prevalence of intrusive memories in adults aged 18 years or above with depression were included and assessed for quality. Meta-analysis was completed under a random effects model.

RESULTS

Seven studies measuring point prevalence of intrusive memories in adult depression were included. The overall pooled prevalence estimate calculated was 76.0% (95% CI 59.4-89.4%), reducing to 66.0% (95% CI 51.0-79.5%) when restricted to intrusive memories experienced within the week prior to assessment. Heterogeneity was high. Between-groups analyses indicated that adults with depression are as likely to experience intrusive memories as adults with PTSD, and more likely to experience intrusive memories than healthy controls (risk ratio of 2.94, 95% CI 1.53-5.67).

LIMITATIONS

The strength of conclusions is limited by the small number of studies included. Consideration of the relationship between depression, intrusive memories and trauma exposure is required.

CONCLUSIONS

Intrusive memories are experienced by a large majority of adults with depression and may therefore be an important target for cognitive intervention. Larger scale measurement of clinical outcome is needed with identification of individual factors predicting treatment response.

Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial

BACKGROUND

Suicide is a major public health problem, and it remains unclear which processes link suicidal ideation and plans to the act of suicide. Growing evidence shows that the majority of suicidal patients diagnosed with major depression or bipolar disorder report repetitive suicide-related images and thoughts (suicidal intrusions). Various studies showed that vividness of negative as well as positive intrusive images may be reduced by dual task (e.g. eye movements) interventions taxing the working memory. We propose that a dual task intervention may also reduce frequency and intensity of suicidal imagery and may be crucial in preventing the transition from suicidal ideation and planning to actual suicidal behaviour. This study aims a) to evaluate the effectiveness of an Eye Movement Dual Task (EMDT) add-on intervention targeting suicidal imagery in depressed patients, b) to explore the role of potential moderators and mediators in explaining the effect of EMDT, and c) to evaluate the cost-effectiveness of EMDT.

METHODS

We will conduct a multi-center randomized clinical trial (RCT) evaluating the effects of EMDT in combination with usual care (n = 45) compared to usual care alone (n = 45). Participants will fill in multiple online batteries of self-report questionnaires as well as complete a semi-structured interview (Intrusion Interview), and online computer tasks. The primary outcome is the frequency and intrusiveness of suicidal imagery. Furthermore, the vividness, emotionality, and content of the suicidal intrusions are evaluated; secondary outcomes include: suicidal behaviour and suicidal ideation, severity of depression, psychological symptoms, rumination, and hopelessness. Finally, potential moderators and mediators are assessed.

DISCUSSION

If proven effective, EMDT can be added to regular treatment to reduce the frequency and vividness of suicidal imagery.

TRIAL REGISTRATION

The study has been registered on October 17th, 2018 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR7563 ).

The German Impact of Future Events Scale (IFES-S): Adaption and Validation for Clinical Samples

Prospective intrusive mental images occur frequently among several psychological disorders. Their assessment is an important tool since the imagination of events can drive future behavior, such as suicidal acts. One valid measure evaluating those prospective images is the impact of future events scale (IFES). However, to date, there is no German equivalent to the English IFES. Therefore, the aim of the present study was to adapt and validate the IFES at hand of a clinical sample and a healthy control sample.After translation, item analyzes were conducted, and as a result, four items were excluded from further analysis resulting in the German short version of the IFES, the IFES-S. Construct validity of the German IFES-S was tested through correlational analysis with convergent and divergent measures. Specificity and sensitivity were assessed through ROC analysis. The German IFES-S showed good internal consistency for the overall measurement with a Cronbach's α of .93. Additionally, it displayed good convergent and divergent validity. An optimal cutoff score of 23 was established to discriminate between clinical populations and healthy controls. In summary, the German IFES-S promises to be a valid self-report instrument for the assessment of prospective intrusive imagery within the context of clinical samples.

Mental imagery in dentistry: Phenomenology and role in dental anxiety

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events

Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record

Association between intrusive negative autobiographical memories and depression: A meta-analytic investigation

The study investigated several associations between depression and intrusive negative autobiographical memories. A systematic literature search identified 23 eligible studies (N = 2,582), which provided 59 effect sizes. Separate meta-analyses indicated that depression was moderately, positively associated with intrusive memory frequency, memory distress, maladaptive memory appraisals, memory avoidance, and memory rumination. Intrusive memory vividness was not significantly associated with depression. There were insufficient data to examine the relationship between depression and memory vantage perspective. Between-study heterogeneity was high for intrusive memory frequency and memory avoidance, and the percentage of females in studies significantly moderated the relationship between these variables and depression. An additional exploratory meta-analysis (3 studies; N = 257) indicated that intrusive memories were experienced more frequently by those with posttraumatic stress disorder than those with depression. Overall, the findings suggest that intrusive memories warrant clinical attention as they may contribute to the maintenance of depressive symptomatology.

Cognitive processing in the aftermath of relationship dissolution: Associations with concurrent and prospective distress and posttraumatic growth

Non-marital romantic relationship dissolution is amongst the most stressful life events experienced by young adults. Yet, some individuals experience posttraumatic growth following relationship dissolution. Little is known about the specific and differential contribution of trait-like and event-specific cognitive processing styles to each of these outcomes. A longitudinal design was employed in which trait-like (brooding and reflection) and dissolution-specific (intrusive and deliberate) cognitive processing was examined as predictors of growth (Posttraumatic Growth Inventory) and distress (Breakup Distress Scale) following a recent relationship dissolution. Initially, 148 participants completed measures of trait-like and dissolution-specific cognitive processing, growth, and distress (T1). A subsample completed a seven-month follow-up (T2). Higher frequency of relationship-dissolution intrusive thoughts predicted concurrent distress after accounting for brooding and relationship characteristics. Further, higher brooding and lower reflection predicted higher distress prospectively. Concurrent growth was predicted by both higher brooding and more deliberate relationship-dissolution thoughts. Prospectively, T1 dissolution intrusive thoughts predicted higher T2 deliberate thoughts, and the interaction between these two constructs predicted higher T2 growth. Therefore, deliberately thinking of the dissolution was related to positive psychological outcomes. In contrast, intrusive dissolution cognitions and a tendency for brooding had a mixed (paradoxical) association with psychological adjustment.

Childhood Socioeconomic Status and Onset of Depression among Japanese Older Adults: The JAGES Prospective Cohort Study

OBJECTIVE

Previous investigations on the impact of childhood socioeconomic status (SES) on depression have focused on middle-aged adults in Western countries. It is unknown whether childhood SES has a long-latency effect on the onset of depression among older adults.

DESIGN

Prospective cohort study.

SETTING

Data were from the Japan Gerontological Evaluation Study.

PARTICIPANTS

We analyzed 10,458 individuals aged 65 years and older without depression (Geriatric Depression Scale <5) at baseline in 2010.

MEASUREMENTS

Participants rated their childhood SES at the age of 15 years according to standards at that time. We used binomial regression analyses with log link and with adjustment for known and potential risk factors to evaluate the risk of depression onset by 2013.

RESULTS

Overall, 13.9% of participants newly reported depression in 2013. After adjusting for age and sex, low childhood SES was positively associated with depression onset (adjusted risk ratio [ARR]: 1.44, 95% confidence interval [CI]: 1.23-1.69). The association decreased after adjustment for education (ARR: 1.33; 95% CI: 1.13-1.57). Even after adjustments for adult SES, current disease status, health behaviors, and social relationships, the association remained significant (ARR: 1.27; 95% CI: 1.08-1.50). The link was stronger among the younger old (65-74 years) than the oldest old (≥75 years).

CONCLUSIONS

Low childhood SES, perhaps due to poverty in post-World War II, has a long-latency effect on the onset of depression among older Japanese adults. The impact of childhood SES on depression was weaker among the oldest old, suggesting survival effects for healthy older Japanese people.

Emotional Mental Imagery as Simulation of Reality: Fear and Beyond-A Tribute to Peter Lang

This article pays tribute to the seminal paper by Peter J. Lang (1977; this journal), "Imagery in Therapy: Information Processing Analysis of Fear." We review research and clinical practice developments in the past five decades with reference to key insights from Lang's theory and experimental work on emotional mental imagery. First, we summarize and recontextualize Lang's bio-informational theory of emotional mental imagery (1977, 1979) within contemporary theoretical developments on the function of mental imagery. Second, Lang's proposal that mental imagery can evoke emotional responses is evaluated by reviewing empirical evidence that mental imagery has a powerful impact on negative as well as positive emotions at neurophysiological and subjective levels. Third, we review contemporary cognitive and behavioral therapeutic practices that use mental imagery, and consider points of extension and departure from Lang's original investigation of mental imagery in fear-extinction behavior change. Fourth, Lang's experimental work on emotional imagery is revisited in light of contemporary research on emotional psychopathology-linked individual differences in mental imagery. Finally, key insights from Lang's experiments on training emotional response during imagery are discussed in relation to how specific techniques may be harnessed to enhance adaptive emotional mental imagery training in future research.

Psychometric properties of the Portuguese version of the Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS): A study with Portuguese Colonial War Veterans

BACKGROUND

The Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS) is a self-report measure designed to assess-trauma-related psychological (in)flexibility, as conceptualized in Acceptance and Commitment Therapy. However, there are no studies to date regarding its psychometric properties. This study explores such properties in the Portuguese version of the AAQ-TS, in Portuguese Colonial War Veterans.

METHOD

A Principal Components Analysis (PCA) was conducted in a sample from the general population of war Veterans (N=371). Confirmatory Factor Analysis (CFA) as well as reliability and convergent validity studies were performed in a different sample from the same population (N=312). For the discriminant validity a clinical sample with a war-related PTSD (N=42) and a non-clinical sample without PTSD (N=44) were used.

RESULTS

The CFA suggested a re-specified 15-item model with good global adjustment and factorial validity. The AAQ-TS showed internal consistency, a good temporal reliability, convergent validity with psychopathological symptoms (related to PTSD, anxiety, depression and stress) and peritraumatic dissociation (altered awareness and depersonalization/derealization). The questionnaire also discriminates between war Veterans with and without a PTSD diagnosis.

LIMITATIONS

The major limitation relates to the samples' characteristics and sampling methods, which can limit the generalization of results.

CONCLUSION

The Portuguese version of the AAQ-TS is a reliable and valid measure to assess experiential avoidance related to trauma in Portuguese Colonial War Veterans.

A dysphoric's TALE: The relationship between the self-reported functions of autobiographical memory and symptoms of depression

Autobiographical memory (AM) is believed to serve self, social and directive functions; however, little is known regarding how this triad of functions operates in depression. Using the Thinking About Life Experiences questionnaire [Bluck, S., & Alea, N. (2011). Crafting the TALE: Construction of a measure to assess the functions of autobiographical remembering. Memory, 19, 470-486.; Bluck, S., Alea, N., Habermas, T., & Rubin, D. C. (2005). A TALE of three functions: The self-reported uses of autobiographical memory. Social Cognition, 23, 91-117.], two studies explored the relationship between depressive symptomology and the self-reported frequency and usefulness of AMs for self, social and directive purposes. Study 1 revealed that thinking more frequently but talking less frequently about past life events was significantly associated with higher depression scores. Recalling past events more frequently to maintain self-continuity was also significantly associated with higher depressive symptomology. However, results from Study 2 indicated that higher levels of depression were also significantly associated with less-frequent useful recollections of past life events for self-continuity purposes. Taken together, the findings suggest atypical utilisations of AM to serve self-continuity functions in depression and can be interpreted within the wider context of ruminative thought processes.

Decentering and Related Constructs: A Critical Review and Metacognitive Processes Model

The capacity to shift experiential perspective-from within one's subjective experience onto that experience-is fundamental to being human. Scholars have long theorized that this metacognitive capacity-which we refer to as decentering-may play an important role in mental health. To help illuminate this mental phenomenon and its links to mental health, we critically examine decentering-related constructs and their respective literatures (e.g., self-distanced perspective, cognitive distancing, cognitive defusion). First, we introduce a novel metacognitive processes model of decentering. Specifically, we propose that, to varying degrees, decentering-related constructs reflect a common mental phenomenon subserved by three interrelated metacognitive processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content. Second, we examine extant research linking decentering-related constructs and their underlying metacognitive processes to mental health. We conclude by proposing future directions for research that transcends decentering-related constructs in an effort to advance the field's understanding of this facet of human experience and its role in (mal)adaptation.

Neural substrates of trait ruminations in depression

Rumination in depression is a risk factor for longer, more intense, and harder-to-treat depressions. But there appear to be multiple types of depressive rumination-whether they all share these vulnerability mechanisms, and thus would benefit from the same types of clinical attention is unclear. In the current study, we examined neural correlates of empirically derived dimensions of trait rumination in 35 depressed participants. These individuals and 29 never-depressed controls completed 17 self-report measures of rumination and an alternating emotion-processing/executive-control task during functional MRI (fMRI) assessment. We examined associations of regions of interest--the amygdala and other cortical regions subserving a potential role in deficient cognitive control and elaborative emotion-processing--with trait rumination. Rumination of all types was generally associated with increased sustained amygdala reactivity. When controlling for amygdala reactivity, distinct activity patterns in hippocampus were also associated with specific dimensions of rumination. We discuss the possibly utility of targeting more basic biological substrates of emotional reactivity in depressed patients who frequently ruminate.

Maladaptive Processing of Maladaptive Content: Rumination as a Mechanism Linking Cognitive Biases to Depressive Symptoms

Cognitive theories propose that negatively biased thinking is an important factor in the development and maintenance of depression. The mechanisms by which cognitive biases lead to depression, however, have not been thoroughly researched. One potential mechanism is that negatively biased thoughts trigger rumination, or the process of focusing passively and repetitively on the causes and consequences of one's mood, a well-established risk factor for depression. In a series of three studies, we examined rumination and other cognitive emotion regulatory strategies as mechanisms of the relationship between cognitive biases and depressive symptoms. We found consistent evidence that rumination mediates the relationship between interpretation and memory biases and depressive symptoms. The indirect effects through rumination were stronger than indirect effects through other cognitive emotion regulation strategies (dampening and worry). These findings indicate that negatively biased thinking may increase risk for depression by increasing rumination, supporting the notion that rumination is a useful target for intervention with depressed clients.

Reduced autobiographical memory specificity relates to weak resistance to proactive interference

BACKGROUND AND OBJECTIVES

Reduced autobiographical memory specificity (rAMS), experiencing intrusive memories, and rumination appear to be risk factors for depression and depressive relapse. The aim of the current study was to investigate whether a weak resistance to proactive interference (PI) might underlie this trio of cognitive risk factors. Resistance to PI refers to being able to ignore cognitive distracters that were previously relevant but became irrelevant for current task goals.

METHOD

Students (N = 65) and depressed patients (N = 37) completed tasks measuring resistance to PI and AMS, and completed questionnaires on intrusive memories and rumination.

RESULTS

In both samples, weaker resistance to PI was associated with rAMS. There was no evidence for a relationship between resistance to PI and intrusive memories or rumination.

LIMITATIONS

As we did not assess other measures of executive functioning, we cannot conclude whether the observed relationship between rumination and PI is due to unique qualities of PI.

CONCLUSIONS

Difficulties to deliberately recall specific, rather than general or categoric autobiographical memories appear to be related to more general problems with the inhibition of interference of mental distracters. The results are in line with the executive control account of rAMS.

Visual mental imagery in psychopathology--implications for the maintenance and treatment of depression

Negative mental images are a common feature in a range of mental disorders as well as in healthy subjects. Intrusive negative mental images have only recently become a focus of attention in clinical research on depression. Research so far indicates that they can be an important factor regarding the onset and chronicity of affective disorders. This article is the first to provide an extensive overview of the current state of research in the field of visual mental images in depression. It aims to investigate disorder-specific characteristics, as well as the role of imagery as a maintaining factor. A detailed definition and description of empirical results about mental images in depressive disorders is followed by a presentation and analysis of treatment studies using imagery techniques in depressed samples. Additionally, methodological issues like small sample sizes and the lack of control groups are pointed out and implications for future research are discussed. Case vignettes are included in the appendix to exemplify the importance of negative mental images in patients suffering from depression.

Alleviating distressing intrusive memories in depression: a comparison between computerised cognitive bias modification and cognitive behavioural education

Negative appraisals maintain intrusive memories and intrusion-distress in depression, but treatment is underdeveloped. This study compared the efficacy of computerised bias modification positive appraisal training (CBM) versus a therapist-delivered cognitive behavioural therapy session (CB-Education) that both aimed to target and alter negative appraisals of a negative intrusive autobiographical memory.

Dysphoric participants (Mean BDI-II = 27.85; N = 60) completed baseline ratings of a negative intrusive memory, negative appraisals and the Impact of Event Scale, and were randomly allocated either one session of CBM, CB-Education, or a no intervention monitoring control condition (Control). Mood and intrusion symptoms were assessed at one week follow-up.

For all groups, there were significant reductions over one week in mood (depression and anxiety), memory intrusiveness and negative appraisals. Groups differed in terms of intrusion-related distress, with the CB-Education group showing greatest reduction, followed by the CBM group.

The study provides evidence for the link between maladaptive appraisals of intrusive memories and distress in depressed mood. Further, both a single session of CB-Education and (to a lesser degree) CBM are useful in reducing intrusion-related distress. This study may have been underpowered to detect differences and replication is needed with larger samples.

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We evaluated techniques that targeted negative appraisals of intrusive memories.

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Compared one-session CBM and CBT interventions, versus Control.

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CBT education was more effective than control in reducing distress at one week.

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CBM of appraisals led to intermediate reductions in distress at one week.

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Maladaptive appraisals of intrusions can be effectively reduced in depression.

The role of obsessive beliefs in patients with major depressive disorder

AIM

The aim of this study is to evaluate the differences in obsessional beliefs between patients with major depressive disorder (MDD) and matched healthy controls using the obsessive-beliefs questionnaire (OBQ).

METHODS

The study sample included 74 outpatients with MDD and 74 healthy subjects. The two groups were matched for age, gender, and education level. The diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). The severity of depression was measured with the Hamilton Depression Rating Scale (HAM-D). All participants filled out the 44-item OBQ.

RESULTS

The total and subscale OBQ scores [Responsibility/Threat Estimation (RT), Perfectionism/Certainly (PC), and Importance/Control of Thoughts (ICT)], were significantly higher in patients with MDD than those of the control group. There was a positive correlation between HAM-D scores and the OBQ subscale scores (RT, PC, and ICT) in the patients.

CONCLUSION

Obsessional beliefs appear to be related to MDD.

Intrusion-based reasoning and depression: cross-sectional and prospective relationships

Intrusion-based reasoning refers to the tendency to form interpretations about oneself or a situation based on the occurrence of a negative intrusive autobiographical memory. Intrusion-based reasoning characterises post-traumatic stress disorder, but has not yet been investigated in depression. We report two studies that aimed to investigate this. In Study 1 both high (n = 42) and low (n = 28) dysphoric participants demonstrated intrusion-based reasoning. High-dysphoric individuals engaged in self-referent intrusion-based reasoning to a greater extent than did low-dysphoric participants. In Study 2 there were no significant differences in intrusion-based reasoning between currently depressed (n = 27) and non-depressed (n = 51) participants, and intrusion-based reasoning did not predict depressive symptoms at 6-month follow-up. Interestingly, previously (n = 26) but not currently (n = 27) depressed participants engaged in intrusion-based reasoning to a greater extent than never-depressed participants (n = 25), indicating the possibility that intrusion-based reasoning may serve as a "scar" from previous episodes. The implications of these findings are discussed.

[Design and validation of the scales for the assessment of the psychological impact of past life events: the role of ruminative thought and personal growth]

INTRODUCTION

Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults' current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG).

MATERIAL AND METHODS

Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed.

RESULTS

The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes.

CONCLUSIONS

Both ruminative thoughts about past life events and personal growth following those events are related to older adults' current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people.

Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework

Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment.

The characteristics of involuntary and voluntary autobiographical memories in depressed and never depressed individuals

This study compares involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Twenty depressed and twenty never depressed individuals completed a memory diary; recording their reactions to 10 involuntary and 10 voluntary memories over 14-30 days. Psychiatric status (Structured Clinical Interview for DSM-IV, SCID-1), psychopathology, rumination and avoidance were assessed. For both groups, involuntary memories more frequently lead to strong reactions than voluntarily memories. For both modes of retrieval, depressed individuals reported more frequent negative reactions than never depressed individuals and rated memories as more central to identity with higher levels of rumination and avoidance. Depressed individuals retrieved both positive and negative memories during involuntary retrieval. These findings support the view that involuntary memory retrieval represents a basic mode of retrieval during healthy and disordered cognition, and that during depression, both involuntary and voluntary memories are central to identity and associated with rumination and avoidance.

Involuntary memories after a positive film are dampened by a visuospatial task: unhelpful in depression but helpful in mania?

Spontaneous negative mental images have been extensively researched due to the crucial role they play in conditions such as post-traumatic stress disorder. However, people can also experience spontaneous positive mental images, and these are little understood. Positive images may play a role in promoting healthy positive mood and may be lacking in conditions such as depression. However, they may also occur in problematic states of elevated mood, such as in bipolar disorder. Can we apply an understanding of spontaneous imagery gained by the study of spontaneous negative images to spontaneous positive images? In an analogue of the trauma film studies, 69 volunteers viewed an explicitly positive (rather than traumatic) film. Participants were randomly allocated post-film either to perform a visuospatial task (the computer game 'Tetris') or to a no-task control condition. Viewing the film enhanced positive mood and immediately post-film increased goal setting on a questionnaire measure. The film was successful in generating involuntary memories of specific scenes over the following week. As predicted, compared with the control condition, participants in the visuospatial task condition reported significantly fewer involuntary memories from the film in a diary over the subsequent week. Furthermore, scores on a recognition memory test at 1 week indicated an impairment in voluntary recall of the film in the visuospatial task condition. Clinical implications regarding the modulation of positive imagery after a positive emotional experience are discussed. Generally, boosting positive imagery may be a useful strategy for the recovery of depressed mood.

Intrusive memories and depression following recent non-traumatic negative life events in adolescents

BACKGROUND

Research in adults suggests that intrusive memories are not just found in individuals with post-traumatic stress disorder (PTSD), yet there is little evidence concerning the phenomenology of intrusive memories in children and adolescents. The present study investigated the frequency of intrusive memories following a recent negative event in an adolescent school sample, and considered the application of cognitive theory to understanding the maintenance of intrusive memories of recent negative events, and their role in maintaining depression.

METHODS

High school students (aged 11-18 years; n=231) completed questionnaires concerning affect experienced during a recent negative event, the frequency of subsequent intrusive memories, memory quality, thought suppression, post-traumatic stress and depressive symptoms.

RESULTS

Most participants had experienced at least one intrusive memory in the previous week, at similar rates for traumatic events and life events. In non-trauma exposed youth, peri-event affect and memory quality accounted for unique variance in a regression model of intrusive memory frequency, while peri-event affect, memory quality, and intrusive memory frequency accounted for unique variance in a regression model of depression.

LIMITATIONS

The study needs replication in younger children. Interview methods may be required to ensure that intrusive memories are being assessed and not intrusive thoughts or ruminations.

CONCLUSIONS

Intrusive memories are common reaction to negative events in adolescents, and may be involved in maintaining subsequent depressed mood. The nature of event memories may have a role in the maintenance of such psychopathology, and may be a target for psychological interventions in this age group.

Cognitive Bias Modification Using Mental Imagery for Depression: Developing a Novel Computerized Intervention to Change Negative Thinking Styles

Why do some people see their glass as half-empty rather than half-full or even imagine that the glass will be filled in the future? Experimental methods can illuminate how individual differences in information processing style can profoundly impact mood or even result in disorders such as depression. A computerized cognitive bias modification intervention targeting interpretation bias in depression via positive mental imagery (CBM-I) was evaluated by investigating its impact on mental health and cognitive bias compared with a control condition. Twenty-six depressed individuals completed either positive imagery-focussed CBM-I or a control condition daily at home over one week. Outcome measures were collected pre-treatment and post-treatment and at two-week follow-up. Individuals in the positive condition demonstrated significant improvements from pre-treatment to post-treatment in depressive symptoms, cognitive bias and intrusive symptoms compared with the control condition. Improvements in depressive symptoms at two-week follow-up were at trend level. The results of this first controlled comparison of positive imagery-focussed CBM-I for depression further support the clinical potential of CBM-I and the development of a novel computerized treatment that could help patients imagine a more positive future. Broader implications concern the modification of individual differences in personality variables via their interaction with key information processing targets. Copyright © 2011 John Wiley & Sons, Ltd.

The Impact of Ruminative Processing on the Development of Intrusive Memories

Despite substantial evidence of the detrimental effects of ruminative self-focus, paradoxically (as noted and reviewed by Watkins, 2004) there are clear suggestions that under some circumstances self-focused attention can actually promote well-being and confer benefits. We sought to replicate the findings of Watkins (2004) that adopting an abstract/analytical mode of processing following a negative event results in increased spontaneous intrusions of the event; that is, results in poor emotional processing. In the current study 57 low (BDI-II ≤ 7) and 59 high (BDI-II ≥ 12) dysphoric undergraduate participants viewed a four minute emotion-eliciting video, were randomly assigned to an analytical, experiential, or distraction processing condition, then monitored the frequency of video-related intrusions. Results indicated the effectiveness of the video in inducing moderately distressing intrusions, and suggest that the hypothesised effects of ruminative self-focus on intrusion severity may be dependent upon the self-referential nature of the material to be processed. Results did support previous findings (Williams & Moulds, 2007) that intrusion-related distress is not merely a function of intrusion frequency. Directions for future investigations of the cognitive processes that are important in the maintenance of depressive disorders are discussed.

Intrusive memories of negative events in depression: is the centrality of the event important?

BACKGROUND AND OBJECTIVES

Following stressful events, there is evidence that the degree to which the event is perceived as central to one's identity and forms a reference point for the attribution of meaning to other events (i.e., "centrality of events") is associated with depression symptoms. However, these findings have primarily come from cross-sectional studies of undergraduate samples, and no past study has investigated whether centrality predicts depression over time. We sought to further examine the role of centrality of negative autobiographical events that were the content of intrusive memories in depression.

METHODS

At Time 1, participants (clinically depressed, recovered and never-depressed) were interviewed and completed self-report measures of depression symptoms, intrusive memories and features, centrality, and avoidance. At Time 2 (six months later), depression and anxiety symptoms were assessed.

RESULTS

Unexpectedly, the three groups did not differ on centrality ratings. Centrality was not associated with concurrent depression symptoms and was not predictive of depression at follow-up. However, as expected, centrality ratings were positively correlated with important intrusive memory variables including memory intrusiveness, and rumination.

LIMITATIONS

The correlational nature of our design prevents us from establishing the causal direction of the relationships reported.

CONCLUSIONS

The degree to which intrusively recalled events are seen as central to identity might not play as important a role in depression as previously expected. Future centrality research needs to take memory frequency/intrusiveness into account before drawing conclusions about the role of this variable in depression.