The interplay between cognitive risk and resilience factors in remitted depression: A network analysis

Exploring the complex interrelation between depressive symptoms, risk, and protective factors: A comprehensive network approach

BACKGROUND

Depressive symptoms seem to be interrelated in a complex and self-reinforcing way. To gain a better understanding of this complexity, the inclusion of theoretically relevant constructs (such as risk and protective factors) offers a comprehensive view into the complex mechanisms underlying depression.

METHODS

Cross-sectional data from individuals diagnosed with a major depressive disorder (N = 986) and healthy controls (N = 1049) were analyzed. Participants self-reported their depressive symptoms, as well as several risk factors and protective factors. Regularized partial correlation networks were estimated for each group and compared using a network comparison test.

RESULTS

Symptoms of depression were more strongly connected in the network of depressed patients than in healthy controls. Among the risk factors, perceived stress, the experience of negative life events, emotional neglect, and emotional abuse were the most centrally embedded in both networks. However, the centrality of risk factors did not significantly differ between the two groups. Among the protective factors, social support, personal competence, and acceptance were the most central in both networks, where the latter was significantly more strongly associated with the symptom of self-hate in depressed patients.

CONCLUSION

The network analysis revealed that key symptoms of depression were more strongly connected for depressed patients than for healthy controls, and that risk and protective factors play an important role, particularly perceived stress in both groups and an accepting attitude for depressed patients. However, the purpose of this study is hypothesis generating and assisting in the potential selection of non-symptom nodes for future research.

Similarities and Differences in the Architecture of Cognitive Vulnerability to Depressive Symptoms in Black and White American Adolescents: A Network Analysis Study

The hopelessness theory, Beck's cognitive theory, and the response styles theory dominate our understanding and the treatment of depression in adolescents. However, research supporting them is largely based on White individuals. Further, the associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black adolescents are not as one would expect based on the predictions from those theories. Both raise the question of if and to what degree these theories and previous findings can be generalized to Black adolescents. Additionally, without a theoretical basis, clinicians regularly use interventions developed based on one theory to influence vulnerabilities described in another theory. Thus, the purpose of our study was to examine the structure of an integrated cognitive stress-vulnerability model as well as the strengths of associations between stressors, cognitive vulnerabilities, and depressive symptoms in Black and White adolescents. In our study, 295 Black (37% female) and 213 White (49% female) ninth-grade students from a public high school participated. Network analyses demonstrated that the three original cognitive theories of depression can and should be integrated and that each variable we examined is comparably relevant for Black and White adolescents. At the same time, the structure of the two integrated networks differed significantly among Black and White adolescents, exhibiting specific distinctions at four edge levels. Furthermore, the predictability of the network is notably lower for Black adolescents than for White adolescents. Important theoretical and clinical implications can be derived.

Effects of current and past depressive episodes on behavioral performance and subjective experience during an N-back task

BACKGROUND AND OBJECTIVES

Depression impairs working memory (WM). And, while many studies have documented impairment in WM during depression remission, those using the N-back task did not find differences between individuals with remitted depression and healthy controls. One reason for these findings may be that certain depression phenotypes, such as the childhood-onset form, which is likely to be associated with persistent WM problems, are underrepresented or unevenly represented in the studies. Because childhood-onset depression (COD) affects individuals while cognitive development is still ongoing, it is more likely to have lasting detrimental effects, as evidenced in residual memory impairment, than depression that onsets later in life. Further, it is unclear if depression episodes have cumulative effects on WM when measured via the N-back.

METHODS

We examined the effects of depression on WM performance (response time, accuracy, signal detection d') and subjective experience (difficulty, mental effort required) during a four-level N-back task among 112 adults with COD (42 currently depressed; 70 remitted depressed) and 80 never-depressed controls.

RESULTS

Compared to never-depressed controls, there was minimal evidence of impaired WM performance among participants with remitted or current depression; the groups also reported overall similar subjective experiences during the N-back. Notably, number of lifetime depressive episodes had a detrimental cumulative effect on response accuracy and d'.

LIMITATIONS

WM was assessed only in regard to verbal memory. The sample size of currently depressed cases was smaller than that of the other groups.

CONCLUSIONS

WM remains largely intact among adults with remitted COD, but increased number of depression episodes worsens WM performance.

Can the Negative Cognitive Bias Be Predicted by Early Victimization of College Students? The Dual Role of Resilience

Victimization could cause cognitive dysfunction like negative cognitive bias. While there are studies of contemporaneous consequences, there is insufficient research on whether and how early victimization will affect adult negative cognitive bias. This study examined the dual role of resilience (i.e., whether resilience would moderate the relationship between early victimization and negative cognitive bias, and/or whether resilience would mediate the same relationship). A total of 972 college students (40% were males, Mage = 19.25, SD = 1.17, range = 16-25) from three universities in Central China completed a series of anonymous questionnaires on early victimization, resilience, and negative cognitive bias. After controlling for demographic variables, the results indicated that early victimization was positively correlated with negative cognitive bias of college students. Moderation analysis indicated that resilience moderated the relationship between early victimization and negative cognitive bias. Mediation analysis revealed that resilience partially mediated the same relationship. Specifically, the effect of early victimization on negative cognitive bias was stronger for college students with high level of resilience than those with low level of resilience. Meanwhile, early victimization affected negative cognitive bias partially through resilience. The findings elucidate the dual role of resilience in the relationship between early victimization and negative cognitive bias. On the one hand, negative cognitive bias can be reduced by enhancing resilience among victims, on the other hand, the protective role of resilience may be weakened with the increase of victimization, reminding us to pay more attention to victims with high level of resilience.

A cross-lagged prospective network analysis of depression and anxiety and cognitive functioning components in midlife community adult women

BACKGROUND

Scar theory proposes that heightened depression and anxiety precede and predict worse cognitive functioning outcomes, whereas the vulnerability theory posits the opposite pathway. However, most investigations on this topic have been cross-sectional, precluding causal inferences. Thus, we used cross-lagged prospective network analyses to facilitate causal inferences in understanding the relations between psychopathology and cognitive functioning components.

METHODS

Racially-diverse midlife women (n = 1816) participated in the Study of Women's Health Across the Nation at two time-points, spanning one year apart. Five psychopathology (anxiety severity, depressed mood, somatic symptoms, positive affect, interpersonal problems) and four cognitive functioning nodes (working memory (WM), processing speed (PS), facial recognition (FCR), and verbal memory (VRM)) were assessed. All analyses adjusted for age, menopausal status, estradiol, and follicle-stimulating hormones.

RESULTS

Contemporaneous networks yielded notable inverse between-node relations (edges) between interpersonal problems and reduced FCR and PS, and between depressed mood and lower FCR, VRM, or PS. Nodes that had the highest likelihood to bridge other constructs were positive affect, anxiety severity, WM, and VRM. Temporal networks produced edges consistent with the scar (v. vulnerability) hypotheses. Higher somatic symptoms were related to reduced PS and WM, and greater depressed mood was correlated with lower future PS and WM. Also, higher anxiety severity coincided with decreased future PS and WM. Greater positive affect was associated with stronger future PS, FCR, and WM. Also, positive affect had the strongest relations with other nodes.

CONCLUSIONS

Findings suggest the importance of targeting symptoms and cognitive functioning simultaneously.

Scales and Interventions for Resilience among Treatment-Seeking Patients with Depression: A Systematic Review

Introduction

Resilience is an ability of an individual to effectively adjust and thrive in adverse stressful conditions. Resilience has protective and compensatory effects against depression. Evaluating resilience clinically and modifying it among patients with depression hugely impacts their prognosis. We aimed to explore different clinical scales for measuring resilience as well as interventions used with an intent to improve resilience among patients with depression.

Methods

A systematic literature review was conducted by searching PubMed central, Biomed central, and google scholar, using relevant MeSH keywords. The population of interest were the patients who were clinically diagnosed with Bipolar or Unipolar Depression and the population were not restricted to any country. Clinical scales for evaluation and interventions for resilience among patients with depression were set as an outcome of the study. Randomized controlled trials (RCTs), Quasi-experimental studies, observational studies, and narrative reviews were considered relevant research designs for extraction.

Results

A total of 8689 articles were identified and 13 articles were included in the final review, which yielded five scales that have been identified and have been used to evaluate resilience among the patients who are clinically diagnosed with depression and six different interventions for building resilience among patients with depression.

Conclusion

Resilience-building interventions will not only act as a preventive measure against depression but also help in promoting recovery and sustaining remission after a depressive episode. Clinical evaluation of resilience and management will significantly support boosting emotional experience.

A Cross-Country Network Analysis of Resilience Systems in Young Adults

Multisystemic resilience has been conceptualised as involving a constellation of protective factors which operate at different levels to promote adaptation and thriving despite experiences of adversity. We used network modelling to discover how protective factors at two different systemic levels (intrapersonal strengths and social-ecological resources) interrelate, drawing on survey data from 5283 emerging adults (M = 24.53 years; 52% female) in Brazil, China, Indonesia, Russia, Thailand, the US and Vietnam. Results indicated that the level of connectivity within and between protective factor levels was similar between the countries, but that there was substantial variation in the specific interrelations among protective factors (both within and between levels), including the presence of some country-specific negative interrelations between protective factors at different levels. The findings support the importance of cultural context in studies of resilience, with implications for the development of appropriate resilience-building interventions for this age group.

Exploring the associations between psychodynamic constructs and psychopathology: A network approach

Psychodynamic therapy effectively reduces symptomatology by focusing on underlying (unconscious) processes instead of symptoms. Nevertheless, the exact interrelationship between psychodynamic constructs and psychopathology remains unclear. This study uses network analysis to explore these associations. We computed a cross-sectional partial correlation network between psychodynamic constructs (i.e., personality functioning, interpersonal relations, and active and passive modes of intrapsychic conflicts according to the Operationalized Psychodynamic Diagnostics [OPD] system) and psychopathology (i.e., depression and somatization) in a naturalistic sample of 341 adults registering for psychodynamic outpatient therapy. We estimated node centrality, node predictability, and bridge symptoms and used community detection analysis. Bootstrap methods were applied to assess network stability. Psychodynamic constructs and psychopathology resulted in separate but connected clusters. Personality functioning emerged as the most influential node in the network and was bridging the clusters. The network was found to be highly stable, allowing reliable interpretations. The results offer important insights on how psychodynamic constructs relate to psychopathology, which can be used to inform treatment approaches. The findings suggest that personality functioning may be an important intervention target. However, future research is needed to include a broader range of diagnoses. In addition, longitudinal studies may clarify the direction of causality.

Gender differences in cannabis use disorder symptoms: A network analysis

BACKGROUND

While cannabis use in women is increasing worldwide, research into gender differences in cannabis use disorder (CUD) symptomology is lacking. In response to limited effectiveness of addiction treatment, research focus has been shifting from clinical diagnoses towards interactions between symptoms, as patterns of symptoms and their interactions could be crucial in understanding etiological mechanisms in addiction. The aim of this study was to evaluate the CUD symptom network and assess whether there are gender differences therein.

METHODS

A total of 1257 Dutch individuals reporting weekly cannabis use, including 745 men and 512 women, completed online questionnaires assessing DSM-5 CUD symptoms and additional items on plans to quit or reduce use, cigarette use, and the presence of psychological diagnoses. Gender differences were assessed for all variables and an Ising model estimation method was used to estimate CUD symptom networks in men and women using network comparison tests to assess differences.

RESULTS

There were gender differences in the prevalence of 6 of the 11 symptoms, but symptom networks did not differ between men and women. Cigarette use appeared to only be connected to the network through withdrawal, indicating a potential role of cigarette smoking in enhancing cannabis withdrawal symptoms. Furthermore, there were gender differences in the network associations of mood and anxiety disorders with CUD symptoms.

CONCLUSION

The association between smoking and withdrawal as well as gender differences in the role of comorbidities in the CUD network highlight the value of using network models to understand CUD and how symptom interactions might affect treatment.

Eating disorder psychopathology and resilience in Iranian college students: A network analysis

OBJECTIVE

Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample.

METHOD

Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms.

RESULTS

Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating.

CONCLUSION

Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.

Resilience to suicidal behavior in young adults: a cross-sectional study

Despite decades of research on suicide risk factors in young people, there has been no significant improvement in our understanding of this phenomenon. This study adopts a positive deviance approach to identify individuals with suicide resilience and to describe their associated psychological and sociodemographic profiles. Australian young adults aged 18–25 years with suicidal thoughts (N = 557) completed an online survey covering sociodemographic, mental health status, emotion regulatory and suicide-related domains. Latent class analysis was used to identify the individuals with suicide resilience. The predictors of suicide resilience were assessed using logistic regression models. The results suggested that one in ten (n = 55) met the criteria for suicide resilience. Factors that had a significant association with suicide resilience included greater cognitive flexibility, greater self-efficacy in expressing positive affect, reduced use of digital technology and less self-harm and substance use as a response to emotional distress. This study identified the factors that may protect young adults with suicidal thoughts from progressing to suicide attempts. Suicide prevention programs might be optimised by shifting from a deficit-based to a strength-based approach through promoting cognitive flexibility, self-efficacy and reducing maladaptive coping.

Post-traumatic Growth and Psychological Resilience During the COVID-19 Pandemic: A Serial Mediation Model

Although the World Health Organization (WHO) has issued guidelines for managing to contain, mitigate, and limit of the COVID-19. However, it is more essential to highlight the urgency and importance of evaluating social functioning and mental health status during the pandemic. College students have experienced serious problems and have had to overcome many negative situations brought about by the pandemic. Accordingly, the present study intended to use Chinese college students as sample to examine the positive adoption and changes during the ongoing COVID-19. Guided by literatures in this filed, we explored the internal mechanism of post-traumatic growth affecting psychological resilience, and considered about mediation roles of positive coping styles and cognitive reappraisal. A total of 463 college students from universities in China effectively completed online questionnaires. The result indicated that these four variables were positively correlated with each other (ps < 0.001). More importantly, our findings proved a direct and positive effect on psychological resilience. Positive coping styles and cognitive reappraisal, respectively, mediated the relationship between post-traumatic growth and psychological resilience. Over all, the hypothesized serial model conclusively fits the data: students with high-level post-traumatic growth tended to report increased use of positive coping strategies, which further facilitated their cognitive reappraisal, and subsequently, promoted their psychological resilience. The findings obtained in this study will provide a theoretical basis and possible viable strategies for both targeted crisis intervention and psychological trauma recovery plans.

Individual differences associated with treatment adherence and transfer effects following gamified web-based cognitive control training for repetitive negative thinking

Recent research suggests beneficial effects of cognitive control training (CCT) on repetitive negative thinking (RNT), a key risk factor for internalizing symptomatology. However, relatively little is known regarding predictors of adherence to internet-delivered CCT as well as moderators of treatment effects for this intervention. Answering these questions could improve efficiency of clinical implementation of CCT as an eHealth intervention. The current pre-registered single-arm trial set-out to address these questions using a web-based gamified CCT procedure based on the adaptive Paced Auditory Serial Addition Task. Participants (N = 382) entered the internet-based study, where we observed considerable drop-out during the assessment phase and the first training sessions. Emotional stability and resilience emerged as predictors for deciding not to commence the intervention. Drop-out throughout the course of CCT was explained by age, emotion regulation-, and personality factors. We used latent profile analysis, a probabilistic modeling approach, to identify clusters of participants (User Profiles) based on indicators of baseline cognitive- and emotional functioning, training progress, and user experience. We obtained three User Profiles, reflecting low-, moderate-, and high-risk status. Effortful control, emotion regulation, internalizing symptomatology, resilience, and emotional stability played a central role in these User Profiles. Interestingly, User Profile predicted training related cognitive gains, as well as effects of CCT on anxiety- and stress symptoms, and reappraisal. Our findings suggest that CCT is most effective for the moderate- and high-risk groups. In addition, the high-risk group would likely benefit from a more intensive training procedure or repeated administration of the training procedure over time to foster long-term retention of training related gains.

Modeling alcohol use disorder as a set of interconnected symptoms - Assessing differences between clinical and population samples and across external factors

Alcohol use disorder is argued to be a highly complex disorder influenced by a multitude of factors on different levels. Common research approaches fail to capture this breadth of interconnecting symptoms. To address this gap in theoretical assumptions and methodological approaches, we used a network analysis to assess the interplay of alcohol use disorder symptoms. We applied the exploratory analysis to two US-datasets, a population sample with 23,591 individuals and a clinical sample with 483 individuals seeking treatment for alcohol use disorder. Using a Bayesian framework, we first investigated differences between the clinical and population sample looking at the symptom interactions and underlying structure space. In the population sample the time spent drinking alcohol was most strongly connected, whereas in the clinical sample loss of control showed most connections. Furthermore, the clinical sample demonstrated less connections, however, estimates were too unstable to conclude the sparsity of the network. Second, for the population sample we assessed whether the network was measurement invariant across external factors like age, gender, ethnicity and income. The network differed across all factors, especially for age subgroups, indicating that subgroup specific networks should be considered when deriving implications for theory building or intervention planning. Our findings corroborate known theories of alcohol use disorder stating loss of control as a central symptom in alcohol dependent individuals.

Effects of Personal Ability and Social Welfare on the Health of Rural-to-Urban Elderly Migrants: An Empirical Analysis from Jiangsu Province, China

This study aims to discuss the relationship between personal endowment and social welfare on the health status of the rural-to-urban elderly migrants. It constructed the theoretical framework of the health vulnerability of rural-to-urban elderly migrants. The health status of rural-to-urban elderly migrants was divided into three dimensions: physical health, mental health, and social adaptation. A total of 658 rural-to-urban elderly migrants in 12 cities of Jiangsu province were selected as samples for empirical test and analyzed the influence of individual endowments and social welfare on the health status of rural-to-urban elderly migrants and their differences. The result shows that personal ability affects the social adaptation ability of rural-to-urban elderly migrants, and social welfare has a significant influence on the physical and mental health of rural-to-urban elderly migrants. Lacking the learning ability of rural-to-urban elderly migrants in sample areas is the main factor that leads to their low social adaptation ability and the unequal social welfare and public services restricting the physiological and mental health status of rural-to-urban elderly migrants.

The Interplay Between Quality of Life and Resilience Factors in Later Life: A Network Analysis

Age-related challenges and transitions can have considerable social, psychological, and physical consequences that may lead to significant changes in quality of life (QoL). As such, maintaining high levels of QoL in later life may crucially depend on the ability to demonstrate resilience (i.e., successful adaptation to late-life challenges). The current study set out to explore the interplay between several resilience factors, and how these contribute to the realization and maintenance of (different facets of) QoL. Based on the previous work, we identified behavioral coping, positive appraisal, self-management ability, and physical activity as key resilience factors. Their interplay with (various facets of) QoL, as measured with the WHOQOL-OLD, was established through network analysis. In a sample of community-dwelling older adults (55+; N=1,392), we found that QoL was most strongly (and directly) related to positive appraisal style and self-management ability. Among those, taking care of multifunctional resources (i.e., yielding various benefits at the same time) seemed to be crucial. It connected directly to "satisfaction with past, present, and future activities," a key facet of QoL with strong interconnections to other QoL facets. Our analysis also identified resilience factor(s) with the potential to promote QoL when targeted by training, intervention, or other experimental manipulation. The appropriate set of resilience factors to manipulate may depend on the goal and/or facet of QoL that one aims to improve.

Characteristics associated with the discrepancy between subjective and objective executive functioning in depression

Major depressive disorder (MDD) is associated with both self-reported (subjective) cognitive complaints and deficits in neurocognitive (objective) measures, but the correspondence between subjective and objective measures of cognition is low. This cross-sectional study aimed to (1) assess the association between subjective and objective measures of executive functions (EFs), and (2) explore factors associated with the discrepancy between subjective and objective EFs in MDD. Sixty-two participants with current or previous mild to moderate MDD and subjective EF complaints completed a clinical trial baseline assessment. An objective EF composite score was drawn from six neurocognitive measures, while the Behavior Rating Inventory of Executive Function-Adult version was applied as a measure of subjective EF. The association between the subjective and objective composites was evaluated using Spearman's rank order correlation. A discrepancy score was calculated to quantify the difference between subjective and objective EF. Factors associated with the discrepancy score were analyzed using regression analysis (p < .05). Participants reported extensive EF difficulties, but most performed in the normal range on objective EF measures. A weak correlation was detected between the subjective and objective measures (r_s = .015). More rumination (β = -.364) and higher IQ (β = -.420) were associated with reporting more subjective complaints than was evident from objective measures of EF (i.e., underestimation). Subjective and objective EF measures are weakly overlapping in MDD. Findings underscore recommendations to include both subjective and objective measures when assessing EFs in depression. In addition, findings suggest that targeting ruminative processes could help correct underestimation.

Combined effects of tDCS over the left DLPFC and gaze-contingent training on attention mechanisms of emotion regulation in low-resilient individuals

Low resilience is characterized by impairments in attention and emotion regulation mechanisms that depend on prefrontal cortical activity. The aim of this study was to test whether transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) can augment the effectiveness of a new computerized mouse-based (gaze)contingent training (MCAT) to improve attention and emotion regulation processes (improved reappraisal, reduced rumination) in individuals reporting low resilience levels. The study used a full-factorial between-subject design combining active and sham MCAT and tDCS interventions. One hundred participants reporting low resilience levels were randomly assigned to receive either a single session of: tDCS with sham MCAT treatment (tDCS group), MCAT with sham tDCS (MCAT group), a combination of tDCS and MCAT (combined group), or sham tDCS and sham MCAT (control group). Transfer to attention regulation, reappraisal success, and state rumination was evaluated using an eye-tracking disengagement task and an emotion regulation paradigm, respectively. MCAT, either alone or combined with tDCS, resulted in improved attention regulation. Furthermore, the group receiving combined MCAT and tDCS also showed some evidence of increased reappraisal ability and reduced rumination. MCAT in combination with left DLPFC neuromodulation has potential to maximize transfer to emotion regulation capacities and to promote resilience.

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

The associations of executive functions with resilience in early adulthood: A prospective longitudinal study

BACKGROUND

Executive functions and resilience, the key components of an individual's ability to participate meaningfully and effectively in their environment, have become increasingly researched topics in psychology and education. However, little is known about the longitudinal associations of executive functions and resilience among emergent adults.

METHODS

We conducted a prospective study with 450 (baseline) participants aged 17-24 years; 420 of these participants also completed a 15-month follow-up. Participants answered questionnaires investigating socio-demographics, executive functions, and resilience, and results were analysed with multivariable logistic regression and cross-lagged analyses.

RESULTS

At baseline, the overall prevalence of low executive functions (T-score ≥ 60) among the sample was 18.2%. Relative to persistently low executive functions, newly developed or persistent high executive functions was significantly associated with higher level of resilience at follow-up (bOR = 8.26, 95% CI [2.57, 26.49]; bOR = 8.74, 95% CI [3.69, 20.70], respectively). Further cross-lagged analyses showed bidirectional relationships of executive functions and various executive functions subtypes with resilience.

LIMITATIONS

The use of self-report measures may lead to recall bias, and intervention or experimental studies are needed to examine causality. This study recruited participants from one vocational school, which may limit the generalisability of the results. Also, follow-up dropout was a potential bias in this study; the observed results should be interpreted with caution.

CONCLUSIONS

Our study proposes that enhancing executive functions may be associated with improved resilience, and vice versa. These findings could influence the development of targeted interventions via mental health professionals to support individuals' development.

The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study

Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck’s cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.

The alteration of cognitive function networks in remitted patients with major depressive disorder: an independent component analysis

INTRODUCTION

Dysfunctional connectivity of resting-state functional networks has been observed in patients with major depressive disorder (MDD), particularly in cognitive function networks including the central executive network (CEN), default mode network (DMN) and salience network (SN). Findings from studies examining how aberrant functional connectivity (FC) changed after antidepressant treatment, however, have been inconsistent. Thus, the purpose of the present study was to explore potential mechanisms of altered cognitive function networks during resting-state between remitted major depressive disorder (rMDD) patients and healthy controls (HCs) and furthermore, the relationship between dysfunctional connectivity patterns in rMDD and clinical symptoms.

METHODOLOGY

In this study, 19 HCs and 19 rMDD patients were recruited for resting-state functional magnetic resonance imaging (fMRI) scanning. FC was evaluated with independent component analysis for CEN, DMN and SN. Two sample t tests were conducted to compare differences between rMDD and HCs. A Pearson correlation analysis was also performed to examine the relationship between connectivity of networks and cognitive function scores and clinical symptoms.

RESULTS

Compared to healthy controls, remitted patients showed lower connectivity in CEN, mostly in the superior frontal gyrus (SFG), middle frontal gyrus (MFG), inferior parietal lobule (IPL) and part of the supramarginal gyrus (SMG). Conversely, the bilateral insula, part of the SMG (a key node of the CEN) and dorsal anterior cingulate cortex (dACC) of the DMN showed higher connectivity in rMDD patients. Pearson correlation results demonstrated that connectivity of the right IPL in CEN was positively correlated with cognitive function scores, and connectivity of the left insula was negatively correlated with BDI scores.

CONCLUSIONS

Though rMDD patients reached the standard of clinal remission, unique impairments of FC in cognitive function networks remained. Aberrant FC between cognitive function networks responsible for executive control was observed in rMDD and may be associated with residual clinical symptoms.

Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach

BACKGROUND

The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population.

METHODS

Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms.

RESULTS

In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality.

CONCLUSION

Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.

The relations among worry, meta-worry, intolerance of uncertainty and attentional bias for threat in men at high risk for generalized anxiety disorder: a network analysis

BACKGROUND

Improving the psychotherapies for generalized anxiety disorder (GAD) is dependent on a deeper understanding of the relations between GAD and its associated cognitive factors. In the present study, we investigate how the core feature of GAD (i.e., worry) and its associated cognitive factors, such as meta-worry, intolerance of uncertainty, and attention bias towards threat, relate to each other in men at high risk for GAD.

METHODS

We used network analysis to explore the relations among these variables in a cross-sectional sample of 122 men at high risk for generalized anxiety disorder. Specifically, we computed the expected influence and predictability of each variable.

RESULTS

In the final network, we found that worry and meta-worry had the highest expected influence and predictability. In contrast, attention bias towards threat showed the lowest expected influence and predictability. The estimates of the expected influence of the nodes were stable (correlation stability coefficient = 0.52).

CONCLUSIONS

The present study is the first to investigate the relations among worry, meta-worry, intolerance of uncertainty, and attention bias towards threat in men at high risk for generalized anxiety disorder. These findings indicate that worry and meta-worry may play important roles in the present network. The implications for clinical interventions and future studies are discussed.

Bridging maladaptive social self-beliefs and social anxiety: a network perspective

The Clark and Wells (1995) model of social anxiety disorder postulates that three types of maladaptive social self-beliefs (high standard, conditional, and unconditional beliefs) play a crucial role in the development of fear and avoidance of social-evaluative situations-i.e., the hallmark symptoms of social anxiety disorder. In this project, we examined associations between the three types of maladaptive social self-beliefs and fear and avoidance of social-evaluative situations in a nonclinical community sample (n = 389). We used network analysis to estimate functional relations among aspects of maladaptive self-beliefs, fear, and avoidance and computed two different network models, a graphical Gaussian model (GGM) and a directed acyclic graph (DAG). Each model estimates edges and the importance of nodes in different ways. Both GGM and DAG pointed to fear and conditional beliefs as especially potent bridges between maladaptive social self-beliefs and social anxiety in our nonclinical sample. Altogether, these results offer data-driven heuristics in the field's larger, ongoing effort to illuminate pathways at play in the development of social anxiety. We situate this study within novel network approaches for developing theory-driven models and tests of the instigation and interactions of maladaptive social self-beliefs and social anxiety. However, because this is the first study to combine GGM and DAG in social anxiety research, we also discussed the caveats to this approach to help to usher the field forward.

A complex systems approach to the study of change in psychotherapy

BACKGROUND

A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions.

DISCUSSION

A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research.

CONCLUSIONS

A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.

Predicting adaptive and maladaptive responses to the Coronavirus (COVID-19) outbreak: A prospective longitudinal study

Background/Objective

The outbreak of COVID-19 and the lack of vaccine made extraordinary actions such as social distancing necessary. While some individuals experience the restrictions on daily life as a heavy burden, others adapt to the situation and try to make the best of it. The present longitudinal study investigated the extent and predictors of the burden induced by the outbreak of COVID-19 in Germany.

Method

Data were assessed in October 2019 using the DASS-21 and the PMH-Scale, and in March 2020 adding a six-item measure of burden and a 2-item rating of sense of control.

Results

In a sample of 436 participants, about 28% stayed in self-quarantine, 22 persons had relevant symptoms and one person was positively tested for COVID-19. Most participants experienced medium to high levels of burden but tried to make the best of it. Stress symptoms in 2019 predicted a higher level of burden and PMH predicted a lower level of burden in March 2020. Remarkably, depression and anxiety symptoms did not significantly predict burden. The protective effect of PMH and the negative impact of stress symptoms were mediated by perceived sense of control.

Conclusions

The results emphasize the protective effect of PMH in extraordinary situations such as the current outbreak of COVID-19.

Depicting the associations between different forms of psychopathology in trauma-exposed adolescents

Psychiatric comorbidity in traumatized youth is prevalent, but such associations between two disorders may be confounded with other comorbid conditions. Few studies have examined the unique relationships among multiple disorders. Which disorders maximally explain the relationships between others and whether such disorders differ by sex remain largely unknown. Using a construct-level network approach, this study characterized the independent associations among nine prevalent emotional and behavioral disorders/problems evaluated by the PTSD Checklist for DSM-5, the Revised Children's Anxiety and Depression Scale, and the Youth Self-Report in a sample of 1181 disaster-exposed adolescents (53.9% girls; a mean age of 14.3 ± 0.8 years). The associations were strong among the seven internalizing problems and between the two externalizing ones, but weaker between these two spectra of psychopathology. Major depressive disorder (MDD) was most strongly connected with others, maximally accounting for the associations, especially those between the two spectra. Overall and individual association strength and the connecting role of MDD were generally equivalent across sex. These findings highlight the necessity of MDD in linking comorbid forms of psychopathology in traumatized youth, and suggest MDD as a potential intervention priority in this population.

Connectivity patterns of cognitive control network in first episode medication-naive depression and remitted depression

BACKGROUND

Cognitive dysfunctions, such as impaired cognitive control, are frequently observed in patients with major depressive disorder (MDD). Although the cognitive control network (CCN) is widely considered a core feature of major depressive disorder (MDD), the relationship between cognitive dysfunction and symptom dimensions remains unclear. This study investigated differences in resting-state functional connectivity of the cognitive control network (CCN) between first-episode medication-naive MDD patients and remitted MDD.

METHODS

We collected resting-state functional MRI (rs-fMRI) data from 22 first-episode medication-naive major depressive disorder (fMDD) patients, 20 patients previously diagnosed with MDD in the remitted phase of depression (rMDD), and 20 healthy controls (HC). The CCN was derived from fMRI images using independent component analysis (ICA), a data-driven image analysis method.

RESULTS

Changes in functional connectivity (FC) within the CCN was mainly attenuated in the right dorsolateral prefrontal cortex and the left inferior parietal lobule, while strengthened in the right dorsal anterior cingulate cortex and the right insula in both fMDD and rMDD groups. Compared with the fMDD group, the rMDD group had decreased FC in the bilateral insula and the right dorsolateral prefrontal cortex. Further analysis explored that the FC in the bilateral insula, the right dorsal anterior cingulate cortex and the right inferior parietal lobule were correlated positively cognitive disturbance factor scores in both patients groups.

CONCLUSIONS

These findings are in agreement with the previous findings that the cognitive control network are impaired in MDD. Furthermore, our results suggest that the alteration of CCN might underpin the cognitive disturbance and the distinct patterns of the CCN between fMDD and rMDD patients may be an important target for effective cognitive remediation in MDD.

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

BACKGROUND

Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility.

METHODS

Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of "network analysis" with the terms "anxiety," "affective disorders," "depression," "schizophrenia," "psychosis," "personality disorders," "substance abuse" and "psychopathology."

RESULTS

The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence.

CONCLUSIONS

A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

Socio-affective and cognitive predictors of social adaptation in vulnerable contexts

People living in vulnerable environments face a harder set of challenges adapting to their context. Nevertheless, an important number of them adapt successfully. However, which cognitive and socio-affective variables are specifically related to these variations in social adaptation in vulnerable contexts has not been fully understood nor directly addressed. Here we evaluated socio-affective variables (anxious attachment style, internal locus of control, self-esteem and stress) and cognitive variables (fluid intelligence, crystallized intelligence, working memory, numeracy, probabilistic reasoning and logical reasoning) to explain variations in social adaptation in a sample of 232 adults living in vulnerable contexts (M = 42.3, SD = 14.9, equal amount of men and women). Our results show that an important amount of variance in social adaptation can be explained by socio-affective variables, principally by self-esteem, while cognitive variables also contributed significantly. As far as we know, this is one of the first steps towards understanding the role of cognitive and socio-affective features on social adaptation. In the long run, this area of research could play an important role on the assignation of resources to ease people's integration into society. Our data and R analysis scripts can be found at: https://osf.io/egxy5/.

Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome

Some people experience persistent symptoms following a mild traumatic brain injury (MTBI), and the etiology of those symptoms has been debated for generations. Post-concussion-like symptoms are caused by many factors both before and after MTBI, and this non-specificity is the bedrock of the conundrum regarding the existence of the post-concussion syndrome. A latent model or common cause theory for the syndrome is inconsistent with the prevailing biopsychosocial conceptualization. It is the thesis of this paper that adopting a network perspective for persistent symptoms following MTBI, including the post-concussion syndrome, could lead to new insights and targeted treatment and rehabilitation strategies. The network perspective posits that symptoms co-occur because they are strongly inter-related, activating, amplifying, and mutually reinforcing, not because they arise from a common latent disease entity. This approach requires a conceptual shift away from thinking that symptoms reflect an underlying disease or disorder toward viewing inter-related symptoms as constituting the syndrome or disorder. The symptoms do not arise from an underlying syndrome—the symptoms are the syndrome. A network analysis approach allows us to embrace heterogeneity and comorbidity, and it might lead to the identification of new approaches to sequenced care. The promise of precision rehabilitation requires us to better understand the interconnections among symptoms and problems so that we can produce more individualized and effective treatment and rehabilitation.

Community structure analysis of rejection sensitive personality profiles: A common neural response to social evaluative threat?

Monitoring social threat is essential for maintaining healthy social relationships, and recent studies suggest a neural alarm system that governs our response to social rejection. Frontal-midline theta (4–8 Hz) oscillatory power might act as a neural correlate of this system by being sensitive to unexpected social rejection. Here, we examined whether frontal-midline theta is modulated by individual differences in personality constructs sensitive to social disconnection. In addition, we examined the sensitivity of feedback-related brain potentials (i.e., the feedback-related negativity and P3) to social feedback. Sixty-five undergraduate female participants (mean age = 19.69 years) participated in the Social Judgment Paradigm, a fictitious peer-evaluation task in which participants provided expectancies about being liked/disliked by peer strangers. Thereafter, they received feedback signaling social acceptance/rejection. A community structure analysis was employed to delineate personality profiles in our data. Results provided evidence of two subgroups: one group scored high on attachment-related anxiety and fear of negative evaluation, whereas the other group scored high on attachment-related avoidance and low on fear of negative evaluation. In both groups, unexpected rejection feedback yielded a significant increase in theta power. The feedback-related negativity was sensitive to unexpected feedback, regardless of valence, and was largest for unexpected rejection feedback. The feedback-related P3 was significantly enhanced in response to expected social acceptance feedback. Together, these findings confirm the sensitivity of frontal midline theta oscillations to the processing of social threat, and suggest that this alleged neural alarm system behaves similarly in individuals that differ in personality constructs relevant to social evaluation.

Unfolding the Complex Dynamic Interplay Between Attentional Processes and Anxiety: A Commentary on Ghassemzadeh, Rothbart, and Posner

Theories about the involvement of attention in feelings of fear and anxiety have been debated in philosophical circles since long before the foundation of experimental psychology and cognitive neuroscience. In this issue, Ghassemzadeh, Rothbart, and Posner (2019) provide a much-needed historical and conceptual review of the relations between attention and anxiety disorders. Throughout their paper, they argue that insights from the study of brain networks of attention offer a particularly viable prospect for best clarifying the complex relations between attentional processes and anxiety. We fully share this view. Moreover, we believe that the computational and conceptual tools of network analysis (also known as graph theory) can enable researchers to move even closer to elucidating the complex dynamic interplay between those phenomena. In this commentary, we explain why and how to use network analysis for this purpose.

Early maladaptive schemas and borderline personality disorder features in a nonclinical sample: A network analysis

Borderline personality disorder (BPD) is a challenging problem. Early maladaptive schemas (EMSs) are considered as important vulnerability factors for the development and maintenance of BPD. Literature suggests a complex relationship between BPD and EMSs. The current study employed network analysis to model the complex associations between central BPD features (i.e., affective instability, identity problems, negative relations, and self-harm) and EMSs in 706 undergraduate students. The severity of BPD symptoms was assessed using the Personality Assessment Inventory-Borderline subscale; the Young Schema Questionnaire-Short Form was used to assess EMSs. Results suggest that specific EMSs show unique associations with different BPD features. Interestingly, affective instability showed no unique associations with EMSs. Identity problems were uniquely associated with abandonment, insufficient self-control, dependence/incompetence, and vulnerability to harm/illness schemas. Negative relations in BPD showed unique connections with mistrust/abuse and abandonment. Finally, BPD self-harm was connected to emotional deprivation and failure. These findings indicate potential pathways between EMSs and specific BPD features that could improve our understanding of BPD theoretically and clinically.

Further evidence that psychopathology networks have limited replicability and utility: Response to Borsboom et al. (2017) and Steinley et al. (2017)

In our target article, we tested the replicability of 4 popular psychopathology network estimation methods that aim to reveal causal relationships among symptoms of mental illness. We started with the focal data set from the 2 foundational psychopathology network papers (i.e., the National Comorbidity Survey-Replication) and identified the National Survey of Mental Health and Wellbeing as a close methodological match for comparison. We compared the psychopathology networks estimated in each data set-as well as in 10 sets of random split-halves within each data set-with the goal of quantifying the replicability of the network parameters as they are interpreted in the extant psychopathology network literature. We concluded that current psychopathology network methods have limited replicability both within and between samples and thus have limited utility. Here we respond to the 2 commentaries on our target article, concluding that the findings of Steinley, Hoffman, Brusco, and Sher (2017)-along with other recent developments in the literature-provide further conclusive evidence that psychopathology networks have poor replicability and utility. (PsycINFO Database Record

Between vulnerability and resilience: A network analysis of fluctuations in cognitive risk and protective factors following remission from depression

Research exploring how cognitive risk- and protective factors relate following remission from internalizing disorders suggests a central role for resilience. However, it remains unclear what constitutes resilience in this context. Furthermore, previous studies have typically relied on cross-sectional data which do not allow to map the temporal dynamics of such relations. Using a seven-day experience sampling period in 85 remitted depressed patients, we examined the interplay between five transdiagnostic vulnerability- and protective factors in daily life. We present a temporal, contemporaneous, and a between-subjects network, providing an in-depth analysis of how these factors relate to daily life fluctuations in residual symptomatology. Furthermore, we test the role of positive affect as a main resilience factor. Resilience uniquely predicted all other factors over time (temporal network). Higher levels of resilience were related to less momentary use of rumination, more deployment of positive appraisal, and lower occurrence of residual symptoms (contemporaneous network). Participants scoring high on resilience mostly engaged in positive appraisal (between-subjects network). Similar structures were obtained when substituting self-reported resilience by positive affect. This highlights the importance of resilience, and in particular, positive affectivity, to cope with stressors following remission. This may be fostered by facilitating the use of positive appraisal.

Co-occurring internalizing and externalizing psychopathology in childhood and adolescence: a network approach

The network approach suggests that psychopathology arises from complex associations between symptoms and may offer insight into the mechanisms that underpin psychiatric comorbidities. The transition from childhood to adolescence is a key period in the development of psychopathology, yet has rarely been considered from a network perspective. As such, the present study examined the network structure of internalizing and externalizing psychopathology from middle childhood through adolescence using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 4405). Eight DSM-IV disorders were assessed using maternal reports when children were aged 7.5, 10.5 and 14 years. Weighted, undirected networks were estimated and the relative importance of each node was assessed using three common measures of node centrality; strength, betweenness, and closeness. A consistent network structure emerged at all three time points; nodes clustered together in two regions of space broadly reflecting the internalizing and externalizing spectra. Permutation tests supported structural invariance across this developmental period. These spectra were bridged by numerous disorder-level interactions, the most consistent of which was between depression and oppositional defiant disorder (ODD). Furthermore, inspection of the centrality indices indicated that generalised anxiety disorder and ODD were the most central disorders in the networks. These findings demonstrate that symptom/disorder-level interplay and reciprocal influence are plausible mechanisms for the association between internalizing and externalizing psychopathology in childhood/adolescence.

Heterogeneity in Cognitive and Socio-Emotional Functioning in Adolescents With On-Track and Delayed School Progression

Adolescence is characterized by considerable changes in cognitive and socio-emotional skills. There are considerable differences between adolescents with regards to the development of these skills. However, most studies examine adolescents' average functioning, without taking into account this heterogeneity. The current study applies network analysis in order to examine heterogeneity of cognitive and socio-emotional functioning in adolescents on-track or delayed in their school progression. Data was collected at two time-points for on-track (n = 320) and delayed (n = 69) adolescents (Mage = 13.30 years, SDage = 0.77). Repeated measures ANOVA showed no significant differences between the groups in cognitive and socio-emotional functioning (p's > 0.05). Network analysis revealed that executive functions play a key role in the network of cognitive, social, and emotional functioning. This is especially the case in the delayed group where executive functions are even more central, both at T1 (inhibition and shifting) and T2 (shifting). Subsequent community analysis revealed three profiles in both groups: a well-adapted and well-balanced group, a group with high levels of need for arousal and risk-taking, and a group with regulation problems. Compared to on-track adolescents, delayed adolescents showed even higher levels of risk-taking in the second profile and higher levels of executive function problems in the third profile at T1. These differences were leveled out at T2, indicating adolescents in the delayed group catch up with their peers. This study highlights the intricate balance between cognitive, social and emotional functioning in adolescents in relation to school performance and provides preliminary evidence of the importance of taking individual differences within groups into account.

Daily dynamic assessment and modelling of intersession processes in ambulatory psychotherapy: A proof of concept study

Background: the typical mode of assessment in studies on intersession processes (ISP) in psychotherapy is using cross-sectional or weekly measurements. Daily dynamics of intersession processes have not yet been studied. Method: intersession process data from 22 ambulatory psychotherapy cases were collected in a naturalistic study with high temporal resolution, resulting in a total of 1026 daily measurements. Multilevel vector autoregressive (VAR) modelling was applied to discover the temporal course and causal influences among intersession processes. Centrality analysis was applied to discover unique functions of various intersession process variables. Results: a group-level network structure was discovered, offering first insights on the role of different intersession processes during psychotherapy. Centrality analysis revealed unique roles for various aspects of the intersession process. Temporal distance from the last session had only weak influence on the ISP. Conclusions: using short, daily measures, the unique role of various aspects of the ISP were uncovered. Some aspects of the ISP, like recalling session contents or reflection on future session contents, are facilitators of overall ISP intensity. Other aspects like thoughts on payment or appointments or negative treatment-related emotions are likely to suppress ISP.

Resilience and Cognitive Function in Patients With Schizophrenia and Bipolar Disorder, and Healthy Controls

Background: This study compared adaptive resilience among patients with schizophrenia, bipolar disorder, and healthy controls, and examined the relationship of resilience to cognitive function. Methods: A sample of 81 patients diagnosed with schizophrenia, 34 with bipolar disorder, and 52 healthy controls completed the Connor-Davidson Resilience Scale (CD-RISC) and cognitive tests of verbal comprehension, executive functioning, and working memory. Paired comparison of diagnostic groups on CD-RISC and cognitive tests was conducted. Linear regression was used to identify the independent association of clinical diagnoses and neurocognition with resilience deficits. Results: Both patient groups showed significantly lower CD-RISC scores and poorer cognitive function than healthy controls and the schizophrenia group scored lower than bipolar group on these measures as well. CD-RISC scores were positively correlated with all three cognitive measures in the entire sample but not within the diagnostic subgroups. Multiple regression analysis showed differences in CD-RISC between diagnostic groups were not mediated by differences in these three measures of neurocognition. Discussion: Schizophrenia and bipolar disorder are associated with impairments in both resilience and cognitive function but the impairment in resilience appears to be independent of deficits in cognitive function measured here and may reflect unmeasured dimensions of cognitive function, other impairments or environmental factors.

Hubness of strategic planning and sociality influences depressive mood and anxiety in College Population

Depressive mood and anxiety can reduce cognitive performance. Conversely, the presence of a biased cognitive tendency may serve as a trigger for depressive mood-anxiety. Previous studies have largely focused on group-wise correlations between clinical-neurocognitive variables. Using network analyses for intra-individual covariance, we sought to decipher the most influential clinical-neurocognitive hub in the differential severity of depressive-anxiety symptoms in a college population. Ninety college students were evaluated for depressive-anxiety symptoms, Minnesota multiphasic personality inventory-2(MMPI-2), and neuro-cognition. Weighted and undirected version of the intra-individual covariance networks, comprised of 18 clinical-neurocognitive variables satisfied small-worldness and modular organization in the sparsity range of K = 0.20-0.21. Furthermore, betweenness centrality of perseverative error for the Wisconsin card sorting test was reduced in more depressive individuals; higher anxiety was related to the increased betweenness centrality of MMPI-2 clinical scale 0(Si). Elevated edge-betweenness centrality of covariance between the MMPI-2 clinical scale 7(Pt) versus commission error of the continuous performance test predicted more anxiety higher than depressive mood. With intra-individual covariance network of clinical-neurocognitive variables, this study demonstrated critical drivers of depressive mood[attenuated influence of strategic planning] or anxiety[domination of social introversion/extroversion, in addition to the influence of compulsivity-impulsivity covariance as a shortcut component among various clinical-neurocognitive features].

How predictable are symptoms in psychopathological networks? A reanalysis of 18 published datasets

BACKGROUND

Network analyses on psychopathological data focus on the network structure and its derivatives such as node centrality. One conclusion one can draw from centrality measures is that the node with the highest centrality is likely to be the node that is determined most by its neighboring nodes. However, centrality is a relative measure: knowing that a node is highly central gives no information about the extent to which it is determined by its neighbors. Here we provide an absolute measure of determination (or controllability) of a node - its predictability. We introduce predictability, estimate the predictability of all nodes in 18 prior empirical network papers on psychopathology, and statistically relate it to centrality.

METHODS

We carried out a literature review and collected 25 datasets from 18 published papers in the field (several mood and anxiety disorders, substance abuse, psychosis, autism, and transdiagnostic data). We fit state-of-the-art network models to all datasets, and computed the predictability of all nodes.

RESULTS

Predictability was unrelated to sample size, moderately high in most symptom networks, and differed considerable both within and between datasets. Predictability was higher in community than clinical samples, highest for mood and anxiety disorders, and lowest for psychosis.

CONCLUSIONS

Predictability is an important additional characterization of symptom networks because it gives an absolute measure of the controllability of each node. It allows conclusions about how self-determined a symptom network is, and may help to inform intervention strategies. Limitations of predictability along with future directions are discussed.

Maternal distress in the context of their child's type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8-15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.

Evidence that psychopathology symptom networks have limited replicability

Network analysis is quickly gaining popularity in psychopathology research as a method that aims to reveal causal relationships among individual symptoms. To date, 4 main types of psychopathology networks have been proposed: (a) association networks, (b) regularized concentration networks, (c) relative importance networks, and (d) directed acyclic graphs. The authors examined the replicability of these analyses based on symptoms of major depression and generalized anxiety between and within 2 highly similar epidemiological samples (i.e., the National Comorbidity Survey-Replication [n = 9282] and the National Survey of Mental Health and Wellbeing [n = 8841]). Although association networks were stable, the 3 other types of network analysis (i.e., the conditional independence networks) had poor replicability between and within methods and samples. The detailed aspects of the models-such as the estimation of specific edges and the centrality of individual nodes-were particularly unstable. For example, 44% of the symptoms were estimated as the "most influential" on at least 1 centrality index across the 6 conditional independence networks in the full samples, and only 13-21% of the edges were consistently estimated across these networks. One of the likely reasons for the instability of the networks is the predominance of measurement error in the assessment of individual symptoms. The authors discuss the implications of these findings for the growing field of psychopathology network research, and conclude that novel results originating from psychopathology networks should be held to higher standards of evidence before they are ready for dissemination or implementation in the field. (PsycINFO Database Record