Toward an Integration of Interpersonal Risk Models of Depression and Cognitive‐Behaviour Therapy

The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic

OBJECTIVES

The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic.

METHODS

Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021.

RESULTS

Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association.

CONCLUSIONS

These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.

How social rejection expectations and depressive symptoms bi-directionally predict each other - A cross-lagged panel analysis

BACKGROUND

Although research suggests that social rejection expectations play a crucial role in the development and maintenance of depressive symptoms, it is not clear whether such expectations are a risk factor for depression or rather a consequence thereof. The present study addressed this issue by investigating the time-lagged bi-directional effects of social rejection expectations and depressive symptoms.

METHODS

In an online survey, participants (N = 347) completed measures of social rejection expectations, depressive symptoms, interpersonal competencies, and perceived social support at baseline and 2 months later. The relationships between the variables were examined using path models and cross-lagged path analyses.

RESULTS

Cross-lagged path analyses provided evidence for a substantial positive effect of social rejection expectations at baseline on depressive symptoms at follow-up in addition to the reverse effect. A mediator analysis indicated that neither interpersonal competencies nor perceived social support mediated these bi-directional effects.

CONCLUSION

The current results demonstrate that social rejection expectations and depressive symptoms bi-directionally predict each other. Thus, social rejection expectations appears to be both a risk factor for - and a symptom of - depression. In order to prevent a vicious circle of social rejection expectations and depressive symptoms, we recommend the early detection and treatment of social rejection expectations. Moreover, social rejection expectations should be specifically addressed in cognitive-behavioural treatment of depression.

Depression Symptoms, Mattering, and Anti-mattering: Longitudinal Associations in Young Adulthood

We examined the dynamic interplay of depression symptoms, mattering (i.e., self-evaluation of importance or significance to others), and anti-mattering across four years of development in young adulthood (age 20–23; N = 452) using a cross-lagged panel model (CLPM). Support for a transactional model between anti-mattering and depression symptoms was found. Specifically, anti-mattering positively predicted later depression symptoms and depression symptoms consistently predicted later anti-mattering. Depression symptoms also shared a negative association with later mattering but not the reverse, supporting a symptoms-driven model of depression symptoms and mattering. Auto-regressive paths, residual covariances, and cross-lagged paths were invariant over time. Accounting for gender, household income, parental education, and fear of COVID-19 as covariates did not change the results. The stability of mattering and anti-mattering suggest careful consideration of how to effectively change these patterns. The implications for assessment and intervention on mattering or anti-mattering in the prevention and treatment of depression are discussed.

Interpersonal Self-Efficacy, Goals, and Problems of Persistently Depressed Outpatients: Prototypical Circumplex Profiles and Distinctive Subgroups

Severely and persistently depressed outpatients ( n = 138) completed interpersonal circumplex measures of self-efficacy, problems, and values/goals. Compared with normative samples, patients showed deficits in agency: They reported less self-efficacy, especially for being assertive, tough, and influential; stronger goals, especially to avoid conflict or humiliation; and more problems, especially with being too timid, inhibited, and accommodating. Circular and structural summary indices suggested greater variability among patients in goal profiles than in efficacy or problem profiles; nonetheless, latent profile analyses identified coherent subgroups of patients with distinct patterns of efficacy (e.g., lacking confidence for speaking up vs. setting boundaries) and problems (e.g., being overly inhibited vs. self-sacrificing) as well as goals (e.g., to be included vs. unobtrusive). Women and those with more severe symptoms were overrepresented in the least agentic groups. The results show how observing patients through multiple circumplex surfaces simultaneously can help clarify their interpersonal dispositions and inform interventions.

It's Not Me, It's You: Self- and Partner-Schemas, Depressive Symptoms, and Relationship Quality

Depression is associated with a host of interpersonal difficulties, particularly within intimate relationships. Although a significant body of literature has supported the presence of a highly consolidated negative self-representation or self-schema, no studies have examined whether depression is also associated with a highly organized negative “partner-schema”, and whether this represents a risk factor for relationship distress. Given the high degree of similarity between cognitive representations of self and close others, it was predicted that depression would be associated with a partner-schema structure mirroring that of the self-schema: an organized cognitive structure characterized by tightly interconnected negative information, and loosely dispersed positive information. In a sample of 291 undergraduate students, results supported this hypothesis. The findings also revealed that partner-schema structure was associated with relationship quality and attributions about a partner's behaviors over and above self-schema structure. These findings have important implications for understanding the link between cognitive risk factors, relational dysfunction, and depressive symptoms.

Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study

The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m²) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.

Emotional availability and social skills: A link between mother-child depressive symptoms

This research examined the intergenerational transmission of depressive symptoms from mothers to their adult children through two succeeding mediators: a child’s perception of emotional availability from their mothers, and a child’s social skills. To do so, this study integrated principles from the integrative model of risk from depressed mother to offspring, attachment theory, and the social skills deficit theory of depression. Child reports of depressive symptoms, perceived emotional availability from mothers, and social skills were assessed as well as mother reports of depressive symptoms from 224 (N = 448) mother-child dyads. Results showed that maternal depressive symptoms were significantly related to child perceptions of emotional availability. Moreover, emotional availability was positively related to child social skills, which in turn was negatively related to child depressive symptoms. Additionally, the indirect effect from maternal depressive symptoms to child depressive symptoms through the mediators was significant. The theoretical and practical implications of these findings are discussed.

Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy

Homework assignments have been shown to produce both causal and correlational effects in prior meta-analytic reviews of cognitive behavior therapy (CBT), but this research area has been characterized by a focus on the amount of compliance (i.e., quantity), and little is known about the role of skill acquisition (i.e., quality). A landmark study by Neimeyer and Feixas (1990) showed stronger homework-outcome relations when quality was assessed, but previous reviews have not considered whether the same pattern is evident across studies. Seventeen studies of CBT (N = 2,312 clients) published following calls for research on homework quality were included in the current meta-analysis. In the present review, homework compliance relations were demonstrated when outcome was assessed at posttreatment (quality Hedges' g = 0.78, 95% Confidence Interval [CI] = 0.03 to 1.53, k = 3, n = 417; quantity g = 0.79, 95% CI = 0.57 to 1.02, k = 15, n = 1537) and at follow-up (quality g = 1.07, 95% CI = 0.06 to 2.08, k = 3, n = 417; quantity g = 0.51, 95% CI = 0.28 to 0.74, k = 7, n = 1291). All effect sizes were different from 0, ps < .05. Differences that were obtained in homework-outcome relations among sources of compliance data (client, therapist, objective) were tentative due to overlapping CIs, but suggest a potential moderating effect. If confirmed by further research, the present findings would suggest that trial methods capable of assessing both quantity and quality have been an important omission in research on homework-outcome relations in CBT.

Primary care management of depression in children and adolescents

Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting.