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Babicola L, Mancini C, Riccelli C, Di Segni M, Passeri A, Municchi D, D'Addario SL, Andolina D, Cifani C, Cabib S, Ventura R. A mouse model of the 3-hit effects of stress: Genotype controls the effects of life adversities in females. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110842. [PMID: 37611651 DOI: 10.1016/j.pnpbp.2023.110842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
Helplessness is a dysfunctional coping response to stressors associated with different psychiatric conditions. The present study tested the hypothesis that early and adult adversities cumulate to produce helplessness depending on the genotype (3-hit hypothesis of psychopathology). To this aim, we evaluated whether Chronic Unpredictable Stress (CUS) differently affected coping and mesoaccumbens dopamine (DA) responses to stress challenge by adult mice of the C57BL/6J (B6) and DBA/2J (D2) inbred strains depending on early life experience (Repeated Cross Fostering, RCF). Three weeks of CUS increased the helplessness expressed in the Forced Swimming Test (FST) and the Tail Suspension Test by RCF-exposed female mice of the D2 strain. Moreover, female D2 mice with both RCF and CUS experiences showed inhibition of the stress-induced extracellular DA outflow in the Nucleus Accumbens, as measured by in vivo microdialysis, during and after FST. RCF-exposed B6 mice, instead, showed reduced helplessness and increased mesoaccumbens DA release. The present results support genotype-dependent additive effects of early experiences and adult adversities on behavioral and neural responses to stress by female mice. To our knowledge, this is the first report of a 3-hit effect in an animal model. Finally, the comparative analyses of behavioral and neural phenotypes expressed by B6 and D2 mice suggest some translationally relevant hypotheses of genetic risk factors for psychiatric disorders.
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Affiliation(s)
- Lucy Babicola
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Camilla Mancini
- University of Camerino, School of Pharmacy, Pharmacology Unit, Camerino, Italy
| | - Cristina Riccelli
- Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Matteo Di Segni
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Alice Passeri
- Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Diana Municchi
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | | | - Diego Andolina
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Carlo Cifani
- University of Camerino, School of Pharmacy, Pharmacology Unit, Camerino, Italy
| | - Simona Cabib
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy.
| | - Rossella Ventura
- IRCCS Fondazione Santa Lucia, Rome, Italy; IRCCS San Raffaele, Rome, Italy.
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Yuan GF, Tam CC, Yang X, Qiao S, Li X, Shen Z, Zhou Y. Associations Between Internalized and Anticipated HIV Stigma and Depression Symptoms Among People Living with HIV in China: A four-wave Longitudinal Model. AIDS Behav 2023; 27:4052-4061. [PMID: 37392272 DOI: 10.1007/s10461-023-04119-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18-60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Cheuk Chi Tam
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xueying Yang
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
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Fernandez DK, Singh S, Deane FP, Vella SA. Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis. Community Ment Health J 2023; 59:275-289. [PMID: 35994182 PMCID: PMC9859906 DOI: 10.1007/s10597-022-01005-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.
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Affiliation(s)
- Dominic K. Fernandez
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Saniya Singh
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Frank P. Deane
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
| | - Stewart A. Vella
- School of Psychology, University of Wollongong, North Wollongong, NSW 2522 Australia
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Edwards DJ. Going beyond the DSM in predicting, diagnosing, and treating autism spectrum disorder with covarying alexithymia and OCD: A structural equation model and process-based predictive coding account. Front Psychol 2022; 13:993381. [PMID: 36148114 PMCID: PMC9485626 DOI: 10.3389/fpsyg.2022.993381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background There is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health. Aim This study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging. Methodology The data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC). Results Heart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception. Conclusion The results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame.
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Wang X, He Y, Feng Z. The antidepressant effect of cognitive reappraisal training on individuals cognitively vulnerable to depression: Could cognitive bias be modified through the prefrontal–amygdala circuits? Front Hum Neurosci 2022; 16:919002. [PMID: 35992951 PMCID: PMC9385997 DOI: 10.3389/fnhum.2022.919002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive reappraisal (CR) is one of the core treatment components of cognitive behavioral therapy (CBT) and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training which hypothesizes that CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias (negative attention bias, negative memory bias, negative interpretation bias, and/or negative rumination bias) and alleviating depressive symptoms. This study aims to (1) explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; (2) test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias (interpretation bias and/or rumination bias); (3) explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and (4) examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals.
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Affiliation(s)
- Xiaoxia Wang
- Department of Basic Psychology, School of Psychology, Army Medical University, Chongqing, China
- *Correspondence: Xiaoxia Wang,
| | - Ying He
- Department of Psychiatry, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhengzhi Feng
- School of Psychology, Army Medical University, Chongqing, China
- Zhengzhi Feng,
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Morris L, Innes A, Smith S, Wilson J, Bushell S, Wyatt M. A qualitative evaluation of the impact of a Good Life Club on people living with dementia and care partners. DEMENTIA 2021; 20:2478-2493. [PMID: 33745346 PMCID: PMC8564258 DOI: 10.1177/1471301221998897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research suggests there is a lack of post-diagnostic support to enable people living with dementia to fulfil social and active lives throughout their dementia journey. Gardening has been found to have many benefits for people living with dementia. Although such research is important, most research frames people with dementia as passive recipients of stimulation. Research into the impact of a community-based gardening group, where people living with dementia are active in the development of an outdoor space, is underdeveloped. Knowledge about the impact of participating in such groups is also sparse. The Good Life Club (GLC) was co-developed and evaluated to respond to these gaps. OBJECTIVES The primary aim of this article is to present the findings regarding the impact of attending the GLC on the self-reported well-being for people living with dementia and care partners. METHODS Qualitative data were collected via 22 semi-structured interviews. Fourteen interviews were conducted before the GLC and eight after the GLC. Thematic analysis was used to analyse data. Dementia Care Mapping data were collected to supplement the interview data. FINDINGS Four key themes were identified. The first was that participants considered having active participation in social life to be a key aspect of living a good life. The second was that the way that the GLC was set up and delivered gave the participants ownership of the GLC and within this they felt able to contribute. The third was the importance of social connectedness and peer support to the well-being of both people living with dementia and care partners. Fourth, positive mood and well-being was directly experienced through gardening. CONCLUSIONS The combination of long-term investment of time and energy to the GLC, ongoing friendships and in-session autonomy act as key ingredients in creating a group that is relaxed, full of humour and highly valued.
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Affiliation(s)
- Lydia Morris
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
| | - Anthea Innes
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
| | - Sarah Smith
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
| | - Jack Wilson
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
| | - Sophie Bushell
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
| | - Megan Wyatt
- School of Health and Society, Institute of Dementia, 5292University of Salford, UK
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7
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Explanatory Styles of Counsellors in Training. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2021. [DOI: 10.1007/s10447-021-09429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractExplanatory style is based on how one explains good and bad events according to three dimensions: personalization, permanence, and pervasiveness. With an optimistic explanatory style, good events are explained as personal, permanent, and pervasive, whereas bad events are explained as external, temporary, and specific. For counsellors, an optimistic explanatory style creates positive expectancy judgments about the possibilities and opportunities for successful client outcomes. In this research study, we explored the explanatory styles expressed in 400 events (200 good events and 200 bad events) extracted from 38,013 writing samples of first year and final year graduate level counsellors in training. Across the three optimism dimensions and within good and bad events, there was one occurrence of a positive relationship between counsellor training time and the amount of expressed optimism. The implications of this study include the need to cultivate optimistic explanatory styles of counsellors in training and practicing counsellors.
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8
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Price RB, Cummings L, Gilchrist D, Graur S, Banihashemi L, Kuo SS, Siegle GJ. Towards personalized, brain-based behavioral intervention for transdiagnostic anxiety: Transient neural responses to negative images predict outcomes following a targeted computer-based intervention. J Consult Clin Psychol 2019; 86:1031-1045. [PMID: 30507228 DOI: 10.1037/ccp0000309] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information. METHOD Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat. RESULTS Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy. CONCLUSIONS Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse). (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Logan Cummings
- Department of Psychology, Florida International University
| | | | - Simona Graur
- Department of Psychiatry, University of Pittsburgh
| | | | - Susan S Kuo
- Department of Psychology, University of Pittsburgh
| | - Greg J Siegle
- Deparments of Psychiatry and Psychology, University of Pittsburgh
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Bunford N, Kinney KL, Michael J, Klumpp H. Threat distractor and perceptual load modulate test-retest reliability of anterior cingulate cortex response. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:120-127. [PMID: 28408292 PMCID: PMC9278877 DOI: 10.1016/j.pnpbp.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/28/2017] [Accepted: 04/06/2017] [Indexed: 11/27/2022]
Abstract
Accumulating data from fMRI studies implicate the rostral anterior cingulate cortex (rACC) in inhibition of attention to threat distractors that compete with task-relevant goals for processing resources. However, little data is available on the reliability of rACC activation. Our aim in the current study was to examine test-retest reliability of rACC activation over a 12-week period, in the context of a validated emotional interference paradigm that varied in perceptual load. During functional MRI, 23 healthy volunteers completed a task involving a target letter in a string of identical letters (low load) or in a string of mixed letters (high load) superimposed on angry, fearful, and neutral face distractors. Intraclass correlation coefficients (ICCs) indicated that under low, but not high perceptual load, rACC activation to fearful vs. neutral distractors was moderately reliable. Conversely, regardless of perceptual load, rACC activation to angry vs. neutral distractors was not reliable. Regarding behavioral performance, ICCs indicated that accuracy was not reliable regardless of distractor type or perceptual load. Although reaction time (RT) was similarly not reliable regardless of distractor type under low perceptual load, RT to angry vs. neutral distractors and to fearful vs. neutral distractors was reliable under high perceptual load. Together, results indicate the test-retest reliability of rACC activation and corresponding behavioral performance are context dependent; reliability of the former varies as a function of distractor type and level of cognitive demand, whereas reliability of the latter depends on behavioral index (accuracy vs. RT) and level of cognitive demand but not distractor type.
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Affiliation(s)
- Nora Bunford
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | - Kerry L. Kinney
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Jamie Michael
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA
| | - Heide Klumpp
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA,Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA
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Yamamoto T, Toki S, Siegle GJ, Takamura M, Takaishi Y, Yoshimura S, Okada G, Matsumoto T, Nakao T, Muranaka H, Kaseda Y, Murakami T, Okamoto Y, Yamawaki S. Increased amygdala reactivity following early life stress: a potential resilience enhancer role. BMC Psychiatry 2017; 17:27. [PMID: 28100219 PMCID: PMC5241989 DOI: 10.1186/s12888-017-1201-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/07/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Amygdala hyper-reactivity is sometimes assumed to be a vulnerability factor that predates depression; however, in healthy people, who experience early life stress but do not become depressed, it may represent a resilience mechanism. We aimed to test these hypothesis examining whether increased amygdala activity in association with a history of early life stress (ELS) was negatively or positively associated with depressive symptoms and impact of negative life event stress in never-depressed adults. METHODS Twenty-four healthy participants completed an individually tailored negative mood induction task during functional magnetic resonance imaging (fMRI) assessment along with evaluation of ELS. RESULTS Mood change and amygdala reactivity were increased in never-depressed participants who reported ELS compared to participants who reported no ELS. Yet, increased amygdala reactivity lowered effects of ELS on depressive symptoms and negative life events stress. Amygdala reactivity also had positive functional connectivity with the bilateral DLPFC, motor cortex and striatum in people with ELS during sad memory recall. CONCLUSIONS Increased amygdala activity in those with ELS was associated with decreased symptoms and increased neural features, consistent with emotion regulation, suggesting that preservation of robust amygdala reactions may reflect a stress buffering or resilience enhancing factor against depression and negative stressful events.
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Affiliation(s)
- Tetsuya Yamamoto
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh School of Medicine, 121 Meyran Avenue, Loeffler Building, 15260-5003 Pittsburgh, PA USA ,0000 0004 0614 710Xgrid.54432.34Japan Society for the Promotion of Science, 8 Ichiban-cho, Chiyoda-ku, Tokyo, 102-8472 Japan ,0000 0001 1092 3579grid.267335.6Present address. Graduate School of Integrated Arts and Sciences, Tokushima University 1-1, Minamijosanjima-cho, 770-8502 Tokushima, Japan
| | - Shigeru Toki
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Greg J. Siegle
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh School of Medicine, 121 Meyran Avenue, Loeffler Building, 15260-5003 Pittsburgh, PA USA ,0000 0001 0650 7433grid.412689.0Western Psychiatric Institute and Clinic, 3811 O Hara St, 15213-2593 Pittsburgh, PA USA
| | - Masahiro Takamura
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Yoshiyuki Takaishi
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Shinpei Yoshimura
- grid.443761.3Faculty of Psychology, Otemon Gakuin University, 2-1-15 Nishiai, 567-8502 Ibaraki, Osaka Japan
| | - Go Okada
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Tomoya Matsumoto
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Takashi Nakao
- 0000 0000 8711 3200grid.257022.0Department of Psychology, Graduate School of Education, Hiroshima University, 1-1-1 Kagamiyama, 739-8524 Higashi-Hiroshima, Hiroshima Japan
| | - Hiroyuki Muranaka
- grid.443768.aFaculty of Health Sciences, Tsukuba International University, 6-20-1 Manabe, 300-0051 Tsuchiura, Ibaraki Japan
| | - Yumiko Kaseda
- Department of Radiology, Hiroshima City General Rehabilitation Center, 1-39-1 Tomo-minami, Asaminami-ku, 731-3168 Hiroshima, Japan
| | - Tsuneji Murakami
- grid.415574.6Kure Kyosai Hospital, 2-3-28 Nishi-chuo, 737-8505 Kure, Hiroshima Japan
| | - Yasumasa Okamoto
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima, Japan.
| | - Shigeto Yamawaki
- 0000 0000 8711 3200grid.257022.0Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
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Ng MY, Weisz JR. Annual Research Review: Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 2016; 57:216-36. [PMID: 26467325 PMCID: PMC4760855 DOI: 10.1111/jcpp.12470] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. FINDINGS The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. CONCLUSION The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families.
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Affiliation(s)
- Mei Yi Ng
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Morris L, Mansell W, McEvoy P. The Take Control Course: Conceptual Rationale for the Development of a Transdiagnostic Group for Common Mental Health Problems. Front Psychol 2016; 7:99. [PMID: 26903907 PMCID: PMC4748307 DOI: 10.3389/fpsyg.2016.00099] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasingly, research supports the utility of a transdiagnostic understanding of psychopathology. However, there is no consensus regarding the theoretical approach that best explains this. Transdiagnostic interventions can offer service delivery advantages; this is explored in the current review, focusing on group modalities and primary care settings. OBJECTIVE This review seeks to explore whether a Perceptual Control Theory (PCT) explanation of psychopathology across disorders is a valid one. Further, this review illustrates the process of developing a novel transdiagnostic intervention (Take Control Course; TCC) from a PCT theory of functioning. METHOD Narrative review. RESULTS AND CONCLUSIONS Considerable evidence supports key tenets of PCT. Further, PCT offers a novel perspective regarding the mechanisms by which a number of familiar techniques, such as exposure and awareness, are effective. However, additional research is required to directly test the relative contribution of some PCT mechanisms predicted to underlie psychopathology. Directions for future research are considered.
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Affiliation(s)
- Lydia Morris
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Warren Mansell
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Phil McEvoy
- Six Degrees Social Enterprise, CIC, The Angel Centre Salford, UK
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Schwartz TL, Santarsieri D. Neural Implications of Psychotherapy, Pharmacotherapy, and Combined Treatment in Major Depressive Disorder. Mens Sana Monogr 2016; 14:30-45. [PMID: 28031623 PMCID: PMC5179626 DOI: 10.4103/0973-1229.193079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Numerous clinical trials have been conducted to determine the utility of antidepressant treatment (ADT), psychotherapy, and combined psycho-pharmaco-psychotherapy (PPPT) in treating major depressive disorder (MDD). While all approaches have shown benefit over placebo to varying degrees, the parallel neurophysiological mechanisms that underlie their efficacy have received little attention. The authors will review and discuss a growing body of literature that relates the factors of treatment selection and response to the principles of neuromodulation, with emphasis regarding how neuroimaging and other experimental data reinforce the need for personalized MDD treatment. This manuscript and its theoretical approaches were supported by conducting relevant literature searches of MEDLINE and PubMed electronic databases, prioritizing systemic reviews, and randomized clinical trials using selected MeSH terms. The authors conclude that ADT, psychotherapy, and PPPT all create potentially observable neurofunctional changes and argue that additive and synergistic potentiation of these effects in PPPT may produce more sustained symptom relief than with monotherapy alone.
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Affiliation(s)
- Thomas L Schwartz
- MD. Professor and Vice Chair of Psychiatry, and Director of Medical Student Psychiatric Education at SUNY Upstate Medical University. Syracuse, NY, USA
| | - Daniel Santarsieri
- B.S., Medical Student at the State University of New York (SUNY) Upstate Medical University in Syracuse, New York, USA E-mail:
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Roepke AM, Seligman MEP. Depression and prospection. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 55:23-48. [PMID: 26096347 DOI: 10.1111/bjc.12087] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 04/17/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions. METHODS We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive. RESULTS Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further. CONCLUSIONS Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.
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Affiliation(s)
- Ann Marie Roepke
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin E P Seligman
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Graur S, Siegle G. Pupillary motility: bringing neuroscience to the psychiatry clinic of the future. Curr Neurol Neurosci Rep 2014; 13:365. [PMID: 23780801 DOI: 10.1007/s11910-013-0365-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Modern pupillometry has expanded the study and utility of pupil responses in many new domains, including psychiatry, particularly for understanding aspects of cognitive and emotional information processing. Here, we review the applications of pupillometry in psychiatry for understanding patients' information processing styles, predicting treatment, and augmenting function. In the past year pupillometry has been shown to be useful in specifying cognitive/affective occurrences during experimental tasks and informing clinical diagnoses. Such studies demonstrate the potential of pupillary motility to be used in clinical psychiatry much as it has been in neurology for the past century.
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Affiliation(s)
- Simona Graur
- University of Pittsburgh, School of Medicine, 121 Meyran St, Pittsburgh, PA 15213, USA
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16
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Forgeard MJC, Elstein JG. Advancing the clinical science of creativity. Front Psychol 2014; 5:613. [PMID: 24994990 PMCID: PMC4063272 DOI: 10.3389/fpsyg.2014.00613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/30/2014] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marie J C Forgeard
- Department of Psychology, Positive Psychology Center, University of Pennsylvania Philadelphia, PA, USA
| | - Jeanette G Elstein
- Department of Psychology, Positive Psychology Center, University of Pennsylvania Philadelphia, PA, USA
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17
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Seligman ME. Chris Peterson’s unfinished masterwork: The real mental illnesses. JOURNAL OF POSITIVE PSYCHOLOGY 2014. [DOI: 10.1080/17439760.2014.888582] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mirrione MM, Schulz D, Lapidus KAB, Zhang S, Goodman W, Henn FA. Increased metabolic activity in the septum and habenula during stress is linked to subsequent expression of learned helplessness behavior. Front Hum Neurosci 2014; 8:29. [PMID: 24550809 PMCID: PMC3909949 DOI: 10.3389/fnhum.2014.00029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/13/2014] [Indexed: 12/04/2022] Open
Abstract
Uncontrollable stress can have a profound effect on an organism's ability to respond effectively to future stressful situations. Behavior subsequent to uncontrollable stress can vary greatly between individuals, falling on a spectrum between healthy resilience and maladaptive learned helplessness. It is unclear whether dysfunctional brain activity during uncontrollable stress is associated with vulnerability to learned helplessness; therefore, we measured metabolic activity during uncontrollable stress that correlated with ensuing inability to escape future stressors. We took advantage of small animal positron emission tomography (PET) and 2-deoxy-2[(18)F]fluoro-D-glucose ((18)FDG) to probe in vivo metabolic activity in wild type Sprague Dawley rats during uncontrollable, inescapable, unpredictable foot-shock stress, and subsequently tested the animals response to controllable, escapable, predictable foot-shock stress. When we correlated metabolic activity during the uncontrollable stress with consequent behavioral outcomes, we found that the degree to which animals failed to escape the foot-shock correlated with increased metabolic activity in the lateral septum and habenula. When used a seed region, metabolic activity in the habenula correlated with activity in the lateral septum, hypothalamus, medial thalamus, mammillary nuclei, ventral tegmental area, central gray, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and rostromedial tegmental nucleus, caudal linear raphe, and subiculum transition area. Furthermore, the lateral septum correlated with metabolic activity in the preoptic area, medial thalamus, habenula, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and caudal linear raphe. Together, our data suggest a group of brain regions involved in sensitivity to uncontrollable stress involving the lateral septum and habenula.
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Affiliation(s)
- Martine M. Mirrione
- Biomedical Sciences Department, Quinnipiac UniversityHamden, CT, USA
- Cold Spring Harbor Laboratory, NeuroscienceCold Spring Harbor, NY, USA
- Brookhaven National Laboratory, Medical DepartmentUpton, NY, USA
| | - Daniela Schulz
- Brookhaven National Laboratory, Medical DepartmentUpton, NY, USA
- Department of Neurobiology and Behavior, Stony Brook UniversityStony Brook, NY, USA
| | | | - Samuel Zhang
- Psychiatry Department, Icahn School of MedicineNew York, NY, USA
| | - Wayne Goodman
- Psychiatry Department, Icahn School of MedicineNew York, NY, USA
| | - Fritz A. Henn
- Cold Spring Harbor Laboratory, NeuroscienceCold Spring Harbor, NY, USA
- Brookhaven National Laboratory, Medical DepartmentUpton, NY, USA
- Psychiatry Department, Icahn School of MedicineNew York, NY, USA
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Abstract
Depressive disorders are among the most common ailments affecting humankind and some of the world's leading causes of medical disability. Despite being common, disabling and a major public health problem, the etiology of depression is unknown. Indeed, investigators have suggested that the causes of depression are multiple and multi-factorial. With these considerations in mind, in this article we examine the hypothesis that our inability to identify the causes of depressive disorders is because depression is a nonspecific epiphenomenon of brain injury or insult arising through multiple pathways.
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Affiliation(s)
- Stephen M Strakowski
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Dygdon JA, Dienes KA. Behavioral excesses in depression: a learning theory hypothesis. Depress Anxiety 2013; 30:598-605. [PMID: 23554104 DOI: 10.1002/da.22111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/10/2013] [Accepted: 03/08/2013] [Indexed: 11/07/2022] Open
Abstract
This paper reviews two learning theory-based models of experiential contributions to depression: response contingent positive reinforcement and learned helplessness. The authors argue that these models connect to a phenomenon that may explain why symptoms of behavioral excess (e.g. rumination) often occur in depression that is otherwise marked by symptoms of behavioral deficit (e.g. anhedonia). Specifically, the authors illustrate that that concept of schedule strain (or low rates of response contingent reinforcement giving rise to low frequencies of behavior) unites these models. Depression is more likely, or more severe, when schedule strain conditions occur in situations containing reinforcers important to the individual and/or when they simultaneously occur in a number of situations. Conditions of schedule strain are known to give rise to adjunctive behaviors: apparently irrelevant, easy behaviors that deliver immediate reinforcement. This paper suggests that, for some depressed individuals, behavioral excess symptoms like rumination and overeating might serve adjunctive functions. Implications of this hypothesis are discussed.
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Affiliation(s)
- Judith A Dygdon
- Department of Psychology, Roosevelt University, Chicago, Illinois 60605, USA.
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Neural Correlates of Three Neurocognitive Intervention Strategies: A Preliminary Step Towards Personalized Treatment for Psychological Disorders. COGNITIVE THERAPY AND RESEARCH 2012; 37:657-672. [PMID: 23935231 DOI: 10.1007/s10608-012-9508-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brain-based behavioral interventions targeting specific neurocognitive mechanisms show initial promise in the treatment of emotional disorders, but personalization of such approaches will be facilitated if brain targets are empirically established. As a preliminary step, we conducted a proof-of-concept study to test whether particular emotion regulatory neural circuitry can be differentially targeted by specific neurocognitive tasks, and whether these tasks effectively inhibit amygdala activity. Eleven healthy individuals underwent an idiographic sadness and guilt induction. Brain response was measured via fMRI during 4 subsequent emotion regulation conditions: fixation, cognitive reappraisal (selected to target the ventrolateral prefrontal cortex), working memory practice (selected to target the dorsolateral prefrontal cortex), and visual distraction (Tetris; selected to target occipital cortex). In whole-brain comparisons to fixation, hypotheses were upheld. Reappraisal uniquely activated left ventrolateral prefrontal cortex, working memory practice uniquely activated left dorsolateral prefrontal cortex, and Tetris uniquely activated bilateral occipitoparietal cortex, activations that were largely robust at the single-subject level. All tasks inhibited amygdala activity relative to fixation. Data support examining whether repeated exposure to these tasks in psychiatric patients affects neural abnormalities implicated in emotional disorders. Ideally, psychiatric treatment will be accelerated by matching specific treatments to patients with specific neural profiles.
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Abstract
The study of well-being is hampered by the multiplicity of approaches, but focusing on a single approach begs the question of what “well-being” really is. We analyze how well-being is defined according to the three main kinds of theories: “Liking” approaches (generally adopted by psychologists), “Wanting” approaches (predominant among economists), and “Needing” approaches (used in both public policy and psychology). We propose an integrative framework, the engine model of well-being, drawing on Seligman (Seligman, M. E. P., 2011 , Flourish. New York, NY: The Free Press) and Sen's (Sen, A. K., 1999 , Development as freedom. Oxford, England: Oxford University Press) emphasis on the plurality of this construct by distinguishing among (a) inputs (resources that enable well-being), (b) processes (internal states of mechanisms influencing well-being), and (c) outcomes (the intrinsically valuable behaviors that reflect the attainment of well-being). We discuss implications for research, measurement, and interventions.
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Southwick SM, Charney DS. The science of resilience: implications for the prevention and treatment of depression. Science 2012; 338:79-82. [PMID: 23042887 DOI: 10.1126/science.1222942] [Citation(s) in RCA: 464] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human responses to stress and trauma vary widely. Some people develop trauma-related psychological disorders, such as posttraumatic stress disorder (PTSD) and depression; others develop mild to moderate psychological symptoms that resolve rapidly; still others report no new psychological symptoms in response to traumatic stress. Individual variability in how animals and humans respond to stress and trauma depends on numerous genetic, developmental, cognitive, psychological, and neurobiological risk and protective factors.
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Affiliation(s)
- Steven M Southwick
- Yale University School of Medicine and Yale Child Study Center, U.S. Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
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Beevers CG. Identifying processes that maintain depression: Strategies and suggestions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2011. [DOI: 10.1111/j.1468-2850.2011.01260.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
An exciting review in this issue (Forgeard et al., 2011) highlights a number of emerging themes in contemporary translational research in this area. A primary challenge for the next generation of researchers reading this work will be how to carry out the grand charges levied by Forgeard et al., on the ground, i.e., to lay the foundations for moving the emerging basic science of depression into the Depression Clinic of Tomorrow. Addressing these challenges could suggest changes in the nature of the basic science, and questions that are being asked, and employed approaches in contemporary depression research. Preconditions for clinical adoption discussed in the review include 1) beginning to hold neuroscience-based measures of features of depression to the same standards held for other depression measures in the clinic, 2) attending to how the proposed methods might actually end up being feasibly imported into the clinic, and 3) what interventions targeted at mechanisms of depression might look like in the next decade.
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