Effects of emotion recognition training on mood among individuals with high levels of depressive symptoms: study protocol for a randomised controlled trial

Sleep and Healthy Aging Research on Depression (SHARE-D) randomized controlled trial: Protocol overview of an experimental model of depression with insomnia, inflammation, and affect mechanisms in older adults

Depression, one of the most common diseases in older adults, carries significant risk for morbidity and mortality. Because of the burgeoning population of older adults, the enormous burden of late-life depression, and the limited efficacy of current antidepressants in older adults, biologically plausible models that translate into selective depression prevention strategies are needed. Insomnia predicts depression recurrence and is a modifiable target to prevent incident and recurrent depression in older adults. Yet, it is not known how insomnia gets converted into biological- and affective risk for depression, which is critical for identification of molecular targets for pharmacologic interventions, and for refinement of insomnia treatments that target affective responding to improve efficacy. Sleep disturbance activates inflammatory signaling and primes immune responses to subsequent inflammatory challenge. In turn, inflammatory challenge induces depressive symptoms, which correlate with activation of brain regions implicated in depression. This study hypothesizes that insomnia serves as a vulnerability factor for inflammation-related depression; older adults with insomnia will show heightened inflammatory- and affective responding to inflammatory challenge as compared to those without insomnia. To test this hypothesis, this protocol paper describes a placebo-controlled, randomized, double-blind study of low dose endotoxin in older adults (n = 160; 60-80 y) with insomnia vs. comparison controls without insomnia. The aims of this study are to examine differences in depressive symptoms, measures of negative affective responding, and measures of positive affective responding as a function of insomnia and inflammatory challenge. If the hypotheses are confirmed, older adults with two "hits", insomnia and inflammatory activation, would represent a high risk group to be prioritized for monitoring and for depression prevention efforts using treatments that target insomnia or inflammation. Moreover, this study will inform the development of mechanism-based treatments that target affect responses in addition to sleep behaviors, and which might also be coupled with efforts to reduce inflammation to optimize efficacy of depression prevention.

An integrated review of social information processing as a mechanism in the association between maltreatment and depression among youth of color

BACKGROUND

Child maltreatment is a potent risk factor for depression across the life course, with maltreatment and depression demonstrated to disproportionately impact youth of color. Despite evidence for mechanisms (e.g., social information processing; SIP) accounting for the effects of maltreatment on youth broadly, pathways of risk for depression among maltreated youth of color specifically remain largely under-investigated.

OBJECTIVE

In an effort to address this gap in the literature, the present review synthesizes available research regarding SIP as a mechanism underlying the impact of maltreatment on the development of depression in general, and among youth of color specifically.

PARTICIPANTS & SETTING

A review of literature was conducted on English language articles published between 1989 and 2022 involving maltreatment, depression, social information processing, and/or youth of color.

METHODS

An electronic database search using terms "Maltreatment," "Depression," "Social Information Processing," "Social Cognition," and "Youth of Color" identified relevant literature.

RESULTS

Synthesis of literature supports SIP as a salient mechanism in the effect of maltreatment on depressive symptomatology for youth broadly, identifying the need for additional empirical work explicitly assessing this pathway among youth of color.

CONCLUSION

In addition to support for SIP as a risk pathway for youth broadly, this review highlights associated processes that can lend support to SIP as a meaningful mechanism of risk for youth of color. Additionally, this review addresses the deficit-based approach through which research and intervention tools evaluate youth of color experiencing maltreatment and depression, proposing alternative approaches towards prevention and intervention efforts with this marginalized population.

How therapists' emotion recognition relates to therapy process and outcome

Empathy is an essential characteristic for therapists that explained 9% of the variance in treatment outcomes. Many measures of empathy are based on self-report questionnaires. Therefore, they reflect how a person perceives his empathic abilities, which can be biased from his true abilities. The ability to recognize emotions has been found to be related to empathy and serves as a measure for the use of empathic abilities. In this study, we examined therapists' empathic abilities, using a novel task for recognizing emotions, and looked at how they related to the therapy process and outcomes. The study included 33 patient-therapist dyads. Therapist empathy was assessed with an emotion detection task, the JeFEE. Clients filled questionnaires after each session regarding therapy progress and their symptoms. We found that emotion recognition moderated the change in (a) client secure attachment to therapist, (b) client avoidant attachment to therapist, (c) client working alliance, (d) client rate of tense or upset they felt during the session, (e) client lack of emotional clarity of emotions, (f) client non-acceptance of emotional responses, (g) client overall emotion regulation and (h) client main target complaint. Implication for therapy and therapists' selection and training are discussed.

Emotional awareness, empathy, and generosity in high-risk youths

Although maltreatment places youths at risk for substantial deficits in prosociality, effective methods of improving these deficits have yet to be identified. The current investigation tested whether prosociality could be enhanced in maltreated youths by increasing their awareness of others' sadness. Maltreated youths (n = 145) and matched community youths (n = 106) aged 6-17 years completed a sharing task within which labels about a peer's emotions (sad vs. neutral) were experimentally manipulated. Youths who received the sad emotion label about a peer's feelings showed greater empathic concern, and in turn generosity, toward that peer than youths who received the neutral label. Findings offer new insight into potential methods of improving prosocial responding in youths and thus provide direction for intervention efforts.

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others' emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9-14 from a community sample (N = 601) completed a facial emotion labeling task. Children's symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = -0.12, p = 0.018), specifically happiness (β = -0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = -0.16, p = 0.003), specifically happiness (β = -0.15, p = 0.006) and fear (β = -0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.

Emotional recognition training modifies neural response to emotional faces but does not improve mood in healthy volunteers with high levels of depressive symptoms

BACKGROUND

There is demand for new, effective and scalable treatments for depression, and development of new forms of cognitive bias modification (CBM) of negative emotional processing biases has been suggested as possible interventions to meet this need.

METHODS

We report two double blind RCTs, in which volunteers with high levels of depressive symptoms (Beck Depression Inventory ii (BDI-ii) > 14) completed a brief course of emotion recognition training (a novel form of CBM using faces) or sham training. In Study 1 (N = 36), participants completed a post-training emotion recognition task whilst undergoing functional magnetic resonance imaging to investigate neural correlates of CBM. In Study 2 (N = 190), measures of mood were assessed post-training, and at 2-week and 6-week follow-up.

RESULTS

In both studies, CBM resulted in an initial change in emotion recognition bias, which (in Study 2) persisted for 6 weeks after the end of training. In Study 1, CBM resulted in increases neural activation to happy faces, with this effect driven by an increase in neural activity in the medial prefrontal cortex and bilateral amygdala. In Study 2, CBM did not lead to a reduction in depressive symptoms on the BDI-ii, or on related measures of mood, motivation and persistence, or depressive interpretation bias at either 2 or 6-week follow-ups.

CONCLUSIONS

CBM of emotion recognition has effects on neural activity that are similar in some respects to those induced by Selective Serotonin Reuptake Inhibitors (SSRI) administration (Study 1), but we find no evidence that this had any later effect on self-reported mood in an analogue sample of non-clinical volunteers with low mood (Study 2).

Interpretation bias training for bipolar disorder: A randomized controlled trial

BACKGROUND

Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD.

METHOD

Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10.

RESULTS

Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009).

CONCLUSION

Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.

MAP1B mutations cause intellectual disability and extensive white matter deficit

Discovery of coding variants in genes that confer risk of neurodevelopmental disorders is an important step towards understanding the pathophysiology of these disorders. Whole-genome sequencing of 31,463 Icelanders uncovers a frameshift variant (E712KfsTer10) in microtubule-associated protein 1B (MAP1B) that associates with ID/low IQ in a large pedigree (genome-wide corrected P = 0.022). Additional stop-gain variants in MAP1B (E1032Ter and R1664Ter) validate the association with ID and IQ. Carriers have 24% less white matter (WM) volume (β = −2.1SD, P = 5.1 × 10⁻⁸), 47% less corpus callosum (CC) volume (β = −2.4SD, P = 5.5 × 10⁻¹⁰) and lower brain-wide fractional anisotropy (P = 6.7 × 10⁻⁴). In summary, we show that loss of MAP1B function affects general cognitive ability through a profound, brain-wide WM deficit with likely disordered or compromised axons.

Intellectual disability (ID) is characterized by an intelligence quotient of below 70 and impaired adaptive skills. Here, analyzing whole genome sequences from 31,463 Icelanders, Walters et al. identify variants in MAP1B associated with ID and extensive brain-wide white matter deficits.

An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence

This study aimed to examine the effect of emotion recognition training on social anxiety symptoms among adolescents, aged 15-18 years. The study included a screening session, which identified participants who scored above a cut-off on a self-report measure of social anxiety for enrolment into a randomized controlled trial (Clinical Trials ID: NCT02550379). Participants were randomized to an intervention condition designed to increase the perception of happiness over disgust in ambiguous facial expressions or a sham intervention control condition, and completed self-report measures of social anxiety, fear of negative evaluation, anxiety-related disorders, and depressive symptoms. The intervention group demonstrated a strong shift in the balance point at which they perceived happiness over disgust in ambiguous facial expressions. This increase in positive perception was not associated with any changes in the primary outcome of social anxiety; however, some evidence of improvement in symptomatology was observed on one of a number of secondary outcomes. Those in the intervention group had lower depression symptoms at 2-week follow-up, compared to those in the control group who received the sham intervention training. Potential reasons for why the shift in balance point measurement was not associated with a concurrent shift in symptoms of social anxiety are discussed.

Cognitive bias modification for facial interpretation: a randomized controlled trial of transfer to self-report and cognitive measures in a healthy sample

Cognitive bias modification is a potential low-intensity intervention for mood disorders, but previous studies have shown mixed success. This study explored whether facial interpretation bias modification (FIBM), a similar paradigm designed to shift emotional interpretation (and/or perception) of faces would transfer to: (i) self-reported symptoms and (ii) a battery of cognitive tasks. In a preregistered, double-blind randomized controlled trial, healthy participants received eight online sessions of FIBM (N = 52) or eight sham sessions (N = 52). While we replicate that FIBM successfully shifts ambiguous facial expression interpretation in the intervention group, this failed to transfer to the majority of self-report or cognitive measures. There was, however, weak, inconclusive evidence of transfer to a self-report measure of stress, a cognitive measure of anhedonia, and evidence that results were moderated by trait anxiety (whereby transference was greatest in those with higher baseline symptoms). We discuss the need for work in both larger and clinical samples, while urging caution that these FIBM training effects may not transfer to clinically relevant domains.

Biased Facial-Emotion Perception in Mental Health Disorders: A Possible Target for Psychological Intervention?

Our perception of emotion in the faces of others affects our own behavior and mood. Indeed, individuals with mood disorders such as depression and aggression often show biases in facial-emotion perception. Here, we review recent and ongoing research suggesting that biased emotion perception may be on the causal pathway of the onset and maintenance of mood disorders, and hence a potential target for intervention. Simple cognitive-bias modification tasks that change participants’ perception of facial expressions of emotion have shown some promise as a therapeutic technique. We outline further directions for continued research investigating the robustness and clinical impact of emotion-bias modification in real-world settings.

An interactive training programme to treat body image disturbance

Objectives

Anorexia nervosa (AN) is a life‐threatening mental health condition. A core feature is a disturbance of body image, such that sufferers see themselves as fatter than they actually are.

Design

We tested the effectiveness of a novel training programme to recalibrate our participants’ perception of body size.

Methods

In a novel adaptation of a cognitive bias training programme, participants judged the body size of a series of female bodies and were given feedback to improve their accuracy over four daily training sessions. In Study 1, we recruited young women with high concerns about their body size for a randomized controlled study. In Study 2, we then applied the training programme to a case series of women with atypical AN.

Results

In Study 1, the training programme significantly improved the body size judgements of women with high body concerns compared to controls. We also found evidence of improved body image and reduced eating concerns in this group. In Study 2, the programme again recalibrated the body size judgements of women with atypical AN. We also saw evidence of a clinically meaningful reduction in their body size and eating‐disordered concerns.

Conclusions

This training has the potential to be a valuable treatment used together with more traditional talking therapies.

Facial recognition of happiness among older adults with active and remitted major depression

Biased emotion processing in depression might be a trait characteristic independent of mood improvement and a vulnerable factor to develop further depressive episodes. This phenomenon of among older adults with depression has not been adequately examined. In a 2-year cross-sectional study, 59 older patients with either active or remitted major depression, or never-depressed, completed a facial emotion recognition task (FERT) to probe perceptual bias of happiness. The results showed that depressed patients, compared with never depressed subjects, had a significant lower sensitivity to identify happiness particularly at moderate intensity of facial stimuli. Patients in remission from a previous major depressive episode but with none or minimal symptoms had similar sensitivity rate to identify happy facial expressions as compared to patients with an active depressive episode. Further studies would be necessary to confirm whether recognition of happy expression reflects a persistent perceptual bias of major depression in older adults.

Psychotropic treatments in Prader-Willi syndrome: a critical review of published literature

Prader-Willi syndrome (PWS) is a rare genetic syndrome. The phenotype includes moderate to intellectual disability, dysmorphia, obesity, and behavioral disturbances (e.g., hetero and self-injurious behaviors, hyperphagia, psychosis). Psychotropic medications are widely prescribed in PWS for symptomatic control. We conducted a systematic review of published literature to examine psychotropic medications used in PWS. MEDLINE was searched to identify articles published between January 1967 and December 2014 using key words related to pharmacological treatments and PWS. Articles with original data were included based on a standardized four-step selection process. The identification of studies led to 241 records. All selected articles were evaluated for case descriptions (PWS and behavioral signs) and treatment (type, titration, efficiency, and side effects). Overall, 102 patients were included in these studies. Treatment involved risperidone (three reports, n = 11 patients), fluoxetine (five/n = 6), naltrexone (two/n = 2), topiramate (two/n = 16), fluvoxamine (one/n = 1), mazindol (one/n = 2), N-acetyl cysteine (one/n = 35), rimonabant (one/n = 15), and fenfluramine (one/n = 15).

CONCLUSION

We identified promising treatment effects with topiramate for self-injury and impulsive/aggressive behaviors, risperidone for psychotic symptoms associated with uniparental disomy (UPD), and N-acetyl cysteine for skin picking. The pharmacological approach of behavioral impairment in PWS has been poorly investigated to date. Further randomized controlled studies are warranted.

WHAT IS KNOWN

Behavioral disturbances in Prader-Willi syndrome including aggressive reactions, skin picking, and hyperphagia might be very difficult to manage. Antipsychotic drugs are widely prescribed, but weight gain and increased appetite are their major side effects.

WHAT IS NEW

Topiramate might be efficient for self-injury and impulsive/aggressive behaviors, N-acetyl cysteine is apromising treatment for skin picking and Antidepressants are indicated for OCD symptoms. Risperidone is indicated in case of psychotic symptoms mainly associated with uniparental disomy.

Early effects of duloxetine on emotion recognition in healthy volunteers

The serotonin-noradrenaline reuptake inhibitor (SNRI) duloxetine is an effective treatment for major depression and generalised anxiety disorder. Neuropsychological models of antidepressant drug action suggest therapeutic effects might be mediated by the early correction of maladaptive biases in emotion processing, including the recognition of emotional expressions. Sub-chronic administration of duloxetine (for two weeks) produces adaptive changes in neural circuitry implicated in emotion processing; however, its effects on emotional expression recognition are unknown. Forty healthy participants were randomised to receive either 14 days of duloxetine (60 mg/day, titrated from 30 mg after three days) or matched placebo (with sham titration) in a double-blind, between-groups, repeated-measures design. On day 0 and day 14 participants completed a computerised emotional expression recognition task that measured sensitivity to the six primary emotions. Thirty-eight participants (19 per group) completed their course of tablets and were included in the analysis. Results provide evidence that duloxetine, compared to placebo, may reduce the accurate recognition of sadness. Drug effects were driven by changes in participants' ability to correctly detect subtle expressions of sadness, with greater change observed in the placebo relative to the duloxetine group. These effects occurred in the absence of changes in mood. Our preliminary findings require replication, but complement recent evidence that sadness recognition is a therapeutic target in major depression, and a mechanism through which SNRIs could resolve negative biases in emotion processing to achieve therapeutic effects.

Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: a randomized, double-blind, placebo-controlled, pilot clinical trial

OBJECTIVE

Herbal remedies play an important role in treatment of psychiatric disorders. The aim of this study was to assess the efficacy of crocin, the main active constituent of saffron, as an adjunctive treatment in major depressive disorder (MDD).

METHOD

This study was a randomized, double-blind, placebo-controlled, pilot clinical trial. It was carried out during 4 weeks in two groups (placebo and treatment) on 40 MDD patients between 24 and 50 years old in Ibn-e-Sina psychiatric hospital, Mashhad, Iran, from March 2013 to December 2013. The crocin group (n=20) was given one selective serotonin reuptake inhibitor (SSRI) drug (fluoxetine 20mg/day or sertraline 50mg/day or citalopram 20mg/day) plus crocin tablets (30mg/day; 15mg BID) and placebo group (n=20) was administered one SSRI (fluoxetine 20mg/day or sertraline 50mg/day or citalopram 20mg/day) plus placebo (two placebo tablets per day) for 4 weeks. Both groups filled beck depression inventory (BDI), beck anxiety inventory (BAI), general health questionnaire (GHQ), the mood disorder questionnaire (MDQ), side effect evaluation questionnaire, and demographic questionnaire before and after one month intervention.

RESULTS

The crocin group showed significantly improved scores on BDI, BAI and GHQ compared to placebo group (Pvalue<0.0001). The averages of decrease in BDI, BAI and GHQ scores in placebo group were 6.15, 2.6 and 10.3 respectively, whereas the values in crocin group were 17.6, 12.7 and 17.2 after 4 weeks trial.

LIMITATIONS

Poor patient compliance with medications and short trial period, small sample size and self-report assessments were the major limitations of this study.

CONCLUSION

These results demonstrated the effect of crocin in depression and could be administered in treatment of MDD patients.

Music training and empathy positively impact adults' sensitivity to infant distress

Crying is the most powerful auditory signal of infant need. Adults' ability to perceive and respond to crying is important for infant survival and in the provision of care. This study investigated a number of listener variables that might impact on adults' perception of infant cry distress, namely parental status, musical training, and empathy. Sensitivity to infant distress was tested using a previously validated task, which experimentally manipulated distress by varying the pitch of infant cries. This task required that participants discriminate between pitch differences and interpret these as differences in infant distress. Parents with musical training showed a significant advantage on this task when compared with parents without. The extent of the advantage was correlated with the amount of self-reported musical training. For non-parents, individual differences in empathy were associated with task performance, with higher empathy scores corresponding to greater sensitivity to infant distress. We suggest that sensitivity to infant distress can be impacted by a number of listener variables, and may be amenable to training.