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Funk J, Takano K, Babl M, Goldstein R, Oberwestersberger R, Kopf-Beck J, Rohleder N, Ehring T. Can an intervention designed to reduce repetitive negative thinking alter the response to a psychosocial stressor? A randomized controlled study. Behav Res Ther 2024; 178:104547. [PMID: 38678755 DOI: 10.1016/j.brat.2024.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
Prior research suggests that repetitive negative thinking (RNT) negatively impacts mental health by intensifying and prolonging emotional reactivity to stress. This study investigated whether an intervention designed to reduce RNT alters emotional reactivity. Young adults with high trait RNT (N = 79) were randomly allocated to an RNT-focused intervention (smartphone app-based, 10 days) or a waiting list before exposure to a standardized stressor. The pre-registered analysis did not reveal a significant condition * time interaction for negative affect. However, exploratory analyses showed that whilst initial increases in negative affect in response to the stressor did not differ between conditions, participants in the intervention condition reported less negative affect throughout the following recovery phase. Additionally, participants in the intervention condition appraised their ability to cope with the stressor as higher and reported less RNT in the recovery phase. In contrast, the intervention did not affect biological stress responses. The findings indicate that RNT-focused interventions might have positive effects on mental health by breaking the self-reinforcing cycle of RNT, negative affect and maladaptive appraisals in response to stress. However, as findings are partly based on exploratory analyses, further research is needed to confirm whether reduced subjective stress reactivity mediates the effects of RNT-focused interventions on psychopathological symptoms.
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Affiliation(s)
- Julia Funk
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment.
| | - Keisuke Takano
- National Institute of Advanced Industrial Science and Technology, Japan, Human Informatics and Interaction Research Institute
| | - Marina Babl
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Rebecca Goldstein
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Regina Oberwestersberger
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Johannes Kopf-Beck
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Nicolas Rohleder
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, Institute of Psychology, Health Psychology
| | - Thomas Ehring
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
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2
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Barry TJ, Hallford DJ. Transdiagnostic and transtherapeutic strategies for optimising autobiographical memory. Behav Res Ther 2024; 180:104575. [PMID: 38852230 DOI: 10.1016/j.brat.2024.104575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Our memories for past personally experienced autobiographical events play an important role in therapy, irrespective of presenting issue, diagnoses or therapeutic modality. Here, we summarise evidence for how autobiographical memory abilities can influence our mental health and the relevance of this for the treatment of mental health problems. We then guide the reader through principles and strategies for optimising autobiographical memory within treatment. We ground these recommendations within research for stand-alone interventions for improving autobiographical memory and from studies of how to support the formation and retrieval of therapeutic memories. Options are given for clinicians to guide clients in improving retrieval of autobiographical memories within treatment, for improving autobiographical memory for the therapeutic experience itself, and for creating improvements in autobiographical memory that endure post-treatment. We also provide worksheets for clinicians to use within treatment.
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Affiliation(s)
- T J Barry
- Department of Psychology, University of Bath, Bath, UK.
| | - D J Hallford
- School of Psychology, Deakin University, Melbourne, Australia
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3
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Stavropoulos L, Cooper DDJ, Champion SM, Keevers L, Newby JM, Grisham JR. Basic processes and clinical applications of mental imagery in worry: A systematic review. Clin Psychol Rev 2024; 110:102427. [PMID: 38640775 DOI: 10.1016/j.cpr.2024.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/17/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry. METHODS PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results. RESULTS The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD. CONCLUSIONS Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.
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Affiliation(s)
- Lauren Stavropoulos
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
| | - David D J Cooper
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Luke Keevers
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney 2022, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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4
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Wang J, Chen H, Xu H, Cai R, Zhao Y, Tan S. Relationship between ruminative style and adolescent depression. Asian J Psychiatr 2024; 96:104008. [PMID: 38598933 DOI: 10.1016/j.ajp.2024.104008] [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: 10/09/2023] [Revised: 02/28/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The role of rumination in depression remains controversial. We aimed to establish the ruminative tendency style theory (RTST), discuss the occurrence of depression in adolescents with rumination as the core, and explore the different associations between adolescent ruminative tendency, ruminative style, and depression. METHODS This study employed an online questionnaire survey of 1110 Chinese adolescents aged 12-17 years, assessing ruminative tendency, ruminative style, stressful life events, depressive state, depressive trait, the Big Five personality traits, and social support. Conditional process analysis was used to test the chain mediation effect with Ruminative Style as a moderator. After screening for the predictor variables, a logistic regression risk prediction model was established and validated internally. RESULTS The chain mediation effect of ruminative tendency and depressive trait between stressful life events and depressive state was significant, with the indirect effect accounting for 63.4%. Ruminative Style negatively moderated the relationship between Ruminative Tendency and Depressive Trait (β=-0.053,P<0.001). The risk prediction model for depressive state showed good calibration and clinical utility. Area under the curve values for the validation and training sets were 0.926 and 0.927, respectively. CONCLUSION Different associations may exist between adolescent ruminative tendency, ruminative style, and depression, and the proposal of ruminative style is of great significance for intervention in adolescent depression.
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Affiliation(s)
- Jinghan Wang
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Haitao Chen
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Hao Xu
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China; North China University of Science and Technology, Tangshan, China
| | - Ruiwen Cai
- North China University of Science and Technology, Tangshan, China; No. 5 Middle School Miyun, Beijing, China
| | - Yanli Zhao
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Shuping Tan
- Peking University Huilongguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China; North China University of Science and Technology, Tangshan, China.
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5
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Rief W, Asmundson GJG, Bryant RA, Clark DM, Ehlers A, Holmes EA, McNally RJ, Neufeld CB, Wilhelm S, Jaroszewski AC, Berg M, Haberkamp A, Hofmann SG. The future of psychological treatments: The Marburg Declaration. Clin Psychol Rev 2024; 110:102417. [PMID: 38688158 DOI: 10.1016/j.cpr.2024.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
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Affiliation(s)
- Winfried Rief
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany.
| | | | - Richard A Bryant
- University of New South Wales, School of Psychology, Sydney, New South Wales, Australia
| | - David M Clark
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Anke Ehlers
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Emily A Holmes
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Solna, Sweden
| | | | - Carmem B Neufeld
- University of São Paulo, Department of Psychology, Ribeirão Preto, SP, Brazil
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Adam C Jaroszewski
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Anke Haberkamp
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Stefan G Hofmann
- Philipps-University of Marburg, Department of Psychology, Translational Clinical Psychology Group, Marburg, Germany
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6
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Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS. Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:696-722. [PMID: 38073271 DOI: 10.1111/aphw.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 05/02/2024]
Abstract
Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amanda C M Fu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivy W Y Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivia H C Jung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wacy W S Lui
- Center for Personal Growth and Crisis Intervention of the Corporate Clinical Psychology Services, Hospital Authority, Ma Tau Wai, Hong Kong
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Hitchcock C, Funk J, Cummins R, Patel SD, Catarino A, Takano K, Dalgleish T, Ewbank M. A deep learning quantification of patient specificity as a predictor of session attendance and treatment response to internet-enabled cognitive behavioural therapy for common mental health disorders. J Affect Disord 2024; 350:485-491. [PMID: 38244796 DOI: 10.1016/j.jad.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Increasing an individual's ability to focus on concrete, specific detail, thus reducing the tendency toward overly broad, decontextualised generalisations about the self and world, is a target within cognitive behavioural therapy (CBT). However, empirical investigation of the impact of within-treatment specificity on treatment outcomes is scarce. We evaluated whether the specificity of patient dialogue predicted a) end-of-treatment symptoms and b) session completion for CBT for common mental health issues. METHODS This preregistered (https://osf.io/agr4t) study trained a deep learning model to score the specificity of patient dialogue in transcripts from 353,614 internet-enabled CBT sessions for common mental health disorders, delivered on behalf of UK NHS services. Data were from obtained from 65,030 participants (n = 47,308 female, n = 241 unstated) aged 18-94 years (M = 34.69, SD = 12.35). Depressive disorders were the most common (39.1 %) primary diagnosis. Primary outcome was end-of-treatment score on the Patient Health Questionnaire-9 (PHQ-9). Secondary outcome was number of sessions attended. RESULTS Linear mixed-effects models demonstrated that increased patient specificity significantly predicted lower post-treatment symptoms on the PHQ-9, although the size and direction of the effect varied depending on the type of therapeutic activity being completed. Effect sizes were consistently small. Higher patient specificity was associated with completing a greater number of sessions. LIMITATIONS We are unable to infer causation from our data. CONCLUSIONS Although effect sizes were small, an effect of specificity was observed across common mental health disorders. Further studies are needed to explore whether encouraging patient specificity during CBT may provide an enhancement of treatment attendance and treatment effects.
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Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
| | - Julia Funk
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Ronan Cummins
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
| | - Shivam D Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Ana Catarino
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
| | - Keisuke Takano
- Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Michael Ewbank
- Ieso Digital Health, Jeffreys Building, Cowley Rd, Milton, Cambridge, United Kingdom
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8
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Bickel EA, Schellekens MPJ, Smink JG, Mul VEM, Ranchor AV, Fleer J, Schroevers MJ. Looking at individual symptoms: the dynamic network structure of depressive symptoms in cancer survivors and their preferences for psychological care. J Cancer Surviv 2024; 18:479-488. [PMID: 35976556 PMCID: PMC9382609 DOI: 10.1007/s11764-022-01246-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The majority of depressed cancer survivors do not receive psychological care, possibly because offered care does not align with their experiences and preferences. We examined (1) which depressive symptoms cancer survivors would like to receive psychological care for; (2) how distinct depressive symptoms are related to each other in the contemporaneous and temporal network of depressive symptoms; and (3) whether survivors' care needs correspond to the interconnectedness of these specific symptoms. METHOD Fifty-two cancer survivors suffering from at least mild depressive symptoms and were not receiving psychological care filled out a baseline questionnaire about their care needs for distinct depressive symptoms, followed by ecological momentary assessments (EMA) assessing depressive symptoms (14 days, five times a day). Multi-level vector autoregression analysis was used to estimate associations between distinct depressive symptoms as well as their centrality within the network. RESULTS Cancer survivors most strongly preferred to receive care for fatigue, feeling down, little enjoyment, and sleep problems. Fatigue, together with worry and lack of concentration, most strongly predicted the onset of other symptoms. Little enjoyment and feeling down were two of the most central symptoms (i.e., strongly connected to other symptoms) in the contemporaneous network and were most strongly influenced by other symptoms in the temporal network. CONCLUSIONS Clinicians can offer specific interventions that target fatigue, as these played an important role in the onset of symptoms and would align with survivors' needs. IMPLICATIONS FOR CANCER SURVIVORS Offering such symptom-specific care may increase the uptake of psychological interventions in cancer survivors.
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Affiliation(s)
- E A Bickel
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M P J Schellekens
- Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, De Bilt, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J G Smink
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - V E M Mul
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - A V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Tsuchiyagaito A, Aoki S, Cochran G, Kawanori Y, Horiuchi S. Hard to let it go: repetitive negative thinking and hoarding in later life in Japan. Aging Ment Health 2024; 28:542-550. [PMID: 37178150 DOI: 10.1080/13607863.2023.2209774] [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: 10/28/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Objectives: Hoarding in older adults can have a detrimental effect on daily life. Repetitive negative thinking (RNT) could result in a greater avoidance of discarding and increased saving behaviors; yet, the unique role of RNT on hoarding in older adults remains understudied. This study aimed to investigate whether the intensity of RNT contributes to hoarding in older adults. Methods: Two hundred and sixty-four older adults in Japan (ages 65-86 years, 132 males and 132 females) participated in an online survey. Hierarchical regression analyses were conducted to examine whether RNT could significantly explain the variance of hoarding after controlling for age, sex, years of education, self-reported cognitive impairment, and depression. Results: As we expected, RNT was significantly associated with greater hoarding behaviors, such as excessive acquisition (β = .27, p = .005) and difficulty in discarding (β = .27, p = .003). On the other hand, reflection, repetitive thinking without negative emotional valence, was significantly associated with higher scores on clutter (β = .36 p < .001). Conclusion: Our findings highlight the importance of addressing RNT in the prevention and treatment of hoarding symptoms among older adults, potentially leading to more effective interventions and improved outcomes in managing hoarding behaviors in this population.
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Affiliation(s)
- Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Shuntaro Aoki
- Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Gabe Cochran
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Satoshi Horiuchi
- Department of Social and Clinical Psychology, Hijiyama University, Hiroshima, Japan
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10
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Nejati V, Nozari M, Mirzaian B, Pourshahriar H, Salehinejad MA. Comparable Efficacy of Repeated Transcranial Direct Current Stimulation, Cognitive Behavioral Therapy, and Their Combination in Improvement of Cold and Hot Cognitive Functions and Amelioration of Depressive Symptoms. J Nerv Ment Dis 2024; 212:141-151. [PMID: 38198673 DOI: 10.1097/nmd.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
ABSTRACT This study aimed to evaluate the effectiveness of repeated transcranial direct current stimulation (rtDCS), cognitive behavioral therapy (CBT), and their combination (rtDCS-CBT) in the treatment of cognitive dysfunction, social cognition, and depressive symptoms in women diagnosed with major depressive disorder (MDD). A total of 40 female participants with MDD were randomly assigned to one of four groups: rtDCS, CBT, rtDCS-CBT, and a control group. The participants' depressive symptoms, executive functions, and social cognition were assessed at baseline, preintervention, postintervention, and during a 1-month follow-up. The rtDCS group received 10 sessions of anodal dorsolateral and cathodal ventromedial prefrontal cortex (2 mA for 20 minutes). The CBT group received 10 sessions of traditional CBT, whereas the combined group received CBT after the tDCS sessions. The results of the analysis of variance indicated that all intervention groups demonstrated significant improvements in depressive symptoms, cognitive dysfunction, and social cognition compared with the control group (all p < 0.001). Furthermore, the rtDCS-CBT group exhibited significantly greater reductions in depressive symptoms when compared with each intervention alone (all p < 0.001). Notably, working memory improvements were observed only in the rtDCS group ( p < 0.001). In conclusion, this study suggests that both CBT and tDCS, either individually or in combination, have a positive therapeutic impact on enhancing executive functions, theory of mind, and depressive symptoms in women with MDD.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Masoumeh Nozari
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Bahram Mirzaian
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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11
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Uysal B, Gormez V, Karatepe HT, Sönmez D, Taştekne F, Tepedelen MS, Jordan TR. Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. Psychol Rep 2024; 127:159-177. [PMID: 37140196 PMCID: PMC10160818 DOI: 10.1177/00332941231174394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.
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Affiliation(s)
- Burcu Uysal
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Vahdet Gormez
- Department of Child and Adolescent, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hasan Turan Karatepe
- Department of Psychiatry, Medical Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Dilruba Sönmez
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Feyzanur Taştekne
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Mehmed Seyda Tepedelen
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Timothy R Jordan
- Department of Psychology, School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
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12
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Vancappel A, Raysseguier C, Coillot H, Jansen E, Bouyer C, Mangolini A, Barbe PG, Debout-Courtault C, Pierre-le Seac'h M, Kazour F, Courtois R, El-Hage W. Development and validation of the Symptomatic Transdiagnostic Test (S2T). L'ENCEPHALE 2024; 50:32-39. [PMID: 36641268 DOI: 10.1016/j.encep.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions. METHOD First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample. RESULTS The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α=0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills. CONCLUSION The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.
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Affiliation(s)
- A Vancappel
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France.
| | - C Raysseguier
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - H Coillot
- Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France
| | - E Jansen
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - C Bouyer
- Pôle cardiovasculaire et métabolique, CHU de Cayenne, Cayenne, France
| | - A Mangolini
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - P G Barbe
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | | | | | - F Kazour
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France
| | - R Courtois
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France
| | - W El-Hage
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France
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13
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Chou T, Dougherty DD, Nierenberg AA, Ghaznavi S. Rumination in bipolar disorder associated with brain network and behavioural measures of inhibitory executive control. Acta Neuropsychiatr 2024; 36:39-43. [PMID: 37622320 DOI: 10.1017/neu.2023.36] [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] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Rumination is a passive form of negative self-focused cognition that predicts depressive episodes for individuals with bipolar disorder (BD). Individuals with BD also have impaired inhibitory executive control; rumination in BD may therefore reflect executive dysfunction. We investigated the relationship between a neural measure of executive functioning (functional connectivity between the frontoparietal control network [FPCN] and the default mode network [DMN] during an effortful task), behavioural measures of executive functioning (the Behavior Rating Inventory of Executive Function) and rumination (the Ruminative Responses Scale). METHODS Fifteen individuals with BD and fifteen healthy controls underwent MRI scans during mental distraction. Using CONN toolbox, between-network FPCN-DMN connectivity values were calculated. We conducted Pearson's r bivariate correlations between connectivity values, BRIEF and RRS scores. RESULTS RRS scores were positively correlated with BRIEF Behavioral Regulation Index (BRI) scores. In individuals with BD, there was a positive correlation between FPCN-DMN functional connectivity during distraction and BRIEF BRI scores. FPCN-DMN functional connectivity was also positively correlated with RRS ruminative brooding scores. Healthy controls did not show significant correlations between these behavioural and neural measures of executive functioning and rumination. CONCLUSION For individuals with BD, the greater the tendency to ruminate and the higher the executive dysfunction, the stronger the connectivity between an executive control network and a network involved in rumination during an unrelated cognitive task. This could reflect continual attempts to inhibit ruminative thinking and shift back to the distraction task. Therefore, engagement in rumination may reflect failed inhibitory executive control.
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Affiliation(s)
- Tina Chou
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Sharmin Ghaznavi
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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14
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Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
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Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
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15
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Hoffmann F, Linz R, Steinbeis N, Bauer M, Dammering F, Lazarides C, Klawitter H, Bentz L, Entringer S, Winter SM, Buss C, Heim C. Children with maltreatment exposure exhibit rumination-like spontaneous thought patterns: association with symptoms of depression, subcallosal cingulate cortex thickness, and cortisol levels. J Child Psychol Psychiatry 2024; 65:31-41. [PMID: 37402634 DOI: 10.1111/jcpp.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Childhood maltreatment is associated with pervasive risk for depression. However, the immediate cognitive and neural mechanisms that mediate this risk during development are unknown. We here studied the impact of maltreatment on self-generated thought (SGT) patterns and their association with depressive symptoms, subcallosal cingulate cortex (SCC) thickness, and cortisol levels in children. METHODS We recruited 183 children aged 6-12 years, 96 of which were exposed to maltreatment. Children performed a mind wandering task to elicit SGTs. A subgroup of children underwent structural magnetic resonance imaging (N = 155) for SCC thickness analyses and saliva collection for quantification of free cortisol concentrations (N = 126) was collected. Using network analysis, we assessed thought networks and compared these networks between children with and without maltreatment exposure. Using multilevel analyses, we then tested the association between thought networks of children with maltreatment exposure with depressive symptoms, SCC thickness, and cortisol levels. RESULTS Children exposed to maltreatment generated fewer positively valenced thoughts. Network analysis revealed rumination-like thought patterns in children with maltreatment exposure, which were associated with depressive symptoms, SCC thickness, and cortisol levels. Children with maltreatment exposure further exhibited decreased future-self thought coupling, which was associated with depressive symptoms, while other-related and past-oriented thoughts had the greatest importance within the network. CONCLUSIONS Using a novel network analytic approach, we provide evidence that children exposed to maltreatment exhibit ruminative clustering of thoughts, which is associated with depressive symptoms and neurobiological correlates of depression. Our results provide a specific target for clinical translation to design early interventions for middle childhood. Targeting thought patterns in children with maltreatment exposure may be an effective strategy to effectively mitigate depression risk early in life.
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Affiliation(s)
- Ferdinand Hoffmann
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Roman Linz
- Research Group "Social Stress and Family Health", Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Nikolaus Steinbeis
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Martin Bauer
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Felix Dammering
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Claudia Lazarides
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Heiko Klawitter
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Lea Bentz
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
- Development, Health, and Disease Research Program, University of California, Irvine, Orange, CA, USA
| | - Sibylle M Winter
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
- Development, Health, and Disease Research Program, University of California, Irvine, Orange, CA, USA
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Institute of Medical Psychology, Berlin, Germany
- Center for Safe & Healthy Children, The Pennsylvania State University, University Park, PA, USA
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16
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Wang H, Zhang T, Zu M, Fan S, Kai Y, Zhang J, Ji Y, Pang X, Tian Y. Electroconvulsive therapy enhances degree centrality in the orbitofrontal cortex in depressive rumination. Psychiatry Res Neuroimaging 2024; 337:111765. [PMID: 38104485 DOI: 10.1016/j.pscychresns.2023.111765] [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: 09/30/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Depressive rumination has been implicated in the onset, duration, and treatment response of refractory depression. Electroconvulsive therapy (ECT) is remarkably effective in treatment of refractory depression by modulating the functional coordination between brain hubs. However, the mechanisms by which ECT regulates depressive rumination remain unsolved. We investigated degree centrality (DC) in 32 pre- and post-ECT depression patients as well as 38 matched healthy controls. An identified brain region was defined as the seed to calculate functional connectivity (FC) in whole brains. Rumination was measured by the Ruminative Response Scale (RRS) and its relationships with identified DC and FC alterations were examined. We found a significant negative correlation between DC of the right orbitofrontal cortex (rOFC) before ECT and brooding level before and after treatment. Moreover, rOFC DC increased after ECT. DC of the left superior temporal gyrus (lSTG) was positively correlated with reflective level before intervention, while lSTG DC decreased after ECT. Patients showed elevated FC in the rOFC with default mode network. No significant association was found between decreased RRS scores and changes in DC and FC. Our findings suggest that functional changes in rOFC and lSTG may be associated with the beneficial effects of ECT on depressive rumination.
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Affiliation(s)
- Hongping Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ting Zhang
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Meidan Zu
- Department of Neurology, Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Siyu Fan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yiao Kai
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jiahua Zhang
- School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Yang Ji
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaonan Pang
- Department of Neurology, Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Neurology, Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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17
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Jia F, Chen X, Du X, Tang Z, Ma X, Ning T, Zou S, Zuo S, Li H, Cui S, Deng Z, Fu J, Fu X, Huang Y, Li X, Lian T, Liao Y, Liu L, Lu B, Wang Y, Wang Y, Wang Z, Ye G, Zhang X, Zhu H, Quan C, Sun H, Yan C, Liu Y. Aberrant degree centrality profiles during rumination in major depressive disorder. Hum Brain Mapp 2023; 44:6245-6257. [PMID: 37837649 PMCID: PMC10619375 DOI: 10.1002/hbm.26510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023] Open
Abstract
Rumination is closely linked to the onset and maintenance of major depressive disorder (MDD). Prior neuroimaging studies have identified the association between self-reported rumination trait and the functional coupling among a network of brain regions using resting-state functional magnetic resonance imaging (MRI). However, little is known about the underlying neural circuitry mechanism during active rumination in MDD. Degree centrality (DC) is a simple metric to denote network integration, which is critical for higher-order psychological processes such as rumination. During an MRI scan, individuals with MDD (N = 45) and healthy controls (HC, N = 46) completed a rumination state task. We examined the interaction effect between the group (MDD vs. HC) and condition (rumination vs. distraction) on vertex-wise DC. We further characterized the identified brain region's functional involvement with Neurosynth and BrainMap. Network-wise seed-based functional connectivity (FC) analysis was also conducted for the identified region of interest. Finally, exploratory correlation analysis was conducted between the identified region of interest's network FCs and self-reported in-scanner affect levels. We found that a left superior frontal gyrus (SFG) region, generally overlapped with the frontal eye field, showed a significant interaction effect. Further analysis revealed its involvement with executive functions. FCs between this region, the frontoparietal, and the dorsal attention network (DAN) also showed significant interaction effects. Furthermore, its FC to DAN during distraction showed a marginally significant negative association with in-scanner affect level at the baseline. Our results implicated an essential role of the left SFG in the rumination's underlying neural circuitry mechanism in MDD and provided novel evidence for the conceptualization of rumination in terms of impaired executive control.
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Affiliation(s)
- Feng‐Nan Jia
- Soochow UniversitySuzhouJiangsuChina
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xiao Chen
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Xiang‐Dong Du
- Soochow UniversitySuzhouJiangsuChina
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Zhen Tang
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xiao‐Yun Ma
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Tian‐Tian Ning
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Si‐Yun Zou
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Shang‐Fu Zuo
- Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Hui‐Xian Li
- The Third Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Shi‐Xian Cui
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
- Sino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
| | - Zhao‐Yu Deng
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Jia‐Lin Fu
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xiao‐Qian Fu
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yue‐Xiang Huang
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xue‐Ying Li
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Tao Lian
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Yi‐Fan Liao
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Li‐Li Liu
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Bin Lu
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Yan Wang
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Yu‐Wei Wang
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Zi‐Han Wang
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
| | - Gang Ye
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Xin‐Zhu Zhang
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Hong‐Liang Zhu
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Chuan‐Sheng Quan
- Department of PsychologyZhangjiagang Fourth People's HospitalZhangjiagangJiangsuChina
| | - Hong‐Yan Sun
- Department of RadiologySuzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Chao‐Gan Yan
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Magnetic Resonance Imaging Research CenterInstitute of Psychology, Chinese Academy of SciencesBeijingChina
- International Big‐Data Center for Depression ResearchChinese Academy of SciencesBeijingChina
- Sino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijingChina
- Sino‐Danish Center for Education and ResearchBeijingChina
| | - Yan‐Song Liu
- Soochow UniversitySuzhouJiangsuChina
- Suzhou Guangji HospitalThe Affiliated Guangji Hospital of Soochow UniversitySuzhouJiangsuChina
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18
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Gülpen J, Brouwer ME, Geurtsen GJ, van Dis EAM, Denys DAJP, Bockting CL. Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis. BMJ MENTAL HEALTH 2023; 26:1-9. [PMID: 37914347 PMCID: PMC10626872 DOI: 10.1136/bmjment-2023-300827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
QUESTION Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy. STUDY SELECTION AND ANALYSIS Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13-65 years, reporting data on severity, remission or relapse. FINDINGS Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges' g=0.36; 95% CI -0.30 to 1.02) or longer (Hedges' g=0.02; 95% CI -0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor. CONCLUSIONS Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed. PROSPERO REGISTRATION NUMBER CRD42020188451.
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Affiliation(s)
- Joost Gülpen
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies E Brouwer
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Eva A M van Dis
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Barton SB, Armstrong PV, Robinson LJ, Bromley EHC. CBT for difficult-to-treat depression: self-regulation model. Behav Cogn Psychother 2023; 51:543-558. [PMID: 37170824 DOI: 10.1017/s1352465822000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat. AIM The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT. METHOD The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components. RESULTS A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation. CONCLUSIONS A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going.
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Affiliation(s)
- Stephen B Barton
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
- Centre for Specialist Psychological Therapies, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Benfield House, Newcastle upon TyneNE6 4PF, UK
| | - Peter V Armstrong
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
| | - Lucy J Robinson
- School of Psychology, Newcastle University, Dame Margaret Barbour Building, Newcastle upon TyneNE2 4DR, UK
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20
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Laicher H, Int-Veen I, Woloszyn L, Wiegand A, Kroczek A, Sippel D, Leehr EJ, Lawyer G, Albasini F, Frischholz C, Mössner R, Nieratschker V, Rubel J, Fallgatter A, Ehlis AC, Rosenbaum D. In situ fNIRS measurements during cognitive behavioral emotion regulation training in rumination-focused therapy: A randomized-controlled trial. Neuroimage Clin 2023; 40:103525. [PMID: 37839195 PMCID: PMC10589893 DOI: 10.1016/j.nicl.2023.103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Repetitive negative thinking (RNT), including rumination, plays a key role in various psychopathologies. Although several psychotherapeutic treatments have been developed to reduce RNT, the neural correlates of those specific treatments and of psychotherapy in general are largely unknown. Functional near-infrared spectroscopy (fNIRS) offers the potential to investigate the neural correlates of psychotherapeutic techniques in situ. Therefore, in this study we investigated the efficacy and neural correlates of a fNIRS adapted Mindfulness-based Emotion Regulation Training (MBERT) for the treatment of depressive rumination in 42 subjects with major depressive disorder (MDD) in a cross-over designed randomized controlled trial. Using psychometric measures, subjective ratings and fNIRS, we analyzed in situ changes in depressive symptom severity, ruminative thoughts and cortical activity in the Cognitive Control Network (CCN). Our results show that MBERT is effective in treating depressive symptoms and rumination. On a neural level, we found consistently higher cortical activation during emotion regulation training compared to control trials in the bilateral inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). Furthermore, cortical oxygenation decreased from session to session in the bilateral DLPFC. The relevance of the results for the psychotherapeutic treatment of MDD as well as further necessary investigations are discussed.
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Affiliation(s)
- Hendrik Laicher
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany.
| | - Isabell Int-Veen
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Leonie Woloszyn
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; Max-Planck Institute of Psychiatry, Munich, Germany
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Daniel Sippel
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Elisabeth J Leehr
- Institute for Translational, University of Muenster, Muenster, Germany
| | - Glenn Lawyer
- Machine Learning Solutions, Luxembourg, Luxembourg
| | - Francesco Albasini
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Christian Frischholz
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Rainald Mössner
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
| | - Julian Rubel
- Psychotherapy Research Unit, Department of Psychology, Osnabrueck University, Osnabrueck, Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen Center for Mental Health (TüCMH), Tuebingen, Germany; German Center for Mental Health (DZPG), partner site Tuebingen, Germany
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Daros AR, Wardell JD, Quilty LC. Multilevel associations of emotion regulation strategy use during psychotherapy for depression: A longitudinal study. J Affect Disord 2023; 338:107-118. [PMID: 37290525 DOI: 10.1016/j.jad.2023.06.014] [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: 08/02/2022] [Revised: 03/24/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with depression select avoidant emotion regulation (ER) strategies more often than engagement strategies. While psychotherapy improves ER strategies, examining the week-to-week changes in ER and their relationship to clinical outcomes is warranted to understand how these interventions work. This study examined the changes in six ER strategies and depressive symptoms during virtual psychotherapy. METHODS Treatment-seeking adults (N = 56) with moderate depression severity completed a baseline diagnostic interview and questionnaires and were followed for up to 3 months as they completed virtual psychotherapy in an unrestricted format (e.g., individual) and orientation (e.g., cognitive-behavioral therapy; CBT). Participants completed weekly assessments of depression and six ER strategies along with assessments of CBT skills and participant-rated CBT components for each psychotherapy session. Multilevel modeling was used to examine associations between within-person changes in ER strategy use and weekly depression scores, controlling for between-person effects and time. RESULTS Depressive symptoms, rumination, and experiential avoidance decreased non-linearly over time while cognitive reappraisal and acceptance increased non-linearly. Controlling for CBT skills, within-person increases in acceptance and cognitive reappraisal, as well as within-person decreases in experiential avoidance, were associated with fewer depressive symptoms over time. People who reported greater CBT components in their sessions also reported fewer depressive symptoms over time. LIMITATIONS The study was unable to make more causal inferences or standardize the type, baseline, or length of psychotherapy received. CONCLUSIONS Improvements in ER strategies were associated with depression symptom reduction during psychotherapy. Future research to elucidate ER strategies as mediators of treatment response is warranted.
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Affiliation(s)
- Alexander R Daros
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Department of Psychology, York University, Canada.
| | - Jeffrey D Wardell
- Department of Psychology, York University, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada
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Chu SA, Tadayonnejad R, Corlier J, Wilson AC, Citrenbaum C, Leuchter AF. Rumination symptoms in treatment-resistant major depressive disorder, and outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) treatment. Transl Psychiatry 2023; 13:293. [PMID: 37684229 PMCID: PMC10491586 DOI: 10.1038/s41398-023-02566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
Rumination is a maladaptive style of regulating thoughts and emotions. It is a common symptom of Major Depressive Disorder (MDD), and more severe rumination is associated with poorer medication and psychotherapy treatment outcomes, particularly among women. It is unclear to what extent rumination may influence the outcomes of, or be responsive to, repetitive Transcranial Magnetic Stimulation (rTMS) treatment of MDD. We retrospectively examined data collected during rTMS treatment of 155 patients (age 42.52 ± 14.22, 79 female) with moderately severe treatment-resistant MDD. The severity of rumination and depression was assessed before and during a course of 30 sessions of measurement-based rTMS treatment using the Ruminative Responses Scale (RSS) and the Patient Health Questionnaire (PHQ-9), respectively. Relationships among baseline levels of rumination, depression, and treatment outcome were assessed using a series of repeated measures linear mixed effects models. Both depression and rumination symptoms significantly improved after treatment, but improvement in depression was not a significant mediator of rumination improvement. Higher baseline rumination (but not depression severity) was associated with poorer depression outcomes independently of depression severity. Female gender was a significant predictor of worse outcomes for all RRS subscales. Both depressive and ruminative symptoms in MDD improved following rTMS treatment. These improvements were correlated, but improvement in rumination was not fully explained by reduction in depressive symptoms. These findings suggest that while improvement in rumination and depression severity during rTMS treatment are correlated, they are partly independent processes. Future studies should examine whether rumination symptoms should be specifically targeted with different rTMS treatment parameters.
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Affiliation(s)
- Stephanie A Chu
- Neuroscience Interdepartmental Program, UCLA, Los Angeles, USA.
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cole Citrenbaum
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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23
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Wallsten D, Norell A, Anniko M, Eriksson O, Lamourín V, Halldin I, Kindbom T, Hesser H, Watkins E, Tillfors M. Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial. Front Psychol 2023; 14:1196945. [PMID: 37744585 PMCID: PMC10513770 DOI: 10.3389/fpsyg.2023.1196945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Repetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of rumination-focused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder. Methods A randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-to-treat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively. Results Group RF-CBT significantly reduced self-reported insomnia at post-treatment and self-reported insomnia and depression at the 2 month-follow-up, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life. Discussion The current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution.
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Affiliation(s)
- Daniel Wallsten
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Annika Norell
- Faculty of Health and Science, Kristianstad University, Kristianstad, Sweden
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Malin Anniko
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | | | - Varja Lamourín
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Ida Halldin
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Tina Kindbom
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Hugo Hesser
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Maria Tillfors
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
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24
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Watkins E, Newbold A, Tester-Jones M, Collins LM, Mostazir M. Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression: A Randomized Optimization Trial. JAMA Psychiatry 2023; 80:942-951. [PMID: 37378962 PMCID: PMC10308300 DOI: 10.1001/jamapsychiatry.2023.1937] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/22/2023] [Indexed: 06/29/2023]
Abstract
Importance There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. Objective To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. Design, Setting, and Participants This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Interventions Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). Main Outcomes and Measures The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Results Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, -7.79 [90% CI, -8.21 to -7.37]; 6-month follow-up difference in PHQ-9 score, -8.63 [90% CI, -9.04 to -8.22]). A baseline score-adjusted analysis of covariance model using effect-coded intervention variables (-1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], -0.09 [90% CI, -0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], -0.18 [90% CI, -0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, -0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, -0.54, [90% CI, -0.97 to -0.11]). Conclusions and Relevance In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. Trial Registration isrctn.org Identifier: ISRCTN24117387.
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Affiliation(s)
- Edward Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Michelle Tester-Jones
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | | | - Mohammod Mostazir
- Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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25
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Öcalan S, Üzar-Özçetin YS. "I am in a Fight with My Brain": A Qualitative Study on Cancer-Related Ruminations of Individuals with Cancer. Semin Oncol Nurs 2023; 39:151450. [PMID: 37210226 DOI: 10.1016/j.soncn.2023.151450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This study aimed to determine the cancer-related ruminations from the subjective perspectives of individuals with cancer. DATA SOURCES The study adopted a qualitative design, and participants (N = 16) were individuals with cancer. The analysis and interpretation of data were carried out according to the phenomenological-hermeneutical method. CONCLUSION The following four themes emerged as a result of the analysis of qualitative data revealing the experiences of individuals with cancer: (1) attributed meanings to cancer-related ruminations, (2) perceived ruminations toward an uncertain future, (3) losing against intrusive ruminations, and (4) fighting with ruminations. The results underline the negative impact of ruminative thoughts on the disease process and social life of individuals with cancer. Individuals with cancer struggle with intense thoughts about the cause, treatment, and future of the disease from the moment they are diagnosed with cancer. In order to stop ruminative thoughts, individuals with cancer have tried solutions such as distracting activities and avoiding thoughts. IMPLICATIONS FOR NURSING PRACTICE Nurses have an important role in catching verbal and nonverbal cues for rumination, as they are constantly together with individuals with cancer and make observations. Therefore, nurses can raise awareness about their ruminative thoughts and teach coping skills to individuals with cancer.
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Affiliation(s)
- Sinem Öcalan
- MSc, PhD Candidate, RN, Research Assistant, Psychiatric Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey.
| | - Yeter Sinem Üzar-Özçetin
- PhD, RN, Associate Professor, School of Nursing, Midwifery, and Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
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26
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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27
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Wong SMY, Chen EYH, Lee MCY, Suen YN, Hui CLM. Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination. Brain Sci 2023; 13:1041. [PMID: 37508974 PMCID: PMC10377138 DOI: 10.3390/brainsci13071041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the "self-focused" type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one's daily activities, not only limited to those related to "self". A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today's context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the "Flow Model of Rumination (FMR)", which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human-device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.
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Affiliation(s)
- Stephanie M Y Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Michelle C Y Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y N Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Wong SMY, Ip CH, Hui CLM, Suen YN, Wong CSM, Chang WC, Chan SKW, Lee EHM, Lui SSY, Chan KT, Wong MTH, Chen EYH. Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors. Psychol Med 2023; 53:4603-4613. [PMID: 35650661 PMCID: PMC10388322 DOI: 10.1017/s0033291722001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. METHODS Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. RESULTS The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. CONCLUSIONS Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.
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Affiliation(s)
- Stephanie M. Y. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Charlie H. Ip
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy L. M. Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y. N. Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Corine S. M. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W. C. Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Sherry K. W. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin H. M. Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K. T. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael T. H. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y. H. Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Funk J, Kopf-Beck J, Watkins E, Ehring T. Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial. Trials 2023; 24:295. [PMID: 37098547 PMCID: PMC10129320 DOI: 10.1186/s13063-023-07295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders. METHODS The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention). DISCUSSION This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people. TRIAL REGISTRATION https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.
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Affiliation(s)
- Julia Funk
- Department of Psychology, LMU Munich, Munich, Germany.
| | | | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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Horczak P, Wang C, De Witte S, De Smet S, Remue J, De Raedt R, Vanderhasselt MA, Wu GR, Lemmens GMD, Baeken C. Combining transcranial direct current stimulation with group cognitive behavioral therapy developed to treat rumination: a clinical pilot study. Front Neurol 2023; 14:1167029. [PMID: 37181556 PMCID: PMC10167311 DOI: 10.3389/fneur.2023.1167029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background As part of repetitive negative thinking (RNT), rumination is a maladaptive cognitive response style to stress or negative mood which can increase the risk of depression and may prohibit complete recovery. Cognitive behavioral therapy (CBT) and transcranial direct current stimulation (tDCS) both proved to be effective in decreasing rumination. However, the combined effects of tDCS and CBT interventions on rumination have not yet been explored. The first aim of this pilot study is to investigate whether the combination of tDCS and CBT has an accumulating positive effect on modulating state rumination. The second aim is to assess the feasibility and safety profile of the proposed combined approach. Method Seventeen adults aged 32-60 years, suffering from RNT, were referred by their primary care professional to participate in an 8-week group intervention for RNT ("Drop It") comprising 8 sessions of CBT. Before each CBT session, patients underwent one double-blinded prefrontal active (2 mA for 20 min) or sham tDCS (anode over F3, cathode over the right supraorbital region) combined with an internal cognitive attention task focused on individual RNT, i.e., online tDCS priming. During each session, the Brief State Rumination Inventory was used to assess state rumination. Results A mixed effects model analysis revealed no significant differences between the stimulation conditions, weekly sessions, or their interaction in terms of state rumination scores. Conclusion Overall, the combination of online tDCS priming followed by group CBT was found to be safe and feasible. On the other hand, no significant additional effects of this combined approach on state rumination were established. Although our pilot study may have been too small to find significant clinical effects, future larger RCT studies on combined tDCS-CBT treatment protocols may reevaluate the selection of internal cognitive attention tasks and more objective neurophysiological measurements, consider the optimal timing of the combination (concurrently or sequentially), or may add additional tDCS sessions when following CBT.
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Affiliation(s)
- Paula Horczak
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Chanyu Wang
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Sara De Witte
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
- Department of Neurology and Bru-BRAIN, University Hospital Brussels, Brussels, Belgium
- Neuroprotection and Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Stefanie De Smet
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Jonathan Remue
- Department of Psychiatry, Ghent University Hospital, Ghent, East Flanders, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Gilbert M. D. Lemmens
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, East Flanders, Belgium
| | - Chris Baeken
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Head and Skin – Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
- Department of Neurology and Bru-BRAIN, University Hospital Brussels, Brussels, Belgium
- Neuroprotection and Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, East Flanders, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Wang T, Li M, Xu S, Xiang A, Xu X, Wang H. The relationship between sleep quality and depression: Critical roles of reflective and brooding rumination and sleep-related cognition. PSYCHOL HEALTH MED 2023; 28:955-963. [PMID: 36106351 DOI: 10.1080/13548506.2022.2124293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
There is a complex interplay between sleep problems and depression. This study explored the possible effects of rumination and dysfunctional beliefs about sleep on the relationship between sleep quality and depression. A cross-sectional survey of 1240 Chinese adults was conducted to assess the possible relationships. The results showed a chain mediating effect of reflection rumination and brooding rumination on the relationship between sleep quality and depression, accounting for 38.91% of the total variance. A moderating role of unreasonable attitudes about sleep was also discovered among the study participants, which enhanced the relationship between reflection and brooding, leading to a further increase in this relationship. Individually-tailored approaches targeting rumination and cognition may more effectively alleviate depression or co-morbid sleep problems and depression than the current standards of care.
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Affiliation(s)
- Tao Wang
- Department of Basic Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Min Li
- Department of Military Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Song Xu
- Health Service Training Center, No.991 Hospital of PLA, Xiangyang, Hubei, China
| | - Aiguo Xiang
- People's Hospital of Fengdu County, Chongqing, China
| | - Xiaoxiao Xu
- Department of Basic Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haiquan Wang
- Department of Basic Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
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From fear of falling to choking under pressure: A predictive processing perspective of disrupted motor control under anxiety. Neurosci Biobehav Rev 2023; 148:105115. [PMID: 36906243 DOI: 10.1016/j.neubiorev.2023.105115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
Under the Predictive Processing Framework, perception is guided by internal models that map the probabilistic relationship between sensory states and their causes. Predictive processing has contributed to a new understanding of both emotional states and motor control but is yet to be fully applied to their interaction during the breakdown of motor movements under heightened anxiety or threat. We bring together literature on anxiety and motor control to propose that predictive processing provides a unifying principle for understanding motor breakdowns as a disruption to the neuromodulatory control mechanisms that regulate the interactions of top-down predictions and bottom-up sensory signals. We illustrate this account using examples from disrupted balance and gait in populations who are anxious/fearful of falling, as well as 'choking' in elite sport. This approach can explain both rigid and inflexible movement strategies, as well as highly variable and imprecise action and conscious movement processing, and may also unite the apparently opposing self-focus and distraction approaches to choking. We generate predictions to guide future work and propose practical recommendations.
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Data and alternative models describing the associations among non-infection pandemic stress, event-related rumination, depression, and anxiety. Data Brief 2023; 46:108864. [PMID: 36589627 PMCID: PMC9792411 DOI: 10.1016/j.dib.2022.108864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Here we present cross-sectional data collected from 1507 participants through the Qualtrics online survey platform. Participants were recruited from Reddit, Facebook, and the Queen's University undergraduate participant pool, and were instructed to complete a pandemic stress survey, the Beck Depression Inventory-II (BDI-II) [1], the Beck Anxiety Inventory (BAI) [2], a modified version of Event-Related Rumination Inventory (ERRI) [3], and a demographics questionnaire. For the 1069 participants who were not exposed to COVID-19 infection, we calculated the sum of each scale/subscale and performed a multiple mediation analysis using MPlus. The results indicated that three models (one primary model and two alternative models) had comparable statistical power to explain the variance as we tested different configurations of predictor, mediator, and outcome variables. Given the cross-sectional nature of the present study, we could not conclude which model was most valid. Therefore, we share our original data and tested models here for others to use. They are useful for researchers who wish to replicate our results, conduct new analyses with these data, or design future studies.
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Mavragani A, Miller L. Assessment and Disruption of Ruminative Episodes to Enhance Mobile Cognitive Behavioral Therapy Just-in-Time Adaptive Interventions in Clinical Depression: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e37270. [PMID: 36602841 PMCID: PMC9853337 DOI: 10.2196/37270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/20/2022] [Accepted: 10/24/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A just-in-time adaptive intervention (JITAI) is "designed to address the dynamically changing needs of individuals via the provision of the type or amount of support needed, at the right time when needed." If and how rumination-focused cognitive behavioral therapy (RFCBT), the gold standard, blocks emotional cascades underlying rumination is unclear. Furthermore, cognitive behavioral therapy has been successfully used as a mobile variant, but RFCBT has not been adapted for a mobile variant (mobile RFCBT [MRFCBT]) or for a JITAI variant. OBJECTIVE This study aimed to pilot-test a fully automated JITAI leveraging RFCBT and ways to identify and block cascading depressive rumination. METHODS Patients in therapy for clinical depression were recruited for a randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to either of the 2 mobile versions of the RFCBT conditions personalized to the individual's rumination timing patterns (JITAI-MRFCBT) or a no-treatment control condition through a double-blind procedure. Although the initial design was to have a 3-armed trial with 2 JITAI conditions (a JITAI and a narrative JITAI condition), we later opted to collapse those 2 conditions into 1 JITAI condition because of the low number of participants. All participants were recruited and participated through their smartphones, receiving 5 SMS text message reminders on each of the 35 days to self-report their rumination-related symptoms (eg, rumination episodes and duration). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7 days provided a rumination baseline, and the last 7 days provided a postintervention rumination value. In total, 42% (25/59) of volunteers were eligible and provided their phone numbers, 20% (5/25) of whom never replied to the SMS text message reminding them to start the RCT. A total of 90% (18/20) of volunteers completed it (ie, finishing, as prespecified, 80% of the questionnaires and training tasks) and, therefore, were included in the analysis. RESULTS Using independent 2-tailed t tests with bootstrapping, results showed that participants in the JITAI-MRFCBT condition, compared with those in the control condition, reported a greater reduction in counts of rumination episodes (mean -25.28, SD 14.50 vs mean 1.44, SD 4.12, P<.001) and greater reduced average time (minutes) spent in rumination (mean -21.53, SD 17.6 vs mean 1.47, SD 1.5; P=.04). Results also suggest that, compared with those in the control group, those in treatment reduced ruminative carryover from one episode to the next. CONCLUSIONS The results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just in time following rumination, thereby blocking the next rumination episode using the same trigger. This study supports a subsequent, full-scale JITAI and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT04554706; https://clinicaltrials.gov/ct2/show/NCT04554706.
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Affiliation(s)
| | - Lynn Miller
- University of Southern California, Annenberg School for Communication and Journalism, Los Angeles, CA, United States
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Toussaint L, Lee JA, Hyun MH, Shields GS, Slavich GM. Forgiveness, rumination, and depression in the United States and Korea: A cross-cultural mediation study. J Clin Psychol 2023; 79:143-157. [PMID: 35700333 DOI: 10.1002/jclp.23376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Although substantial research has separately investigated forgiveness, rumination, and depression in the United States, few studies have investigated all three constructs in the same sample and we know of no studies that have examined how forgiveness, rumination, and depression are interrelated across cultures. METHOD To address this issue, we conducted a cross-cultural study wherein 204 and 297 healthy young adults from Korea and the United States, respectively, completed the Heartland Forgiveness Scale, Ruminative Response Scale, and Beck Depression Inventory-II. RESULTS Compared to US participants, Korean participants exhibited more forgiveness, similar levels of rumination, and slightly more depression. Two-group structural equation models revealed that forgiveness was directly related to depressive symptoms, and that forgiveness was indirectly related to depressive symptoms through rumination, in both the United States (proportion mediated = 0.363) and Korea (proportion mediated = 0.394). This indirect association did not differ across cultures. CONCLUSION Considered together, these results suggest that forgiveness appears to have beneficial effects on depression that are mediated through forgiveness-related reductions in rumination, and, importantly, that these effects are similar across cultures.
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Affiliation(s)
- Loren Toussaint
- Department of Psychology, Luther College, Decorah, Iowa, USA
| | - Jiahn A Lee
- Department of Psychology, Chung-Ang University, Seoul, Korea
| | - Myoung Ho Hyun
- Department of Psychology, Chung-Ang University, Seoul, Korea
| | - Grant S Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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Chen H, He Q, Wang M, Wang X, Pu C, Li S, Li M. Effectiveness of CBT and its modifications for prevention of relapse/recurrence in depression: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2022; 319:469-481. [PMID: 36162683 DOI: 10.1016/j.jad.2022.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND CBT and its modifications are effective for depression, but its efficacy for preventing depressive relapse/recurrence remains unclear. METHODS A systematic review and meta-analysis was conducted scrutinizing the efficacy of CBT and its modifications for preventing depressive relapse/recurrence in randomized controlled trials. The retrieval database included PubMed, Web of Science, MEDLINE, and three major Chinese databases (CNKI, VIP, Wanfang), and the retrieval period was from January 1, 2009, to July 1, 2022. Data were analyzed by RevMan 5.4 and Stata 16. RESULTS A total of 28 randomized controlled trials with 3938 participants were included. The relapse/recurrence rates in CBT and its modifications and the control group were 31.6 % and 41.3 %, respectively; CBT and its modifications significantly reduced the risk of developing a new depressive episode (RR, 0.73, 95%CI, 0.64-0.83). Stratified by follow-up time, both CBT and its modifications significantly reduced the relapse/recurrence of depression at ≤12 months (RR, 0.61, 95%CI, 0.47-0.79) and > 12 months (RR, 0.74, 95%CI, 0.59-0.93) compared with other active treatments. The beneficial effects of CBT and its modifications alone in reducing depressive relapse/recurrence were equivalent to those of antidepressant medication alone (RR, 1.01, 95 % CI, 0.79-1.28). Meta-regression results showed that the intervention method (P = 0.005) was one of the sources of heterogeneity. LIMITATIONS Further subgroup analysis is limited by the literature. CONCLUSION CBT and its modifications are reliable interventions for preventing relapse/recurrence in patients with depression. Further research is needed to determine the specific conditions for CBT and its applications in clinical practice.
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Affiliation(s)
- Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Qin He
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Mingting Wang
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xing Wang
- Nanchang University Institute of Life Science, School of Life Sciences (Nanchang University), Nanchang 330000, China
| | - Changqin Pu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Shunfei Li
- Institute of Military Hospital Management, Chinese PLA General Hospital, Beijing 100853, China.
| | - Mengqian Li
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
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Salemi E, Mirzazade Z, Dehshiri G, Zahraei S. Sensitivity to punishment and emotional eating: The mediating role of shame and rumination. Psychol Psychother 2022; 95:875-887. [PMID: 35661385 DOI: 10.1111/papt.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The relationship between sensitivity to punishment (SP) and emotional eating has been previously examined. However, effective variables in this relationship have yet to be recognized. This study aimed to investigate the relationship between SP and emotional eating via facets of shame and rumination. DESIGN Serial Mediation model was proposed. METHOD Female university students in Iran (n = 174) completed Sensitivity to Punishment and Sensitivity to Reward Questionnaire-Revised and Clarified (SPSRQ-RC), Dutch Eating Behaviour Questionnaire (DEBQ), Experience of Shame Scale (ESS) and Ruminative Responses Scale (RRS). RESULTS SP showed a significant effect on emotional eating. Moreover, we observed that the relationship between SP and emotional eating was separately mediated by shame (general, characterological and bodily shame) and rumination. We further noticed the sequentially mediating role of shame (general, characterological and behavioural shame) and rumination in the relationship between SP and emotional eating. CONCLUSION Findings suggest that high SP can increase the risk of emotional eating through negative emotions (e.g. shame) and disturbed cognitions (e.g. rumination). Therefore, for a better understanding, it seems necessary to consider emotional eating a maladaptive behaviour adopted as a possible result of the impairment of temperamental, emotional and cognitive systems.
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Affiliation(s)
- Elnaz Salemi
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Zahra Mirzazade
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Gholamreza Dehshiri
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Shaghayegh Zahraei
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
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Stevenson JC, Akram U. Self-critical thinking mediates the relationship between perfectionism and perceived stress in undergraduate students: a longitudinal study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Joubert AE, Moulds ML, Werner‐Seidler A, Sharrock M, Popovic B, Newby JM. Understanding the experience of rumination and worry: A descriptive qualitative survey study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:929-946. [PMID: 35411619 PMCID: PMC9790473 DOI: 10.1111/bjc.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Rumination and worry have been implicated in the onset, severity, maintenance and relapse risk of depression and anxiety disorders. Despite this, little research has examined individuals' personal experiences of these processes. This study investigates how individuals experience these processes, which will provide insight into these common features of mental disorders and inform the development of an online intervention specifically targeting rumination and worry. DESIGN An online qualitative survey was conducted to gain insight into people's personal definitions, experiences with and understandings of rumination and worry. METHODS Participants answered open- and close-ended questions about their personal understanding of rumination and worry, typical thought content, triggers, frequency, duration and coping strategies. Participant responses were coded into themes. Participants also completed self-report questionnaires of depression, anxiety and stress and repetitive negative thinking. RESULTS Two hundred and seven adults completed the online survey (76% female; mean age = 28.2 years, range = 17-71), 51% of whom reported previously experiencing depression and anxiety. All participants were familiar with the concept of worry, whereas 28% of participants indicated they had never heard of rumination. Participants reported most commonly ruminating and/or worrying about personal relationships, past mistakes, negative experiences and conversations/social interactions. The most commonly reported triggers for rumination and/or worry were social situations/interpersonal interactions (25%) and negative events/experiences (24%). Distraction was the most common coping strategy (48%); however, 21% reported being unable to stop themselves from ruminating and/or worrying. CONCLUSIONS The results provide a unique insight into the personal experiences and understandings of rumination and worry of potential end users of treatment programs targeting these processes.
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Affiliation(s)
- Amy E. Joubert
- Clinical Research Unit for Anxiety and Depression (CRUfAD)St. Vincent's HospitalSydneyNew South WalesAustralia,School of Psychology, Faculty of ScienceUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michelle L. Moulds
- School of Psychology, Faculty of ScienceUniversity of New South WalesSydneyNew South WalesAustralia
| | - Aliza Werner‐Seidler
- Black Dog InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Maria Sharrock
- Clinical Research Unit for Anxiety and Depression (CRUfAD)St. Vincent's HospitalSydneyNew South WalesAustralia,School of Psychiatry, UNSW MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bojana Popovic
- School of Psychology, Faculty of ScienceUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jill M. Newby
- Black Dog InstituteThe University of New South WalesSydneyNew South WalesAustralia
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Otto MW, Lubin RE, Rosenfield D, Taylor DJ, Birk JL, Espie CA, Shechter A, Edmondson D, Shepherd JM, Zvolensky MJ. The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity. Sleep 2022; 45:zsac117. [PMID: 35639820 PMCID: PMC9548665 DOI: 10.1093/sleep/zsac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Indexed: 07/29/2023] Open
Abstract
STUDY OBJECTIVES This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status. METHODS In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality. RESULTS Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings. CONCLUSIONS If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.
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Affiliation(s)
- Michael W Otto
- Corresponding author. Michael W. Otto, Department of Psychological and Brain Sciences, Boston University, 900E Commonwealth Ave., Boston, MA, 02215. E-mail:
| | - Rebecca E Lubin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX,USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,USA
- HEALTH Institute, University of Houston, Houston, TX,USA
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41
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Peets K, Turunen T, Salmivalli C. Rumination Mediates the Longitudinal Associations Between Elementary-School Victimization and Adolescents' Internalizing Problems. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16885-NP16906. [PMID: 34107816 DOI: 10.1177/08862605211025020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Identifying potential mechanisms responsible for victimized children's maladjustment over time is a crucial step in our efforts to alleviate negative consequences of victimization. In this study, we examined whether rumination would serve as a potential mediator of the prospective links between victimization in late childhood and symptoms of depression and anxiety in adolescence. The sample included 552 Finnish students (238 boys; Mage in third grade = 9.85 years, SD = .71) who participated in a longitudinal study. Participants filled out several measures where they were asked about the frequency of different forms of victimization (in third and fourth grade), how much they ruminated about their past victimization and whether it elicited sadness and anger (in seventh grade), and the degree to which they experienced depressive and anxiety symptoms (in third and seventh grade). We found that greater frequency of victimization in elementary school led to increases in symptoms of depression and anxiety through rumination. These findings suggest that at least some victimization-related negative consequences can be minimized if we are able to help young people to stop reliving their painful memories.
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The relationship between symptoms of obsessive compulsive disorder and depression during therapy: A random intercept cross-lagged panel model. J Behav Ther Exp Psychiatry 2022; 76:101748. [PMID: 35738694 DOI: 10.1016/j.jbtep.2022.101748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We know little about how symptoms of obsessive-compulsive disorder and depression interact during psychological therapy. Although some previous research suggests that reductions in the severity of depression are driven by reductions in OCD, support for this conclusion is limited due to the exclusion of individuals with severe depression and limitations of the statistical approaches used. METHODS This study re-examined the interaction between symptoms of OCD and depression during therapy in a sample of 137 adults with a primary diagnosis of OCD and a full range of depression severity. All participants received a 12 to 16-week specialist residential treatment. Participants completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model. RESULTS Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD. LIMITATIONS The present study was conducted in a residential setting, meaning the findings may not generalise to outpatient settings characterised by less severe OCD and depression. CONCLUSIONS Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD.
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Yan K, Yusufi MH, Nazari N. Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial. World J Clin Cases 2022; 10:8599-8614. [PMID: 36157826 PMCID: PMC9453349 DOI: 10.12998/wjcc.v10.i24.8599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals.
AIM To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders.
METHODS In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire.
RESULTS The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group.
CONCLUSION This study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.
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Affiliation(s)
- Kou Yan
- School of Humanities and Education, Xi'an Eurasia University, Xi'an 710065, Shaanxi Province, China
| | | | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Lorestan, Iran
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44
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Zhou SC, Luo D, Wang XQ, Zhu J, Wu S, Sun T, Li XY, Kang L, Ma S, Lu B, Liu Q, Yang BX, Liu Z. Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes. J Affect Disord 2022; 311:311-318. [PMID: 35597473 DOI: 10.1016/j.jad.2022.05.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear. METHODS Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis. RESULTS Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI. LIMITATIONS The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality. CONCLUSIONS The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.
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Affiliation(s)
- Si Chen Zhou
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China
| | - Dan Luo
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China; Population and Health Research Center, Wuhan University, Wuhan, China
| | - Xiao Qin Wang
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China
| | - Junyong Zhu
- School of Public Health, Wuhan University, Wuhan, China
| | - Shuqin Wu
- School of Public Health, Wuhan University, Wuhan, China
| | - Ting Sun
- Health science center, Yangtze University, Jingzhou, China
| | - Xin Yi Li
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Baili Lu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Qian Liu
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China; Population and Health Research Center, Wuhan University, Wuhan, China.
| | - Bing Xiang Yang
- Mental and Behavioural Health Research Center, School of Nursing, Wuhan University, Wuhan, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China; Population and Health Research Center, Wuhan University, Wuhan, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
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Squires SD, Hu M, Milev RV, Poppenk J. The impact of non-infection pandemic stress on depression and anxiety severity: Investigating mediation by intrusive and deliberate rumination. J Affect Disord 2022; 310:291-295. [PMID: 35561882 PMCID: PMC9088212 DOI: 10.1016/j.jad.2022.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/27/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social restrictions to curb COVID-19's spread have had adverse effects on population mental health. Rumination is one mechanism through which pandemic stress (PS) might translate into psychopathology. In particular, intrusive rumination (IR) is believed to be problematic. In this study, we investigated whether IR and deliberate rumination (DR) mediated the associations between PS and both depression and anxiety severity. METHODS 1090 participants recruited online and from an undergraduate psychology participation pool completed an assessment of COVID-19 PS, as well as the Event-Related Rumination Inventory, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Total scores for PS, IR, DR, depression, and anxiety severity were tested in a parallel mediation model. RESULTS PS positively predicted IR, DR, depression, and anxiety severity. IR positively predicted 1depression and anxiety severity, whereas DR did not. Indirect effects of PS on depression and anxiety severity were significant for IR, but not DR. Direct effects of PS on anxiety and depression severity were significant. Taken together, IR partially mediated the association between PS and both measures of psychopathology, and DR did not. LIMITATIONS This study was limited by its cross-sectional design and the lack of assessment of when PS exposure occurred. CONCLUSIONS Regarding PS that is unrelated to infection by COVID-19, IR is one mechanism through which psychopathology may emerge, whereas DR appears to be benign. Promoting a shift from IR to DR may therefore be one strategy for mitigating the negative effects of PS and other stressors on mental health.
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Affiliation(s)
- Scott D. Squires
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada,Corresponding author
| | - Mianzhi Hu
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Roumen V. Milev
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada,Department of Psychology, Queen's University, Kingston, Ontario, Canada,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Jordan Poppenk
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada,Department of Psychology, Queen's University, Kingston, Ontario, Canada,School of Computing, Queen's University, Kingston, Ontario, Canada
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46
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Effectiveness of Existential Therapy Based on Ontological Core Schemas on Rumination and Mindfulness of Depressed Women: A Randomized Clinical Trial Design. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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47
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Nature-Based Meditation, Rumination and Mental Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159118. [PMID: 35897493 PMCID: PMC9332585 DOI: 10.3390/ijerph19159118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023]
Abstract
Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings.
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48
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Rogiers R, Baeken C, Watkins ER, van den Abbeele D, Remue J, de Raedt R, Lemmens GMD. A Psychoeducational CBT-based Group Intervention ("Drop It") for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes. Int J Group Psychother 2022; 72:257-292. [PMID: 38446560 DOI: 10.1080/00207284.2022.2066535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Repetitive negative thinking (RNT)-such as worry and rumination-is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled "Drop It" that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT.
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49
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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Mizuno A, Karim HT, Newmark J, Khan F, Rosenblatt MJ, Neppach AM, Lowe M, Aizenstein HJ, Mennin DS, Andreescu C. Thinking of Me or Thinking of You? Behavioral Correlates of Self vs. Other Centered Worry and Reappraisal in Late-Life. Front Psychiatry 2022; 13:780745. [PMID: 35815034 PMCID: PMC9256986 DOI: 10.3389/fpsyt.2022.780745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Psychotherapeutic approaches in late-life anxiety have limited effect on reducing worry severity. The self-referential processing of worry contents (self- vs. other-focused worry) and reappraisal styles (internal vs. external locus of control) are important elements in psychotherapy, but little is known about these processes in late-life. We aimed to characterize severe worry from a self-referential processing perspective. We recruited 104 older adults with various levels of worry and used a personalized task to induce and reappraise worry. We analyzed the association between (1) worry severity/frequency for worry content (self- or other-focused) and (2) for reappraisal style (internal vs. external locus of control) with clinical inventories measuring anxiety, worry, depression, rumination, neuroticism, emotion regulation strategies, perceived stress, and physical illness burden. Higher self-worry severity was associated with higher scores of clinical inventories of worry, depression, perceived stress, and neuroticism, whereas other-worry severity did not show any association. Greater self-worry frequency was associated with higher medical burden. External locus of control in reappraisal statements was associated with lower worry severity in men. Overall, more severe and frequent self-focused worry was associated with a greater psychological and physiological burden. These results are useful in tailoring psychotherapy for older adults with severe worry.
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Affiliation(s)
- Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Helmet Talib Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Faiha Khan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Alyssa M. Neppach
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - MaKayla Lowe
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Howard Jay Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Douglas S. Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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