Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression

In treating an acute episode of winter depression, cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy are comparably efficacious, with improvement in depression symptoms during CBT-SAD mediated by reduced seasonal beliefs (i.e., maladaptive thoughts about the seasons, light availability, and weather). Here, we tested whether the enduring benefit of CBT-SAD over light therapy following treatment is associated with offsetting seasonal beliefs during CBT-SAD. Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6 weeks of light therapy or group CBT-SAD and followedup one and two winters after treatment. Outcomes measured during treatment and at each follow-up included depression symptoms on the Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version and Beck Depression Inventory-Second Edition. Candidate mediators measured at pre-, mid-, and posttreatment were SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); brooding rumination (Ruminative Response Scale-Brooding subscale; RRS-B); and chronotype (Morningness-Eveningness Questionnaire; MEQ). Latent growth curve mediation models found a significant positive path from treatment group to the slope of SBQ during treatment, with CBT-SAD showing larger improvements in seasonal beliefs with overall change in seasonal beliefs in the medium-effect range, and significant positive paths from SBQ slope to depression scores at the first and second winter follow-ups, indicating greater change towards more flexible seasonal beliefs during active treatment was associated with less severe depression symptoms following treatment. Estimated indirect effects (treatment group → SBQ change * SBQ change → outcome) were also significant at each follow-up for each outcome with βindirect ranging from .091 to .162. Models also found significant positive paths from treatment group to the slope of MEQ and RRS-B during treatment, with light therapy showing a greater increase in "morningness" and CBT-SAD showing a greater decrease in brooding during active treatment; however, neither construct emerged as a mediator of follow-up depression scores. Change in seasonal beliefs during treatment mediates both the acute antidepressant and long-term effects of CBT-SAD and explains lower depression severity following CBT-SAD relative to light therapy.

Development and Validation of the Smoker Self-Stigma Questionnaire (SSSQ)

INTRODUCTION

Researchers have become increasingly concerned with the stigmatizing impact that regulations and policies aimed to curve down cigarette smoking may have in smokers. Given the lack of psychometrically validated tools available to assess smoking stigma, we developed and evaluated the Smoker Self-Stigma Questionnaire (SSSQ).

METHODS

A total of 592 smokers recruited through Amazon's Mechanical Turk (MTurk) completed an online, Qualtrics survey that included 45 items developed and vetted by tobacco-research experts. The items were assigned a priori to three, theoretical stigma factors or domains (enacted, felt, and internalized). We first conducted a confirmatory factor analysis (CFA) on the responses from one-half of the participants with the goal of distilling the 45-item pool to an 18-item instrument with 6 items per factor. A promising, 18-item, three-factor measure was then cross-validated with the second half of the sample.

RESULTS

The second CFA yielded excellent fit indices, as well as adequate and significant factor loadings. Subscale scores obtained from the separated factors differentially predicted nicotine dependence and motivation to quit cigarettes, providing convergent and discriminant validity for the SSSQ and its proposed, three-factor structure.

CONCLUSIONS

Overall, the SSSQ fills an important research gap by providing a psychometrically sound measure that investigators can use to study smoking stigma.

IMPLICATIONS

Prior research on smoking self-stigma has used a wide variety of psychometrically invalid measures and reported inconsistent findings. This is the first study that presents a measure of smoking self-stigma that is not a merely and arbitrary adaptation of a mental illness stigma measure, but that is theoretically driven and created from a large and comprehensive pool of items vetted by tobacco-research experts. Having demonstrated and then cross-validated its excellent psychometric properties, the SSSQ provides the field with a promising tool to assess, investigate, and replicate the causes and effects of smoking self-stigma.

Latent Classes of Perceived Addictiveness Predict Marijuana, Alcohol, and Tobacco Use in Youth and Young Adults

Background: Mass media substance use prevention efforts target addiction perceptions in young people. This study examined youth and young adults' (YAs) perceived addictiveness across several substances and the associations between addiction perceptions and substance use. Methods: Data were collected in 2019 in an online cohort study of Vermonters aged 12-25. Latent class analyses grouped participants by perceived addictiveness of nicotine, caffeine, alcohol, marijuana, cigarettes, electronic vapor products (EVPs), and opioids. Bivariate multinomial logistic and modified Poisson regression estimated associations between sociodemographics, substance use correlates, and subsequent use across latent classes. Results: Four latent classes captured addiction perceptions: high perceived addictiveness of EVPs, cigarettes, marijuana, and alcohol (Class 1: n = 317; 31.3%), low perceived addictiveness of marijuana, alcohol, and caffeine (Class 2: n = 151; 14.3%), low perceived addictiveness of marijuana (Class 3: n = 581; 46.5%), and low perceived addictiveness of nicotine, cigarettes, and EVPs (Class 4: n = 83; 7.9%). For each year increase in age, there was a 36% increased likelihood of being in Class 2 (vs. Class 1) and a 148% increased likelihood of belonging to Class 3 (vs. Class 1). Low perceived addictiveness classes were associated with ever and past 30-day marijuana and alcohol use and predicted past 30-day alcohol use at three-month follow-up. Membership in Classes 2 and 3 also predicted past 30-day marijuana use at Wave 3. Discussion: The strong association between age and latent classes defined by low perceived addictiveness suggests age group differences in addiction perceptions. Findings suggest that YAs may benefit from prevention messaging on addictiveness.

An examination of the heterogeneity of the relationships between posttraumatic stress disorder, self-compassion and gratitude

Previous research has found both self-compassion and gratitude to be protective against overall posttraumatic stress disorder (PTSD) symptom severity. PTSD is a highly heterogeneous disorder; however, it is unclear if these protective constructs are differentially associated with each cluster of PTSD. The present study examined differences in the association of self-compassion and gratitude with the four clusters of PTSD as indicated by the DSM-5. Participants were 1424 trauma-exposed individuals recruited via Amazon's Mechanical Turk. The mean age of participants was 31.49 (SD = 11.25) years old, and 55.3% of the sample identified as female. A structural equation model (SEM) approach was used to examine relationships between factors of gratitude, self-compassion and the four PTSD symptom clusters. A two-factor model of self-compassion best fits the data. Both the self-compassion and gratitude factors were significantly associated with all symptom clusters of PTSD. Wald chi-square tests indicated self-compassion and gratitude to have the strongest association with negative alterations in cognitions and mood (NACM) PTSD symptoms. These findings may have important implications for treatment targets to reduce specific symptoms of PTSD, particularly in PTSD symptoms related to negative affect.

Applying experimental therapeutics to examine cognitive and chronological vulnerabilities as mediators of acute outcomes in cognitive-behavioral therapy and light therapy for winter depression

OBJECTIVE

We applied the experimental therapeutics approach to test whether acute treatment outcomes for winter seasonal affective disorder (SAD) are mediated by a cognitive mechanism in cognitive-behavioral therapy (CBT-SAD) versus a chronobiologic mechanism in light therapy (LT).

METHOD

Currently depressed adults with major depression, recurrent with seasonal pattern (N = 177; 83.6% female, 92.1% non-Hispanic White, M age = 45.6) were randomized to 6 weeks of LT or group CBT-SAD. SAD symptoms were assessed weekly on the Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version. At pre-, mid-, and posttreatment, participants completed measures of general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); chronotype (Morningness-Eveningness Questionnaire; MEQ); and depressive symptoms (Beck Depression Inventory-Second Edition).

RESULTS

Parallel-process growth models showed evidence for hypothesized mechanisms. For SAD-specific negative cognitions (SBQ), both symptom measures showed (1) an effect of treatment group on the slope of the mediator, with CBT-SAD demonstrating greater decreases, and (2) an effect of the slope of the mediator on the slope of the outcome. These effects held for the SBQ but not the broader measure of depressogenic cognitions (DAS). For the chronotype measure (MEQ), treatment assignment affected change, whereby LT was associated with reduced "eveningness," but this was unrelated to change in symptoms.

CONCLUSIONS

CBT-SAD promoted decreases in SAD-specific negative cognitions, and these changes were related to decreases in symptoms. Consistent with the theory that LT corrects misaligned circadian rhythms, LT reduced eveningness, but this did not correspond to symptom improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Structural brain correlates of adolescent resilience

BACKGROUND

Despite calls for integration of neurobiological methods into research on youth resilience (high competence despite high adversity), we know little about structural brain correlates of resilient functioning. The aim of the current study was to test for brain regions uniquely associated with positive functioning in the context of adversity, using detailed phenotypic classification.

METHODS

1,870 European adolescents (M_age  = 14.56 years, SD_age  = 0.44 years, 51.5% female) underwent MRI scanning and completed behavioral and psychological measures of stressful life events, academic competence, social competence, rule-abiding conduct, personality, and alcohol use.

RESULTS

The interaction of competence and adversity identified two regions centered on the right middle and superior frontal gyri; grey matter volumes in these regions were larger in adolescents experiencing adversity who showed positive adaptation. Differences in these regions among competence/adversity subgroups were maintained after controlling for several covariates and were robust to alternative operationalization decisions for key constructs.

CONCLUSIONS

We demonstrate structural brain correlates of adolescent resilience, and suggest that right prefrontal structures are implicated in adaptive functioning for youth who have experienced adversity.

Is parenting the mediator of change in behavioral parent training for externalizing problems of youth?

Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT.

Comparison of categorical alcohol dependence versus a dimensional measure for predicting weekly alcohol use in heavy drinkers

BACKGROUND

The DSM specifies categorical criteria for psychiatric disorders. In contrast, a dimensional approach considers variability in symptom severity and can significantly improve statistical power. The current study tested whether a categorical, DSM-defined diagnosis of Alcohol Dependence (AD) was a better fit than a dimensional dependence measure for predicting change in alcohol consumption among heavy drinkers following a brief alcohol intervention (BI). DSM-IV and DSM-5 alcohol use disorder (AUD) measures were also evaluated.

METHODS

Participants (N=246) underwent a diagnostic interview after receiving a BI, then reported daily alcohol consumption using an Interactive Voice Response system. Dimensional AD was calculated by summing the dependence criteria (mean=4.0; SD=1.8). The dimensional AUD measure was a summation of positive Alcohol Abuse plus AD criteria (mean=5.8; SD=2.5). A multi-model inference technique was used to determine whether the DSM-IV categorical diagnosis or dimensional approach would provide a more accurate prediction of first week consumption and change in weekly alcohol consumption following a BI.

RESULTS

The Akaike information criterion (AIC) for the dimensional AD model (AIC=7625.09) was 3.42 points lower than the categorical model (AIC=7628.51) and weight of evidence calculations indicated there was 85% likelihood that the dimensional model was the better approximating model. Dimensional AUD models fit similarly to the dimensional AD model. All AUD models significantly predicted change in alcohol consumption (p's=.05).

CONCLUSION

A dimensional AUD diagnosis was superior for detecting treatment effects that were not apparent with categorical and dimensional AD models.

Molecular-genetic correlates of infant attachment: a cautionary tale

This paper advises caution in relation to the increasing interest in molecular-genetic association studies in developmental psychology based on a set of empirical examples from the NICHD Study of Early Child Care and Youth Development (SECCYD) that highlight the fragility of effects reported in the literature on the molecular-genetic correlates of infant attachment. Specifically, this paper updates and provides three extensions to results reported in Luijk et al. (2011), which recently failed to replicate evidence from smaller-sample studies that a set of dopaminergic, serotonergic, and oxytonergic markers are significantly associated with infant attachment security or disorganization. First, we report here that the average effect of "usual suspect" polymorphisms on infant attachment security and disorganization in the SECCYD is approximately zero. Second, because Luijk et al. (2011) reported data based exclusively on the White infants in the SECCYD, this paper reveals that the average effect of polymorphisms featured in this literature is also of trivial magnitude in the non-White sub-sample (cf. Chen, Barth, Johnson, Gotlib, & Johnson, 2011). Third, this paper attempts, but fails, to replicate a recent finding by Raby et al. (2012) suggesting that, although molecular-genetic polymorphisms might not be implicated in security versus insecurity, the serotonin transporter gene contributes to variation in emotional distress during the Strange Situation Procedure. Implications for future research on the genetics of developmental phenotypes in general and attachment in particular are discussed, with a focus on statistical power and model-based theory testing.

Pathways of Adaptation from Adolescence to Young Adulthood: Antecedents and Correlates

This study examines longitudinal change using a person-centered approach to differentiate patterns of adaptive functioning from adolescence to adulthood. Data are drawn from a 20-year longitudinal study of competence and resilience in the lives of 205 school children (29% minority). Results indicate five distinct pathways of adaptation: (1) low-declining, (2) low-improving, (3) middle-improving, (4) middle-declining, and (5) consistently high. The study also compares the five groups on childhood risks and resources, and on longitudinal assessment of competence and adversity. Interestingly, the most dramatic changes in pathways of adaptation occur during the period of emerging adulthood.

Developmental cascades: linking academic achievement and externalizing and internalizing symptoms over 20 years

A developmental cascade model linking competence and symptoms was tested in a study of a normative, urban school sample of 205 children (initially 8 to 12 years old). Internalizing and externalizing symptoms and academic competence were assessed by multiple methods at the study outset and after 7, 10, and 20 years. A series of nested cascade models was tested through structural equation modeling. The final model indicated 2 hypothesized cascade effects: Externalizing problems evident in childhood appeared to undermine academic competence by adolescence, which subsequently showed a negative effect on internalizing problems in young adulthood. A significant exploratory effect was consistent with internalizing symptoms containing or lowering the net risk for externalizing problems under some conditions. These 3 cascade effects did not differ by gender and were not attributable to effects of IQ, parenting quality, or socioeconomic differences. Implications are discussed for developmental models of cascades, progressions, and preventive interventions.

Resources and resilience in the transition to adulthood: continuity and change

Patterns of continuity and change in competence and resilience over the transition to adulthood were examined in relation to adversity and psychosocial resources, with a focus on adaptive resources that may be particularly important for this transition. Variable-focused and person-focused analyses drew on data from the Project Competence longitudinal study of a school cohort followed over 20 years from childhood through emerging adulthood (EA) into the young adulthood (YA) years with excellent retention (90%). Success in age-salient and emerging developmental tasks from EA to YA was examined in a sample of 173 of the original participants with complete data on adversity, competence, and key resources. Regressions and extreme-group analyses indicated striking continuity in competence and resilience, yet also predictable change. Success in developmental tasks in EA and YA was related to core resources originating in childhood (IQ, parenting quality, socioeconomic status) and also to a set of EA adaptive resources that included planfulness/future motivation, autonomy, adult support, and coping skills. EA adaptive resources had unique predictive significance for successful transitions to adulthood, both overall and for the small group of individuals whose pattern of adaptation changed dramatically from maladaptive to resilient over the transition. Results are discussed in relation to the possibility that the transition to adulthood is a window of opportunity for changing the life course.

Mediating links between maternal depression and offspring psychopathology: the importance of independent data

BACKGROUND

Research examining intergenerational transmission of psychopathology is often limited by reliance on the same individuals for information on multiple constructs of interest. To counteract this limitation, data from a prospective, longitudinal study of at-risk youth were analyzed to test the hypothesis that parenting and family environmental factors mediate the association between maternal depressive symptoms and offspring psychopathology in late adolescence.

METHOD

Data were taken from 184 families of the Minnesota Longitudinal Study of Parents and Children. Measures included the CES-D and Beck depression inventories, home environment ratings and a family conflict scale, and CBCL behavior problem checklist and K-SADS psychiatric symptom scores. Regression analyses were conducted to test for mediation of maternal depression effects by family environmental factors.

RESULTS

Analyses using a single informant and time point showed evidence for substantial mediation; however, in analyses spanning independent informants and multiple time points mediating effects were markedly reduced. Sex differences were found, in that parenting and family environmental factors related to psychopathology for males, whereas maternal depression was more directly related to psychopathology for females.

CONCLUSIONS

Results emphasize the importance of independent data for testing mediational claims, and support claims that the processes involved in the intergenerational transmission of psychopathology are different for male and female youth.

The prediction of disruptive behaviour disorders in an urban community sample: the contribution of person-centred analyses

BACKGROUND

Variable- and person-centred analyses were used to examine prediction of middle childhood behaviour problems from earlier child and family measures.

METHOD

A community sample of 164 families, initially recruited at antenatal clinics at two South London practices, was assessed for children's behaviour problems and cognitive ability, maternal mental health, and the family environment when the children were 4 years old. At age 11, children, mothers, and teachers reported the child's disruptive behaviour, and mothers and children were interviewed to identify cases of disruptive behaviour disorders (DBD).

RESULTS

Neither social class nor ethnicity predicted the child's disruptive behaviour at age 11. Rather, path analyses and logistic regression analyses drew attention to early behavioural problems, maternal mental health and the child's cognitive ability at 4 as predictors of disruptive behaviour at age 11. Cluster analysis extended these findings by identifying two distinct pathways to disruptive symptoms and disorder. In one subgroup children who showed intellectual difficulties at 4 had become disruptive by 11. In a second subgroup mothers and children both showed psychological problems when the child was 4, and the children were disruptive at age 11. The person-centred approach also revealed a high-functioning group of cognitively able 4-year-olds in supportive environments, at especially low risk for DBD.

CONCLUSIONS

Combining variable- and person-centred analytic approaches can aid prediction of children's problems, draw attention to pertinent developmental pathways, and help integrate data from multiple informants.