Neural correlates of emotional processing in depression: changes with cognitive behavioral therapy and predictors of treatment response

Major depressive disorder (MDD) is characterized by the presence of disturbances in emotional processing. However, the neural correlates of these alterations, and how they may be affected by therapeutic interventions, remain unclear. The present study addressed these issues in a preliminary investigation using functional magnetic resonance imaging (fMRI) to examine neural responses to positive, negative, and neutral pictures in unmedicated MDD patients (N = 22) versus controls (N = 14). After this initial scan, MDD patients were treated with cognitive behavioral therapy (CBT) and scanned again after treatment. Within regions that showed pre-treatment differences between patients and controls, we tested the association between pre-treatment activity and subsequent treatment response as well as activity changes from pre- to post-treatment. This study yielded three main findings. First, prior to treatment and relative to controls, patients exhibited overall reduced activity in the ventromedial prefrontal cortex (PFC), diminished discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus, and enhanced responses to negative versus positive stimuli in the left anterior temporal lobe (ATL) and right dorsolateral PFC. Second, CBT-related symptom improvement in MDD patients was predicted by increased activity at baseline in ventromedial PFC as well as the valence effects in the ATL and dorsolateral PFC. Third, from pre- to post-treatment, MDD patients exhibited overall increases in ventromedial PFC activation, enhanced arousal responses in the amygdala, caudate, and hippocampus, and a reversal of valence effects in the ATL. The study was limited by the relatively small sample that was able to complete both scan sessions, as well as an inability to determine the influence of comorbid disorders within the current sample. Nevertheless, components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.

Neural correlates of promotion and prevention goal activation: an fMRI study using an idiographic approach

Regulatory focus theory [Higgins, E. T. Beyond pleasure and pain. American Psychologist, 52, 1280-1300, 1997] postulates two social-cognitive motivational systems, the promotion and prevention systems, for self-regulation of goal pursuit. However, the neural substrates of promotion and prevention goal activation remain unclear. Drawing on several literatures, we hypothesized that priming promotion versus prevention goals would activate areas in the left versus right prefrontal cortex (PFC), respectively, and that activation in these areas would be correlated with individual differences in chronic regulatory focus. Sixteen participants underwent functional magnetic resonance imaging while engaged in a depth-of-processing task, during which they were exposed incidentally to their own promotion and prevention goals. Task-related cortical activation was consistent with previous studies. At the same time, incidental priming of promotion goals was associated with left orbital PFC activation, and activation in this area was stronger for individuals with a chronic promotion focus. Findings regarding prevention goal priming were not consistent with predictions. The data illustrate the centrality of self-regulation and personal goal pursuit within the multilayered process of social cognition.

Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

Gritty people try harder: grit and effort-related cardiac autonomic activity during an active coping challenge

Grit, a recently proposed personality trait associated with persistence for long-range goals, predicts achievement in a wide range of important life outcomes. Using motivational intensity theory, the present research examined the physiological underpinnings of grit during an active coping task. Forty young adults completed the Short Grit Scale and worked on a self-paced mental effort task. Effort-related autonomic nervous system (ANS) activity was assessed using impedance cardiography, which yielded measures of sympathetic activity (pre-ejection period; PEP) and parasympathetic activity (respiratory sinus arrhythmia; RSA). Multilevel models revealed that people high on the Perseverance of Effort subscale showed autonomic coactivation: both PEP and RSA became stronger during the task, reflecting higher activity of both ANS divisions. The Consistency of Interest subscale, in contrast, predicted only weaker sympathetic activity (slower PEP). Taken together, the findings illuminate autonomic processes associated with how "gritty" people pursue goals, and they suggest that more attention should be paid to the facets' distinct effects.

Effort Deficits and Depression: The Influence of Anhedonic Depressive Symptoms on Cardiac Autonomic Activity During a Mental Challenge

Motivational approaches to depression emphasize the role of dysfunctional motivational dynamics, particularly diminished reward and incentive processes associated with anhedonia. A study examined how anhedonic depressive symptoms, measured continuously across a wide range of severity, influenced the physiological mobilization of effort during a cognitive task. Using motivational intensity theory as a guide, we expected that the diminished incentive value associated with anhedonic depressive symptoms would reduce effort during a "do your best" challenge (also known as an unfixed or self-paced challenge), in which effort is a function of the value of achieving the task's goal. Using impedance cardiography, two cardiac autonomic responses were assessed: pre-ejection period (PEP), a measure of sympathetic activity and our primary measure of interest, and respiratory sinus arrhythmia (RSA), a measure of parasympathetic activity. As expected, PEP slowed from baseline to task as anhedonic depressive symptoms increased (as measured with the DASS Depression scale), indicating diminished effort-related sympathetic activity. No significant effects appeared for RSA. The findings support motivational intensity theory as a translational model of effort processes in depression and clarify some inconsistent effects of depressive symptoms on effort-related physiology found in past work.

Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies

To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant's repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the scan session to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive behavioral therapy by personalizing skills and facilitating generalization.

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Participants watched their therapy skills change brain activation in real time.

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Rt-fMRI neurofeedback selectively predicted individual strategy efficacy ratings.

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Ratings for unscanned control strategies did not change pre/post neurofeedback.

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A single scan session changed metacognitions about therapy skills 4 weeks later.

Neural correlates of idiographic goal priming in depression: goal-specific dysfunctions in the orbitofrontal cortex

We used functional magnetic resonance imaging (fMRI) to determine whether depressed (vs non-depressed) adults showed differences in cortical activation in response to stimuli representing personal goals. Drawing upon regulatory focus theory as well as previous research, we predicted that depressed patients would manifest attenuated left orbitofrontal cortex (OFC) activation in response to their own promotion goals as well as exaggerated right OFC activation in response to their own prevention goals. Unmedicated adults with major depression (n = 22) and adults with no history of affective disorder (n = 14) completed questionnaires and a personal goal interview. Several weeks later, they were scanned during a judgment task which (unknown to them) included stimuli representing their promotion and prevention goals. Both groups showed similar patterns of task-related activation. Consistent with predictions, patients showed significantly decreased left OFC and increased right OFC activation compared to controls on trials in which they were exposed incidentally to their promotion and prevention goals, respectively. The results suggest that depression involves dysfunction in processing two important types of personal goals. The findings extend models of the etiology of depression to incorporate cognitive and motivational processes underlying higher order goal representation and ultimately may provide an empirical basis for treatment matching.

Do depressive symptoms "blunt" effort? An analysis of cardiac engagement and withdrawal for an increasingly difficult task

Research on depression and effort has suggested "depressive blunting"-lower cardiovascular reactivity in response to challenges and stressors. Many studies, however, find null effects or higher reactivity. The present research draws upon motivational intensity theory, a broad model of effort that predicts cases in which depressive symptoms should increase or decrease effort. Because depressive symptoms can influence task-difficulty appraisals-people see tasks as subjectively harder-people high in depressive symptoms should engage higher effort at objectively easier levels of difficulty but also quit sooner. A sample of adults completed a mental effort challenge with four levels of difficulty, from very easy to difficult-but-feasible. Depressive symptoms were assessed with the CESD and DASS; effort-related cardiac activity was assessed via markers of contractility (e.g., the cardiac pre-ejection period [PEP]) obtained with impedance cardiography. The findings supported the theory's predictions. When the task was relatively easier, people high in depressive symptoms showed higher contractility (shorter PEP), consistent with greater effort. When the task was relatively harder, people high in depressive symptoms showed diminished contractility, consistent with quitting. The results suggest that past research has been observing a small part of a larger trajectory of trying and quitting, and they illustrate the value of a theoretically grounded analysis of depressive symptoms and effort-related cardiac activity.

Treatment of Depression From a Self-Regulation Perspective: Basic Concepts and Applied Strategies in Self-System Therapy

Self-regulation models of psychopathology provide a theory-based, empirically supported framework for developing psychotherapeutic interventions that complement and extend current cognitive-behavioral models. However, many clinicians are only minimally familiar with the psychology of self-regulation. The aim of the present manuscript is twofold. First, we provide an overview of self-regulation as a motivational process essential to well-being and introduce two related theories of self-regulation which have been applied to depression. Second, we describe how self-regulatory concepts and processes from those two theories have been translated into psychosocial interventions, focusing specifically on self-system therapy (SST), a brief structured treatment for depression that targets personal goal pursuit. Two randomized controlled trials have shown that SST is superior to cognitive therapy for depressed clients with specific self-regulatory deficits, and both studies found evidence that SST works in part by restoring adaptive self-regulation. Self-regulation-based psychotherapeutic approaches to depression hold significant promise for enhancing treatment efficacy and ultimately may provide an individualizable framework for treatment planning.

Creative motivation: creative achievement predicts cardiac autonomic markers of effort during divergent thinking

Executive approaches to creativity emphasize that generating creative ideas can be hard and requires mental effort. Few studies, however, have examined effort-related physiological activity during creativity tasks. Using motivational intensity theory as a framework, we examined predictors of effort-related cardiac activity during a creative challenge. A sample of 111 adults completed a divergent thinking task. Sympathetic (PEP and RZ) and parasympathetic (RSA and RMSSD) outcomes were assessed using impedance cardiography. As predicted, people with high creative achievement (measured with the Creative Achievement Questionnaire) showed significantly greater increases in sympathetic activity from baseline to task, reflecting higher effort. People with more creative achievements generated ideas that were significantly more creative, and creative performance correlated marginally with PEP and RZ. The results support the view that creative thought can be a mental challenge.

Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression

OBJECTIVE

A randomized trial compared the time course and differential predictors of symptom improvement in 2 treatments for depression.

METHOD

Forty-nine adults (84% female) who were not taking antidepressant medications and met diagnostic criteria for major depressive disorder or dysthymia were randomly assigned either to cognitive-behavioral therapy (CBT) or self-system therapy (SST), a treatment that targets problems in self-regulation, the ongoing process of evaluating progress toward personal goals. Self-regulatory variables (promotion and prevention focus and goal disengagement and reengagement) were assessed as potential moderators of efficacy. At intake, most participants reported depression in the moderate to severe range and had histories of recurrent episodes and previous treatment attempts. Self-reported symptoms of depression and anxiety were assessed at each therapy session. Multilevel modeling was used to examine (a) differences in change associated with the treatment conditions and (b) moderation of treatment efficacy by pretreatment measures of self-regulatory deficits.

RESULTS

Both treatments were effective and did not show differences in the magnitude or rate of symptom change or in dropout rates, suggesting that CBT and SST were equally effective in improving depression and anxiety. Patients with self-regulatory deficits, however, showed greater improvement in depressive symptoms with SST. Specifically, patients with low promotion focus and low goal reengagement responded better to SST, whereas patients with high prevention focus responded better to CBT.

CONCLUSIONS

Overall, the results corroborate previous research suggesting that SST is a viable short-term treatment for depression that is particularly effective in helping patients compensate for self-regulatory deficits.

Perfectionism and Effort-Related Cardiac Activity: Do Perfectionists Try Harder?

Do perfectionists try harder? Previous research on perfectionism and effort has used self-report items and task performance as indicators of effort. The current study investigated whether individual differences in perfectionism predicted effort-related cardiac activity during a mental effort task. Based on past research that suggests adaptive perfectionism is associated with higher effort, it was hypothesized that self-oriented perfectionism (SOP) would predict increased effort on the task. One hundred and eleven college students completed the Multidimensional Perfectionism Scale (MPS) and a self-paced parity task in which they received a small cash reward (3 cents) for each correct response. Impedance cardiography was used to assess autonomic reactivity, and regression models tested whether SOP and socially prescribed perfectionism (SPP) explained autonomic reactivity. Overall, participants showed both sympathetic (faster pre-ejection period; PEP) and parasympathetic activation (elevated high-frequency heart rate variability; HRV) during the task, reflecting higher effort and engagement. Contrary to predictions, individual differences in perfectionism did not moderate cardiac reactivity. These findings draw attention to the importance of assessing physiological components of effort and motivation directly rather than inferring them from task performance or self-reported effort.

Psychopathology, everyday behaviors, and autonomic activity in daily life: An ambulatory impedance cardiography study of depression, anxiety, and hypomanic traits

Discrepancies regarding the link between autonomic nervous system (ANS) activity and psychopathology may be due in part to inconsistent measurement of non-psychological factors, including eating, drinking, activity, posture, and interacting with others. Rather than sources of noise, behaviors like being active and being with others may be the behavioral pathways that connect psychopathology symptoms to autonomic activity. The present study examined whether behaviors mediate the association of depression, anxiety, and hypomanic traits with ANS by using experience sampling methodology and ambulatory impedance cardiography. Participants (n = 49) completed measures of affect and one day of experience sampling and ambulatory impedance cardiography. The association of hypomanic traits with heart rate variability and heart rate was mediated by physical activity, and social activity mediated the association of depressive symptoms and respiration. These results highlight the importance of considering the pathways between psychopathology and ANS and the mediating role that everyday behaviors play.

Appetitive Motivation in Depressive Anhedonia: Effects of Piece-Rate Cash Rewards on Cardiac and Behavioral Outcomes

Deficits in self-regulation and motivation are central to depression. Using motivational intensity theory (Brehm & Self, 1989), the present research examined how depressive anhedonia influences effort during a piece-rate appetitive task. In piece-rate tasks, people can work at their own pace and are rewarded for each correct response, so they can gain rewards more quickly by expending more effort. A sample of community adults (n = 78) was evaluated for depressive anhedonia using a structured clinical interview, yielding depressive anhedonia and control groups. Participants completed a self-paced cognitive task, and each correct response yielded a cash reward (3 cents or 15 cents, manipulated within-person). Using impedance cardiography, effort-related physiological activity was assessed via the cardiac pre-ejection period (PEP). The results indicated lower reward responsiveness in the anhedonia group. Compared to the control group, the depressive anhedonia group showed significantly less baseline-to-task change in PEP, and they performed marginally worse on the task. The experiment supports the predictions made by applying motivational intensity theory to depression and offers a useful paradigm for evaluating anhedonic effects on effort while people are striving for appealing rewards.

Conscientiousness and Effort-Related Cardiac Activity in Response to Piece-Rate Cash Incentives

Although conscientiousness predicts many aspects of motivation, from delay of gratification to higher achievement, its relationship to responses to monetary incentives is surprisingly inconsistent. Several studies have found null or relationships between conscientiousness and behavioral performance in piece-rate, pay-for-performance tasks, in which people earn money for each unit of work completed. In the present study, we examined the role of conscientiousness in effort-related cardiac activity and behavioral performance during a pay-for-performance task. People worked on a self-paced, piece-rate cognitive task in which they earned 1 cent or 5 cents, manipulated within-person, for each correct response. Conscientiousness predicted greater physiological effort (i.e., shorter pre-ejection period [PEP] reactivity) as incentives increased but had no effect on behavioral performance. The findings suggest that conscientiousness is significantly related to effort for piece-rate tasks, and they reinforce a core idea in motivational intensity theory: effort, performance, and persistence are distinct outcomes that often diverge, so drawing conclusions about effort from performance can be complex.

The Effects of Psychotherapy for Major Depressive Disorder on Daily Mood and Functioning: A Longitudinal Experience Sampling Study

Experience sampling methodology (ESM) was used in a randomized controlled trial of short-term therapy to examine changes in daily affect and reactivity to daily event appraisals among depressed patients. Fifty-five depressed adults (mean age 37 years, 80% female) were randomly assigned to one of two therapy conditions. Using an interactive voice response system, participants rated activities and emotional functioning eight times per day for seven days. Thirty-one participants completed treatment and repeated ESM post-treatment. Broad improvements in mood, cognition, and physical functioning were similar across treatment conditions, with the largest improvements for markers of positive affect. Participants demonstrated increased resilience, i.e., diminished reactivity to stressors at post-treatment. Changes in reactivity to positive daily situations were minimal. Findings underscore the utility of ESM in psychotherapy research and the importance of including measures of both positive and negative affect and experiences.

Evaluation of the internal consistency, factor structure, and validity of the Depression Change Expectancy Scale

The psychometric properties and predictive validity of the Depression Change Expectancy Scale (DCES), a modification of an expectancy scale originally developed for patients with anxiety disorders, were examined in two studies. In Study 1, the 20-item scale was administered along with a battery of questionnaires to a sample of 416 dysphoric undergraduate students and demonstrated good internal consistency. A two-factor solution most parsimoniously accounted for the variance, with one factor containing all pessimistically worded items (DCES-P) and the second containing all optimistically worded items (DCES-O). The DCES-P showed patterns of correlations with other measures of related constructs consistent with hypothesized relationships; the DCES-O showed similar, but weaker, relationships with the other measures. Multilevel modeling was used to examine the predictive utility of the DCES in a clinical sample of 63 adults (Study 2). Improved depressive symptoms (over 6 weeks) were strongly associated with optimistic expectancies but were unrelated to pessimistic expectancies for change. The DCES appears to be a promising measure of expectancies for improvement among individuals with depressive symptoms.

RZ Interval as an Impedance Cardiography Indicator of Effort-Related Cardiac Sympathetic Activity

Research on effort and motivation commonly assesses how the sympathetic branch of the autonomic nervous system affects the cardiovascular system. The cardiac pre-ejection period (PEP), assessed via impedance cardiography, is a common outcome, but assessing PEP requires identifying subtle points on cardiac waveforms. The present research examined the psychometric value of the RZ interval (RZ), which has recently been proposed as an indicator of sympathetic activity, for effort research. Also known as the initial systolic time interval (ISTI), RZ is the time (in ms) between the ECG R peak and the dZ/dt Z peak. Unlike PEP, RZ involves salient waveform points that are easily and reliably identified. Data from two experiments evaluated the suitability of RZ for effort paradigms and compared it to a popular automated PEP method. In Studies 1 (n = 89) and 2 (n = 71), participants completed a standard appetitive task in which each correct response earned a small amount of cash. As expected, incentives significantly affected PEP and RZ in both experiments. PEP and RZ were highly correlated (all rs ≥ 0.89), and RZ consistently yielded a larger effect size than PEP. In Study 3, a quantitative synthesis of the experiments indicated that the effect size of RZ's response to incentives (Hedges's g = 0.432 [0.310, 0.554]) was roughly 15% larger than PEP's effect size (g = 0.376 [0.256, 0.496]). RZ thus appears promising for future research on sympathetic aspects of effort-related cardiac activity.

Perfectionism and the Impact of Intrinsic and Extrinsic Motivation in Daily Life

Abstract. Previous research indicates that socially prescribed perfectionism (SPP) and self-oriented perfectionism (SOP) are associated with extrinsic and intrinsic motivation, respectively. However, little is known about the impact of daily intrinsic and extrinsic motivated goals on affect in perfectionists. This daily diary study examined the extent to which perfectionism moderates the relationship between motivation (intrinsic and extrinsic) and affect (including self-conscious emotions). Participants ( N = 132) varying in levels of perfectionism completed 14 days of online surveys that included questions about pursuit of daily goals and affect. SOP did not predict the covariation of types of motivation and affect. SPP, by contrast, predicted the covariation of extrinsic motivation and guilt (and pride). Results suggest that for people high on SPP, pursuing extrinsic motivated goals is associated with higher levels of guilt and lower levels of pride. Future directions and implications are discussed.

Individual Differences in Expectancies for Change in Depression: Associations with Goal Pursuit and Daily Experiences

More optimistic expectations for change in patients entering treatment often predict more favorable outcomes. However, our understanding of the nature and function of those expectancies is limited. The current study tested the proposal that optimistic expectancies among patients seeking outpatient psychotherapy for major depressive disorder may be explained in part by having a more adaptive self-regulatory style. A sample of 56 adults (78.6% female; mean age 36.5) completed measures of expectancies, depressive symptoms, and aspects of self-regulation. Participants also completed a week of experience sampling using a cell phone system that signaled them 8 random times per day for 7 days. Results were largely consistent with hypotheses. Depressed participants with more optimistic expectancies had a stronger promotion goal orientation, higher goal re-engagement, and reported greater progress on their most important personal goals; daily positive affect and positive situational appraisals were also higher. Findings may suggest a possible self-regulatory mechanism underlying optimistic expectancies for change.

Perfectionism and Loneliness: The Role of Expectations and Social Hopelessness in Daily Life

Introduction: Research suggests that social disconnection is one pathway that explains why perfectionists have higher negative mental health outcomes. However, thus far research has not examined the role that perfectionists' expectations, about their social world, plays in explaining social disconnection. The current study examined whether negative expectations about future social events and social hopelessness explained the relations between socially prescribed perfectionism (SPP), self-oriented perfectionism (SOP), and social disconnection.

Method: The current study used experience sampling methodology (ESM) with 145 participants to test multilevel structural equation models examining whether negative expectations and social hopelessness mediated the relation between SPP (as well as SOP) and loneliness at the following time point.

Results: Results indicate that having negative expectations for future social interactions and feeling socially hopeless explains the relation between SPP and loneliness both when loneliness was measured concurrently and loneliness measured later in the day. Having lower levels of social hopelessness explained the relation between SOP and loneliness when loneliness was measured concurrently and later in the day.

Discussion: Findings suggest that SPP and SOP are differently associated with cognitions about social interactions and relationships in daily life, which in turn explains variations in loneliness. Results indicate that targeting socially prescribed perfectionists’ negative social cognitions in treatment may be effective for reducing loneliness.