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Differential Cognitive Response to a Mood Challenge Following Successful Cognitive Therapy or Pharmacotherapy for Unipolar Depression
Abstract
This study examined the nature of cognitive reactivity to mood changes in formerly depressed patients. Patients who recovered either through cognitive-behavior therapy (CBT; N = 25) or through pharmacotherapy (PT; N = 29) completed self-reported ratings of dysfunctional attitudes before and after a negative mood induction procedure. In response to similar levels of induced sad mood, PT patients showed a significant increase in dysfunctional cognitions compared with patients in the CBT group. To evaluate the effects of such cognitive reactivity on the subsequent course of depression, follow-up analyses reassessed 30 patients several years after initial testing. Results indicated that patients' reactions to the mood induction procedure were predictive of depressive relapse. These findings argue for differential effects of treatment on cognitive reactivity to mood induction and for the link between such reactivity and risk for later depressive relapse.
... They suggested that the MBCT training had altered the encoding and retrieval of personal events. This supports the theoretical underpinning of MBCT, which suggests that individuals who have experienced depressive episodes have learnt an association between sadness and negative thought patterns, such that whenever they experienced sadness, a cycle of negative thinking is triggered (e. g. Segal, Gemar & Williams, 1999). These negative thought cycles also lead to a ruminative style of thinking, including analysis of why the individual feels sad and their self-perceived short-comings. ...
... Cognitive Therapy (I 1BCT; which was developed for use 59 with patients with a history of depressive illness. This too uses many of the same techniques as are present in b4BSR, and in fact many of the exercises are identical However, it combines these skills with elements of cognitive therapy (CBT; in order to help patients identify patterns of negative thought which are proposed to lead into depressive cycles and low mood Segal, Gemar & Williams, 1999). ...
... This would fit with the literature around ruminative thinking styles and depressive thought patterns. (Segal, Gemar & Williams, 1999). Those who are prone to enter depressive ruminative cycles of thought are unable to control their attention and re-direct it once engaged in such negative thought processes. ...
p>The literature on mindfulness as a clinical intervention has rapidly expanded in recent years but questions about its use and effectiveness remain unanswered, one of which concerns the active agents of change. The current study aimed to investigate two specific techniques which currently form part of larger mindfulness training packages: mindful breathing and the body scan. 59 university undergraduates were recruited and were tested on a number of measures of stress tolerance, psychological symptoms and affect, as well as attention and mindfulness skills. A range of mixed design ANOVA statistics are calculated but no significant effect of training in either technique is reported. The study suggests that non-specific factors, such as membership of a group, might be important in the success of mindfulness training.</p
... Studies have shown that the use of pharmacotherapy for depression has indeed lifted the depressed mood and reduced symptoms of depression, but still left an increased vulnerability to relapse compared to cognitive therapy shown by other markers other than depressive symptomatology. Tn a study by Segal et al. (1999), patients treated with selective serotonin reuptake inhibitors (SSRI's) had higher post-treatment scores on the DAS but also had an increased cognitive reactivity to a mood induction as measured by elevated scores on the DAS, compared to patients treated with cognitive behavioural therapy. Further, the SSRI treated patients were also more likely to experience a depressive relapse. ...
... As discussed in Chapter 3, the use of self-report measures (e.g., Segal et a!., 1999) and some implicit tasks (e.g., Dobson & Shaw, 1987) may only measure the results of explicit processing. Therefore, it is problematic to ascertain from the results of some research studies whether the data obtained is a result of explicit or implicit/automatic processes, and therefore the result of schematic functioning and vulnerability to depression. ...
... However, the high BDI group did not differ in their view of other people. The consistency of results across the two types of implicit and explicit measurement is in accord with the cognitive model of depression (Beck, 1967(Beck, , 1976, whereby, high scores on self-report measures of depression are also linked to negatively biased information processing of the self (Alloy et aI., 1999;Segal et a!., 1999). This suggests that combining both implicit and explicit measures is a potentially useful way to approach schema research. ...
p>Research into schemata in depression has found little evidence for schematic activity in the absence of a depressed or low mood. This has led to a widespread view that schemata in depression are latent and only influence information processing in the presence of a low or depressed mood (Segal, 1988). The lack of evidence of schematic activity in the absence of a depressed mood may be due to traditional conceptualisation of schema and the methodological difficulties inherent in the implicit tasks that are used. The aim of this thesis was to investigate schematic activity using two relatively new automatic self-evaluation tasks (the IAT and EAST). It was found that positive automatic self-evaluation was weaker in analogue depressed individuals, high-trait depressives, and recovered clinical depressives compared to non-depressed individuals and low-trait depressives. More importantly, these differences in automatic self-evaluation were not affected by mood or levels of depression. This thesis provides some support that vulnerability to depression or schematic activity can be measured in the absence of a depressed mood. These results also provide support for the growing evidence that automatic self-evaluation may be implicated as a vulnerability factor related to affective disorders (De Raedt, Schacht, Franck, & De Houwer, 2006; de Jong, 2000, Tanner, Stopa, & De Houwer, in press), and why SSRI antidepressant treatment may not be effective in preventing relapse in depression (Hensley, Nadiga, & Uhlenhuth, 2004). Suggestions for further research into schemata include further examination into the role of positive automatic self-evaluation in healthy individuals, the ratio of and different kinds of positive and negative schematic content in individuals who are, and who are not, vulnerable to depression, and investigating schemata from the ontological and neuroscientific perspectives.</p
... The paradigms used to assess attentional bias include; stimulus identification, lexical decision, Stroop interference, visual dot probe and dichotic listening tasks. Memory bias is most commonly assessed using recall tasks (Segal et al., 1999). There is no specific measure of the cognitive distortions which Beck (1967) describes therefore it has not been possible to assess whether these change following successful CBT. ...
... Research shows that prior to a negative mood induction there are few differences on measures of negative views of the self or dysfunctional depression related attitudes between never-depressed and recovered depressed individuals. However, when mood is low, the majority of studies demonstrate that recovered depressives show higher scores on both these measures (Segal et al., 1999; ...
... In addition, given that dysfunctional assumptions may not be accessible during non-depressed mood, they should be measured following a negative mood induction. Segal, Gemar, and Williams (1999) studied scores on the DAS following a mood induction in formally depressed patients in order to assess whether they still held dysfunctional assumptions that would potentially trigger depression (termed level of cognitive reactivity). They used a sample of 25 patients who had recovered from depression following CBT and a sample of 29 patients who had recovered following pharmacotherapy (PT). ...
p>The literature review 'Belief change in cognitive-behavioural therapy (CBT): what do current cognitive models propose are the cognitions that should be targets for CBT? What is the evidence that these cognitions change during cognitive therapy for depression?' considers the evidence for Beck's (1967;1976) theory that dysfunctional cognitions maintain depression and that CBT alleviates depression by altering these cognitions. The review suggests that there is insufficient evidence to suggest that substantial cognitive change occurs during CBT and that this change alone leads to distress reduction. Alternative models of the mechanism of change in CBT are introduced and the review then makes recommendations for further research to investigate the process of change in CBT.
The empirical paper 'Belief change in CBT for people with auditory-hallucinations' presents a single-case multiple-baseline design study investigating the impact of three components of cognitive-behavioural therapy (CBT) proposed to be the active factors in CBT for psychosis, on negative self-evaluative beliefs, delusional beliefs and distress levels. The study also explored the relationship between the two target beliefs. Four individuals with a diagnosis of schizophrenia (DSM IV; American Psychiatric Association, 1994) and treatment resistant, subjectively distressing voices, participated.
Formulation had little or no impact on belief conviction or levels of distress. For two participants a reduction in conviction in negative self-evaluative beliefs generalised to a reduction in conviction in delusional beliefs. For all participants there was a positive correlation between the two beliefs.</p
... Since dysfunctional beliefs appeared to be dependent on mood, both the differential activation hypothesis of Teasdale (1988) and the mood state hypothesis of Miranda and Persons (1988) shifted the focus from unprimed dysfunctional beliefs toward moodlinked activation of these beliefs (i.e., cognitive reactivity [CR]) as a risk factor for relapse in depression. Several studies have found support for the prediction of relapse by cognitive reactivity after remission from MDD (233 patients; Kuyken et al., 2010;Segal, Gemar, & Williams, 1999;Segal et al., 2006). Though, one recent study found no evidence for cognitive reactivity in patients remitted from MDD (Jarrett et al., 2012), whereas Lethbridge and Allen (2008) were unable to corroborate the predictive validity of cognitive reactivity (52 patients). ...
... Only one of Segal's studies (Segal et al., 2006) randomized patients over treatment conditions. Moreover, interpretation of true mediation by change in cognitive reactivity is limited; both Segal et al. (1999) and Segal et al. (2006) were unable to examine pretreatment cognitive reactivity as they used currently depressed patient samples, and Kuyken et al. (2010) only measured post-treatment cognitive reactivity as well in their sample of remitted patients. ...
... Mood provocation procedure. Patients completed a mood provocation procedure as described by Segal et al. (1999Segal et al. ( , 2006 following inclusion in the study. Patients listened to a piece of music by Prokofiev called "Russia under the Mongolian Yoke" from the movie Alexander Nevsky. ...
... There is evidence to suggest that a negative or sad mood can intensify dysfunctional attitudes in remitted depressed subjects [Miranda and Persons, 1988;Miranda et al., 1998]. This phenomenon is referred to as 'cognitive reactivity' and is associated with an increased risk of depressive relapse [Lethbridge and Allen, 2008;Rojas et al., 2014;Segal et al., 1999Segal et al., , 2006. Dysfunctional attitudes and AT are closely linked [Pössel and Knopf, 2008;Winkeljohn Black and Pössel, 2015]. ...
... To offset the negative mood, subjects listened to the 7-min version of Suite No. 1, Op. 46, 'Morning Mood', also from the Peer Gynt Suite [see Rojas et al., 2014]. This approach to mood induction was similar to that of other working groups [Lethbridge and Allen, 2008;Segal et al., 1999Segal et al., , 2006. The effectiveness of the musical piece in inducing a negative mood had been shown in an earlier study [Rojas et al., 2014]. ...
... Contrary to our expectation, however, there were no significant changes in the PAT and NAT. The state character of the AT can be used to explain this result [Beck et al., 1994;Kelava and Schermelleh-Engel, 2012], in comparison to the fixed trait of the dysfunctional attitudes [Beck et al., 1994;Rojas et al., 2014;Segal et al., 1999Segal et al., , 2006. Thus, the level of the AT reflects mainly the actual state at discharge. ...
... Jedoch kann ein trauriges Gefühl diese latenten dysfunktionalen Einstellungen reaktivieren und somit zu deren Intensivierung führen. Dieser Prozess wurde als kognitive Reaktivität bezeichnet (Scher, Ingram & Segal, 2005;Segal, Gemar & Williams, 1999). ...
... Zudem gibt es einige Hinweise dafür, dass eine gesteigerte kognitive Reaktivität einen Risikofaktor für einen depressiven Rückfall darstellt (Otto et al., 2007;Scher et al., 2005). So zeigte sich, dass je intensiver die Aktivierung irrationaler Einstellungen bei remittiert depressiven Probanden nach der Provokation einer traurigen Stimmung ist, desto höher ist auch ihr Risiko, in den Folgemonaten einen depressiven Rückfall zu erleiden (Segal et al. 1999;Segal et al., 2006). In einer naturalistischen Studie mit einer einjährigen Katamnesephase wurde bei 30 remittierten Depressiven festgestellt, dass nur die Interaktion zwischen irrationalen Einstellungen und negativen Lebensereignissen zu einem depressiven Rückfall beiträgt bzw. ...
... In den hier zitierten Studien zur Stimmungsinduktion wurden meist die Ergebnisse der "Dysfunctional Attitude Scale" aus 40 Items (DAS-A) mit denjenigen einer anderen DAS-Version (DAS-B) verglichen. Diese Versionen erwiesen sich aber bislang als nicht äquivalent (Jarrett et al., 2012; Lethbrige & Allen, 2008; Power, Katz, McGuffin, Dug-18 Roberto Rojas, Edgar Geissner und Martin Hautzinger gan, Lam & Beck, 1994;Segal et al., 1999Segal et al., , 2006 (Lethbridge & Allen, 2008;Segal et al., 1999Segal et al., , 2006 angewandte 10-minütige verlangsamte Version von Sergei Prokofiev "Russia under the mongolian yoke" mit der 10-minütigen Version von "Asses Tod" aus der Peer Gynt Suite von Edvard Grieg. Die Reihenfolge der Präsentation der Musikstücke wurde per Zufall bestimmt. ...
... Außerdem konnte festgestellt werden, dass das Risiko in den Folgemonaten einen Rückfall in die Depression zu erleiden umso höher war, je intensiver das Wiederauftreten der dysfunktionalen Einstellungen bei remittiert depressiven Personen nach der Provokation einer traurigen Stimmung (kognitive Reaktivität) war. Dieser Effekt zeigte sich ungeachtet dessen, ob die Betroffenen mit kognitiver Verhaltenstherapie oder rein pharmakotherapeutisch behandelt wurden (Segal, Gemar & Williams, 1999;Segal, Kennedy, Gemar, Hood, Pedersen & Buis, 2006). ...
... Die DAS ist sowohl in der Therapie als auch für die Grundlagenforschung depressiver Störungen ein wichtiges Instrument. Insbesondere das Interesse am Phänomen der kognitiven Reaktivität als Prädiktor eines frühen Rezidivs bei depressiven Personen ist sehr erfolgversprechend (Jarrett et al., 2012;Lethbridge & Allen, 2008;Segal et al., 1999Segal et al., , 2006. In Studien dieser Art wurde vor und nach einer 10-minütigen Stimmungsinduktion das Ausmaß ungünstiger Einstellungen gemessen. ...
... Die ursprüngliche Parallelversion DAS-40-B (siehe oben) erwies sich inhaltlich und psychometrisch als deutlich unzureichend (Hautzinger et al., 2005;Oliver & Baumgart, 1985;Power et al., 1994). Verschiedene Autoren haben daher die Entwicklung einer psychometrisch verbesserten Parallelversion empfohlen (Lethbridge & Allen, 2008;Power et al., 1994;Segal et al., 1999Segal et al., , 2006 Eine mögliche theoretische Grundlage für die Gruppierung der dysfunktionalen Einstellungen wird berücksichtigt (Safran, Vallis, Segal & Shaw, 1986;Segal et al., 2006). Vergleichbare, reliable und valide, parallele Kurzformen der DAS hätten den Vorteil, dass Probanden weniger Fragen beantworten müssten und ein zeitökonomischer Einsatz u. a. bei experimentellen Studien ermöglicht würde. ...
DAS-18 form A and form B: Development and psychometric evaluation of two short and comparable versions of the Dysfunctional Attitude Scale
The Dysfunctional Attitude Scale (DAS) has proved to be an effective questionnaire. The direct comparison of change in dysfunctional attitudes at short time intervals is necessary especially for exploration of cognitive vulnerability and reactivity in remitted depressed individuals. Until now, there are no suitable short and parallel versions of the DAS available.
Question: This study examined the psychometric properties and the comparability of the DAS-18A and DAS-18B. The psychometric characteristics of the short versions were tested in 94 major depressive and 110 healthy subjects.
Results: DAS-18A and DAS-18B showed good reliability and validity as well as a similar item-factor structure as the DAS with 40 items.
Conclusion: The results recommend the two short versions as parallel and time-saving questionnaires that are suitable for repeated testing.
Key words: dysfunctional attitudes, DAS, depression, cognitive reactivity, questionnaire
... Four hundred and ninety-eight undergraduate participants completed measures assessing attributional style, attributional accuracy, and symptoms of dysphoria. Measures were administered both before and after a sad mood induction, previously established to elicit a transient dysphoric mood (e.g., Segal et al., 1999). Results from the current study indicated that the mood induction paradigm did in fact elicit an increase in dysphoric mood, as reflected by changes in BDI scores (p < .001, ...
... • All measures were administered before and after a sad mood induction, previously established to elicit a sad mood (e.g., Segal, Gemar, & Williams, 1999). The mood induction involved asking participants to recall a time in their life when they felt sad while listening to a piece of music-Prokofiev's "Russia Under the Mongolian Yoke" (1934) from the film Alexander Nevsky. ...
... The mood induction involved asking participants to recall a time in their life when they felt sad while listening to a piece of music-Prokofiev's "Russia Under the Mongolian Yoke" (1934) from the film Alexander Nevsky. Prior research indicates that this kind of sad mood induction is effective in eliciting a short-lived negative mood state (e.g., Kuijsters, Redi, Ruyter, & Heynderickx, 2016;Segal et al., 1999). ...
The current study attempted to replicate findings from Moore, Dawkins, Fisher and Fresco (2016) and Moore and Fresco (2007), but also presented an important extension of the work with an addition of a mood priming paradigm. This allowed for the investigation of whether biased attributions seemed to cause dysphoria (attributional bias as a risk factor) or dysphoria caused biased attributions (attributional bias as a scar or indicator of negative mood). Four hundred and ninety-eight undergraduate participants completed measures assessing attributional style, attributional accuracy, and symptoms of dysphoria. Measures were administered both before and after a sad mood induction, previously established to elicit a transient dysphoric mood (e.g., Segal et al., 1999). Results from the current study indicated that the mood induction paradigm did in fact elicit an increase in dysphoric mood, as reflected by changes in BDI scores (p < .001, Cohen's d = .33). However, results did not replicate previous findings and somewhat contradict those of Moore et al. (2016) and Moore and Fresco (2007).
... Mood states (i.e., affective state) can influence the type of thoughts individuals might experience in relation to themselves, consequently affecting eating behaviors [11][12][13][14]. Previous research has highlighted that mood is a factor that must be considered when studying ED development [14]. ...
... Participants first filled out the Centre for Epidemiological Studies-Depression scale and the Visual Analog Mood Scale to measure pre-induction mood states. During the negative mood induction, participants listened to music and were asked to recall a time when they felt sad [11,33,34]. The mood induction consisted of a six-minute music exposure to induce low mood (i.e., sadness), presented through headphones. ...
... The music selected was a slowed down version, at half speed, of an orchestral song by Prokofiev; "Russia Under the Mongolian Yoke". This is a standardized, commonly used, validated method in depression research to transiently lower mood experimentally [11,33,34]. Following the music task, participants filled out the Visual Analog Mood Scale post-induction and the CFQ-BI (time 2). ...
PurposeThe extent to which body image-related thoughts are endorsed and drive behaviors, a process known as Body Image-Related Cognitive Fusion (BI-CF), is an important contributor to disordered eating. Moreover, negative mood and negative self-referential processes (e.g., low self-compassion) have been reportedly associated with disordered eating; however, their associations with BI-CF are not known. The aim of this study was to investigate, among young adults, the association between (1) BI-CF and disordered eating attitudes and behaviors (2) BI-CF and self-compassion, and (3) whether sad mood influences BI-CF.Method
Participants completed online questionnaires that assessed BI-CF, self-compassion, negative affect, cognitive reactivity and disordered eating (N = 601). A subsample (n = 51) underwent an in-lab session in which they were exposed to a validated psychological sad mood induction task followed by the assessment of BI-CF.Results67.8% of variation in disordered eating was accounted for by BI-CF while controlling for covariates. Self-compassion was the strongest predictor of BI-CF levels, irrespective of other eating disorder or depression risk factors (p < 0.001). Increases in sad mood did not influence levels of BI-CF.Conclusion
The endorsement of body image-related thoughts seems to play an important role in disordered eating. Compassionate self-responding may have positive influences on reducing negative body image-related thoughts. Furthermore, BI-CF appears to be a relatively stable phenomenon, irrespective of change in mood state. Results offer implications for the improvements in prevention and intervention models targeted towards disordered eating through self-compassion and cognitive defusion.Level of evidencePart I: Level V, cross-sectional descriptive study. Part II: Level I, experimental study.
... Eight studies used a combined analysis of treatments, where different treatment groups were analysed for differences in RR, and if the difference was non-significant they were grouped together for the investigation of predictors of RR (Chopra et al., 2008;Evans et al., 1992;Gollan et al., 2006;Harkness et al., 2012;Harkness et al., 2014;Segal et al., 1999;Segal et al., 2006;Wigman et al., 2014). Overall, studies that analysed RR after CBT alone reported a mean RR rate of 29.1%, and studies that grouped different treatments together (e.g. ...
... All 4 observational studies (Quiring et al., 2002;Thase et al., 1992;Segal et al., 1999;Wigman et al., 2014) were rated as having good quality by the two reviewers. ...
... df = 2, p = 0.47) and rank correlation tests (Kendall's tau = -0.33, p = 0.75) for funnel plot asymmetry were not statistically significant and the fail-safe N was 9. et al., 2008;Fresco et al., 2007;Gollan et al., 2006;Segal et al., 1999;Segal et al., 2006;Thase et al., 1992). However, two of these (Chopra et al., 2008;Fresco et al., 2007) were secondary analyses using the sample from Segal et al. (2006) and were therefore excluded from metaanalysis. ...
Background
Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.
Aim
This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.
Method
We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis ( k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.
Results
Meta-analyses indicated that residual depressive symptoms ( r = 0.34 [0.10, 0.54], p = .01) and prior episodes ( r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not ( r = 0.18 [−0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.
Conclusions
Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.
... DAS scores tended to increase more in individuals with a history of depression than in never-depressed individuals (Gemar, Segal, Sagrati, & Kennedy, 2001;Jeanne, Gross, Persons, & Hahn, 1998;Miranda & Persons, 1988;Van der Does, 2002). More interestingly, high CR (DAS-change) scores predicted a shorter time to relapse or recurrence (Segal, Gemar, & Williams, 1999;Segal et al., 2006). In several studies, however, CR as measured by DAS-change did not predict recurrence (Jarrett et al., 2012;Lethbridge & Allen, 2008;van Rijsbergen et al., 2013). ...
... However, the factor structure of these two versions appears to be different (Power et al., 1994) and the mean scores of the A/B versions and DAS-change scores may be dependent on the order of administration (Gemar et al., 2001). In research settings, such systematic differences can be corrected statistically at a group level (Segal et al., 1999;Van der Does, 2002), but this is impossible at the individual level in clinical settings. This limits the usefulness of DAS-change scores in clinical practice. ...
... The mood-induction was defined as effective if the subject's mood score decreased by 10% or more (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996). We expected lower mood after mood-induction, which would be comparable between groups (Segal et al., 1999). After the baseline visit, all participants received a booklet with the LEIDS-R to fill out before the second visit, which was an MRI session in context of a larger study (mean time between baseline visit (visit 1) and MRI visit (visit 2) was 17.7 AE 17.2 days). ...
Objectives:
Cognitive reactivity (CR) to sad mood is a risk factor for major depressive disorder (MDD). CR is usually measured by assessing change on the Dysfunctional Attitudes Scale (DAS-change) after sad mood-induction. It has, however, been suggested that the versions of the DAS (A/B) are not interchangeable, impacting the reliability and validity of the change score. The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) is an alternative self-report measure of CR. Studies examining the relationship between LEIDS-R and DAS-change have shown mixed results. We examined whether scores of these CR measures differed between remitted MDD and controls, the relationship between these CR measures, and the effect of order of DAS administration on DAS-change.
Design:
Cross-sectional design with two groups (remitted MDD and controls).
Methods:
Sixty-eight MDD patients remitted from ≥2 previous episodes, not taking antidepressants, and 43 never-depressed controls participated in a mood-induction and filled in the DAS-A/B in randomized order before and after mood-induction, and LEIDS-R separately.
Results:
LEIDS-R scores and pre-mood-induction DAS scores were significantly higher in remitted MDD than controls (p < .001, Cohen's d = 1.48; p = .001, Cohen's d = 0.66, respectively). DAS-change did not differ between these groups (p = .67, Cohen's d = 0.08). LEIDS-R correlated with DAS-change (r = .30, p = .042), but only in the group that filled in DAS-B before DAS-A. In remitted MDD, DAS-change was dependent on the order of DAS versions before and after mood-induction (10.6 ± 19.0 vs. -1.2 ± 10.5, for order B-A and A-B, respectively), with a significant group × order interaction (p = .012).
Conclusions:
Existing DAS versions are not interchangeable, which compromises the usefulness of mood-inductions in clinical practice. The LEIDS-R seems a valid measure of cognitive vulnerability to depression.
Practitioner points:
Clinical implications: Cognitive reactivity (CR) is a risk factor of depressive recurrence. The current measurement of CR, by assessing change on the Dysfunctional Attitudes Scale (DAS) after mood-induction, is not reliable. The Leiden Index Depression Sensitivity-Revised (LEIDS-R) is an alternative CR measure. In contrast to mood-induction, it reliably assesses depression vulnerability. The use of mood-inductions for clinical/research purposes is unnecessary.
Limitations of the study:
We were not able to examine the effect of previous treatment, which could have affected results as psychological treatments probably have differential effects on CR. Examining un-medicated patients may have led to selection of a sample not completely representative for the general MDD population. We did not administer both parallel versions of the DAS (A/B) before and after mood-induction. This might have provided better understanding of their differential sensitivity to change.
... Negative thinking styles are a core feature of major depression, encompassing negative thinking, automatic thoughts, dysfunctional attributional style and dysfunctional attitudes, with irrational thought patterns in high level mental models used to interpret experience leading to self-deprecation, self-reproach, feelings of guilt, and a general negative outlook on the world and the self (Sheppard and Teasdale, 1996). Neuropsychological underpinnings of negative thinking styles include a mood-congruent processing bias toward negative stimuli, involving attention, memory, and processing speed. ...
... This observation has clinical implications. A consistent literature showed that in MDD self-esteem, negative thinking, and dysfunctional attitudes predict duration of the depressive episodes (Williams et al., 1990), recovery (Bothwell and Scott, 1997), hopelessness (Cannon et al., 1999) and suicidality (Whisman et al., 1995); they influence decision making thus impacting quality of life (Mukherjee et al., 2020); and they correlate with subsequent depression (Kernis et al., 1991), change very slowly (Fennell and Campbell, 1984), may persist undetected after recovery in formerly depressed patients (Hedlund and Rude, 1995), and can be targeted by specific therapeutic interventions (Segal et al., 1999). If post-COVID depression shares these psychopathological features with MDD, as it is observed when depression is triggered by other medical conditions (see Introduction), they are likely to influence its outcome as well, and should then be considered as a target for treatment. ...
Background
COVID-19 is associated with depressive psychopathology in survivors. Negative thinking styles are a core feature of major depression, fostering the experience of negative emotions and affects and hampering recovery. This cognitive vulnerability has been observed in medical conditions associated with depression, but never explored in post-COVID depression.
Methods
We studied 729 participants: 362 COVID-19 survivors, 73 inpatients with Major Depressive Disorder (MDD), and 294 healthy participants (HC). Severity of depression was self-rated on the Zung Self-Rating Depression Scale (ZSDS). Neuropsychological bias toward negative emotional stimuli and the negative outlook on the self were tested in a self-description task, yielding latencies and frequencies of attribution of morally tuned elements. Dimensions of negative thinking and depressive cognitive style in evaluation of hypothetical events were measured on the Cognition Questionnaire (CQ).
Results
22.4% COVID survivors self-rated depression above the clinical threshold. Frequencies and latencies of attribution of morally negative elements, and CQ scores, correlated between themselves and predicted ZSDS scores, with post-COVID depressed patients showing intermediate scores between the more severe MDD patients, and non-depressed post-COVID participants and HC.
Limitations
Recruitment was in a single center, thus raising the possibility of population stratification.
Conclusions
The breadth of self-reproach and depressive cognitive style in evaluating events showed the same association with severity of depression in MDD and in post-COVID depressed patients, distributing along a gradient of severity, thus suggesting that individual features of negative thinking styles are shared in these conditions, and should be addressed as treatment targets in depressed COVID-19 survivors.
... Six MIPs were used in the study. Participants were exposed to one of three sad MIPs used in influential cognitive vulnerability research (e.g., Ingram et al., 1994;Segal et al., 1999) or to one of three matched-control, neutral MIPs. Consistent with the procedures used in these studies, MIPs were 7 min in length. ...
... The timing, music, and instructions used in the experimental conditions were chosen based on the protocols most commonly used in MIP research studies conducted by leading depression researchers (e.g., Jarrett et al., 2012;Lethbridge and Allen, 2008;Segal et al., 1999). The timing, music, and instructions used in the control conditions were chosen based on protocols that closely resembled sad-MIP protocols (e. g., Bates et al., 1999). ...
Background
: Mood Induction Procedures (MIPs) are used widely in research on cognitive vulnerability to depression. Although empirical evidence supports certain MIPs as effective, little research has evaluated whether MIP-induced sad moods are sufficiently persistent. This study aimed to determine (1) how long an MIP-induced mood lasts according to commonly used operational definitions and (2) whether these findings vary according to the type of MIP used.
Methods
: Four-hundred-and-one undergraduate students were randomly assigned to one of three commonly used sad MIPs (music, memory, music+memory) or to one of three matched neutral MIPs. Mood was repeatedly measured immediately prior to and following the MIP.
Results
: Results did not support the widely held belief that commonly used MIPs induce a sufficient and persistent sad mood. The memory-related MIPs induced the most persistent sad mood. Based on the majority of operational definitions, however, induced mood effects did not last longer than 4 min, regardless of MIP type.
Limitations
: Future studies should examine additional factors that may have affected the trajectories observed in the current study (e.g., task completed in between mood measurements) and in vulnerable (e.g., past-depressed) populations.
Conclusions
: This study constitutes an important first step in validating the use of MIPs in cognitive vulnerability research and provides researchers with important information on future study designs. More important, the study raises doubt about the validity of various conclusions drawn from some MIP studies and calls into question the theoretical conceptualizations of depression that are based on potentially biased results and a possibly incomplete literature.
... Indeed, lower levels of global self-esteem were observed in remitted and recovered AD and MDD when compared to those who had never been diagnosed with a depressive or anxiety disorder (van Tuijl et al. 2016). The notion that remaining scars lie dormant and can be activated by mild sad moods (Gemar et al. 2001;Segal et al. 1999), should mean that recovered and remitted MDD and AD are likely to report less stable self-esteem than a relatively healthy comparison group, even when controlling for global self-esteem. Supporting this notion, former MDD showed lower self-esteem stability than a never-depressed comparison group, and similar levels as current MDD (Franck and De Raedt 2007). ...
... Future longitudinal research should look at whether unstable self-esteem following MDD and AD predicts relapse. Furthermore, scars have been hypothesised to lie dormant until activated by life events or stressors (Segal et al. 1999). Such stressors need not necessarily be major in order to (re-)activate the scars as self-esteem may fluctuate in response to subtle changes in mood and daily (minor) life events (Clasen et al. 2015;Kernis et al. 1991;Roberts and Monroe 1994). ...
Self-esteem has not only been observed to be generally low in depression and anxiety, but also unstable. Few studies have looked at unstable self-esteem in clinical samples. The present study compared self-reported self-esteem instability across current depression (n = 60), anxiety (n = 111), and comorbid depression/anxiety (n = 71), remitted depression (n = 41), and anxiety (n = 29), recovered depression (n = 136) and anxiety (n = 98), and a never clinically depressed or anxious comparison group (n = 382). The comparison group had more stable self-esteem than all groups. Once controlling for overall levels of self-esteem, differences with current depression or anxiety, remitted depression, and recovered depression or anxiety remained, but disappeared for the comorbid group. The current findings are consistent with the view that not only enduring low self-esteem per se, but also high self-esteem reactivity may contribute to the aetiology of affective disorders.
... Dr. Zindel Segal (University of Toronto) and his colleagues tested whether schema activation vis-à-vis priming is related to vulnerability to relapse in depression. Segal et al. (1999), for example, compared patients who were successfully treated with either cognitive therapy or antidepressant medication. Following treatment, participants were administered the DAS, given a negative mood prime to induce a dysphoric state, and administered a parallel form of the DAS. ...
... The music was chosen based on previous work by Clark and Teasdale (1985) and is the seven-minute orchestral introduction by Prokofiev entitled "Russia under the Mongolian Yoke." This type of mood induction procedure (i.e., music plus autobiographical recall) has been validated by previous research (Martin, 1990) and is used extensively in CR research (e.g., Segal et al., 1999;2006). Immediately following the mood induction, participants provided another VAS mood rating, completed the alternate form of the DAS and then provide a final VAS mood rating. ...
Objective: “Decentering” is defined as the ability to observe one’s thoughts and feelings as temporary, objective events in the mind (Safran & Segal, 1990), and is increasingly regarded as a candidate mechanism in mindfulness-based interventions. The current study sought to examine the role of decentering, and other related variables, in the efficacy of Mindfulness-based cognitive therapy (MBCT) as compared to two active comparison conditions. Method: Formerly depressed individuals (N = 227), randomly assigned to MBCT (n = 74), relaxation group therapy (RGT; n = 77) or treatment-as-usual (TAU; n = 76), completed self-report measures of decentering and symptoms of depression at pre-, mid-, and post-treatment, and relapse was assessed at 3, 6, 9, and 12 months, post-treatment. Results: With regard to the acute treatment phase, results indicated that, whereas levels of depression increased in both RGT and TAU, MBCT patients remained free from symptom gains. Moreover, gains in decentering from mid- to post-treatment predicted reductions in depression from pre- to post-treatment for MBCT and TAU, but not for RGT. Participants who experienced increases in decentering, measured from mid- to post-treatment, generally evidenced the lowest levels of relapse/recurrence (during the four follow-up assessments), largely irrespective of treatment group. However, results related to change in decentering should be considered exploratory due to small cell sizes among participants who did not experience gains in decentering.Conclusions: Taken together, these results suggest that decentering is a potent mechanism for reduction of relapse in major depression, albeit one that is non-specific to MBCT.
... PIT treatments teach patients with psychological disorders to increase their awareness of underlying emotions through insight and self-understanding; these treatments are more effective in producing enduring changes in the patient [19]. Other studies promote treatments using pharmacotherapy, although the side effects from long-term medication use still need to be studied [20]. Furthermore, these methods may not provide sufficient feedback for patients to objectively evaluate the improvement in their abilities. ...
Emotion regulation plays a vital role in human beings daily lives by helping them deal with social problems and protects mental and physical health. However, objective evaluation of the efficacy of emotion regulation and assessment of the improvement in emotion regulation ability at the individual level remain challenging. In this study, we leveraged neurofeedback training to design a real-time EEG-based brain-computer interface (BCI) system for users to effectively regulate their emotions. Twenty healthy subjects performed 10 BCI-based neurofeedback training sessions to regulate their emotion towards a specific emotional state (positive, negative, or neutral), while their EEG signals were analyzed in real time via machine learning to predict their emotional states. The prediction results were presented as feedback on the screen to inform the subjects of their immediate emotional state, based on which the subjects could update their strategies for emotion regulation. The experimental results indicated that the subjects improved their ability to regulate these emotions through our BCI neurofeedback training. Further EEG-based spectrum analysis revealed how each emotional state was related to specific EEG patterns, which were progressively enhanced through long-term training. These results together suggested that long-term EEG-based neurofeedback training could be a promising tool for helping people with emotional or mental disorders.
... It is also known that negative or sad mood can lead to increased access to DA. This phenomenon, called cognitive reactivity (Jeanne et al., 1998), presents a risk factor for disorder relapse/recurrence among remitted depressive patients (Otto et al., 2007;Rojas et al., 2014;Scher et al., 2005;Segal et al., 1999Segal et al., , 2006. ...
Background
Stressful event exposure, dysfunctional attitudes (DA), negative automatic thoughts (NAT), and declining positive automatic thoughts (PAT) have been associated with depressive relapse/recurrence. Few studies have investigated the course of these variables and their relevance for relapse/recurrence in remitted depression.
Methods
Following successful inpatient treatment, in 39 remitted depressive patients, stressful events, DA, NAT, PAT, and depressive relapse/recurrence were assessed five times during a 16-month follow-up. Data were analyzed with mixed effect models, and mediation effects were tested.
Results
Stressful events after discharge correlated with depressive relapse/recurrence. This association was mainly mediated by a stress-related decline of PAT within four months post discharge. Patients’ DA were relatively stable during the observation period and did not depend on stressful events, indicating DA as a risk trait for depressive relapse/recurrence. Mediation analyses revealed that independent of stress, DA were linked to depressive relapse/recurrence through more NAT.
Conclusion
Our findings suggest stressful events evoke relapse/recurrence in remitted depression through rapid deterioration of PAT after discharge from inpatient therapy. DA are expressed through NAT which additionally contribute to higher risk of depressive relapse/recurrence. Consequently, maintenance therapy requires techniques to promote the maintenance of PAT, and to effectively restructure DA and NAT.
... We selected measures of constructs that already showed promise as a candidate risk factor in earlier research in the context of anxiety (e.g. anxiety sensitivity; Taylor, 1999), and depression (e.g., cognitive reactivity; Segal et al., 1999), and measures of mechanisms that showed promise in both anxiety and depression disorders (e.g., repetitive negative thinking; Papageorgiou and Wells, 2008). Next to these relatively specific psychological constructs, also more generic trait characteristics/personality dimensions with an established link to psychopathology were measured (e.g., neuroticism; Ormel et al., 2004) Each of these psychological risk factors in NESDA shall be introduced below and we review their key outcomes across all articles listed under 'psychological vulnerabilities' on the NESDA website (https://www. ...
The Netherlands Study of Depression and Anxiety (NESDA; Nbaseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders.
Methods
: A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders.
Results
: All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders.
Conclusion
: NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.
... Mood-induction procedures using music, typically asks participants to focus on a time or event in their lives when they felt sad while listening to a piece of sad music, commonly the orchestral introduction by Prokofiev, "Russia Under the Mongolian Yoke" played at half-speed (van der Does, 2002). This paradigm was popularized by Segal, Gemar, and Williams (1999) in a study investigating cognitive reactivity following a sad mood induction in individuals who underwent either cognitive therapy or medication treatment for Major Depressive Disorder. Although the Emotional Stroop Task, an adapted version of the Stroop Task using emotionally-valenced words, is not used to induce emotions, it is commonly used in emotion regulation research to evaluate attentional biases related to emotion, which can have implications for attention-related emotion regulation processes . ...
The majority of research on emotion regulation processes has been restricted to controlled laboratory settingsthat use experimental paradigms to investigate short-term outcomes (Berking & Wupperman, 2012). A true understanding of emotion regulation requires an unobtrusive, ecologically valid assessment of the construct as it naturally unfolds in the environment. Digital phenotyping, or moment-by-moment quantification of individual-level human behavior using data from smartphone sensors (Torous & Onnela, 2016), is a novel method for evaluating human behavior in naturalistic settings. The present project is the first to implement digital phenotyping in the investigation of emotion regulation. The central aim of the study was to evaluate whether smartphone-based digital phenotyping data predicted individual differences in emotion regulation in both in-lab and naturalistic settings. During an in-lab session, unselected adult participants (N = 69) completed self-report questionnaires measuring trait emotion regulation as well as state affect/emotion regulation following a neutral mood induction, negative mood induction, and recovery period. Smartphone-based digital phenotyping data were collected during a 7-day follow-up period using the Beiwe Research Platform (Onnela & Rauch, 2016), an open-access mobile- and cloud-based research tool for collecting digital data via smartphones. Results showed that variation in mobile power state level and GPS distance were significantly associated with variation in negative state affect and state cognitive reappraisal over time. Clustering and classification analyses showed power state level and GPS distance over time to accurately, and with high sensitivity and specificity, classify two trait emotion clusters. Variation in power state level and GPS distance together with trait and state emotion regulation was not associated with current depressive symptoms. Overall, the findings provide initial data on the use of digital phenotyping data in predicting individual differences in state and trait emotion regulation in both in-lab and naturalistic settings. The results suggest that operationalizations of digital phenotyping data and modeling approaches are particularly important factors to consider when implementing digital phenotyping methodology in the study of mental health processes such as emotion regulation.
... Little is known about how CBT effects are maintained after active treatment ends. Here, some have suggested that the change that occurs during treatment (e.g., reductions in cognitive reactivity and internalizations of therapists; Knox, 2003;Segal et al., 1999) permanently affects clinical outcomes, while others highlight the role of compensatory skills (e.g., CBT skills) to address fluctuations in clinical outcomes (Hollon et al., 2006). CBT skill acquisition and performance during active treatment, as well as ongoing CBT skills practice after it has ended, have been shown to relate to lower relapse rates and better depression outcomes during follow-up (Michalak et al., 2008;Morgan et al., 2014;Powers et al., 2008;Strunk et al., 2013). ...
Background
While the acquisition and application of Cognitive Behavior Therapy (CBT) skills is a core component and likely mechanism of effect maintenance in all CBT-based treatments, the extent of post-therapeutic CBT skills usage among internet-delivered CBT (iCBT) clients remains under-researched.
Method
Nested within a pragmatic randomized controlled trial, 241 participants received an 8-week supported iCBT intervention for anxiety and/or depression and answered open-ended questions about their use and experience of CBT skills at 3-, 6-, 9-, and 12-month follow-up. Recurrent, cross-sectional qualitative analysis following the descriptive and interpretive approach was used to create a taxonomy, through which all qualitative data was coded.
Results
In total 479 qualitative responses across 181 participants were analyzed. Participants reported using a wide range of CBT skills and associated helpful and hindering experiences and impacts. The reasons for discontinued CBT skills usage were diverse, ranging from rare adverse effects to healthy adaptation.
Conclusion
The study shows how clients receiving iCBT in routine care learn CBT skills during treatment and utilize them in productive ways post-treatment. Findings coincide with similar research in face-to-face CBT and may inform future research to drive innovation and iCBT intervention development.
... The cognitive vulnerability construct most examined in mood priming studies is cognitive reactivity, defined as the change in DAS scores from before to after a dysphoric mood induction (Segal et al. 1999). Rather than using a simple change score, newer studies have operationalized cognitive reactivity as residualized DAS change scores, derived from regressing post-mood induction DAS scores on pre-mood induction DAS scores. ...
Background
Cognitive vulnerability-stress models explain depression as the result of an interaction between negative cognitive styles and stressful life events; however, the specific content of the cognitive diathesis varies by model.
Methods
This study examined three cognitive diatheses (i.e., unprimed cognitions, cognitive reactivity, and mood reactivity) in a prospective longitudinal design assessing currently non-depressed college students (N = 322) at the start of the semester with follow-up at the end of the semester, approximately 3 months later. At baseline, depressive symptoms, major depression history, negative life events in the past year, unprimed dysfunctional attitudes, and both cognitive reactivity and mood reactivity over a dysphoric mood induction were assessed. Depressive symptoms and negative life events in the interim were assessed at follow-up.
Results
After controlling for gender, past year negative life events, and baseline depression severity; unprimed dysfunctional attitudes significantly predicted subsequent depression severity, whereas cognitive reactivity and mood reactivity did not. None of the cognitive vulnerabilities interacted with negative life events over the interim to predict later depression. After controlling for gender, past year negative life events, baseline depression severity, and history of depression; mood reactivity and the mood reactivity × depression history interaction significantly predicted later depressive symptoms. Greater levels of mood reactivity predicted higher depressive symptoms in those with a history of depression and lower depressive symptoms in those without history of depression.
Conclusions
Results suggest that different vulnerabilities may be relevant to predicting increases in depressive symptoms over time in those individuals who have not previously been depressed vs. those who have.
... Future studies should look to further examine alternative ways to measure style and content response patterns. Also, whether the distinction between content and style items is important when dysfunctional attitudes are assessed following a mood induction remains to be addressed (see Segal, Gemar, & Williams, 1999). Fourth, our results were found in the context of a group of participants who went through a course of BtB, and thus these findings may not generalize to other samples. ...
Objectives
Internet‐based cognitive behavioral therapy (iCBT) is an effective treatment option for depression, but its long‐term effects are not well understood. We investigate for whom iCBT may have more enduring effects by evaluating dysfunctional attitudes as predictors of relapse.
Methods
The sample consists of 31 iCBT responders (20 women, average age 31.6) who were followed for 1 year.
Results
Higher Dysfunctional Attitudes Scale scores predicted higher risk of relapse (hazard ratio = 1.98). This relation remained significant when controlling for high style (dysfunctional) or content (functional) responses. Having relatively more positive extreme responses on style rather than content items did not predict risk of relapse.
Conclusions
Our results were consistent with the value of differentiating an extreme style of responding from otherwise endorsing belief in dysfunctional attitudes. Research that refines our understanding of patients' individual risk for relapse has the potential to inform how treatment might be individually tailored.
... The negative mood induction methodology combines music and autobiographical recall to create a mild, transient sad mood. This induction method has been validated by previous research (Martin, 1990;Segal, Gemar & Williams, 1999;Segal et al., 2006). Participants listened to a digitally re-mastered, half-speed, non-lyrical piece of classical individually on the computer screen, printed in red, green, yellow, or blue and participants were asked to select the matching color key on the keyboard (i.e., f for red, g for green, h for yellow, j for blue). ...
The central aim of this study was to investigate the predictive role of perceived control in binge eating severity, mood reactivity, and possible concomitants with reduced cardiovascular function as measured by high frequency heart rate variability (HF-HRV/RSA). Participants (N = 75) included normal to overweight men and women who completed self-report measures assessing perceived control, binge eating severity, perceived stress, negative affect, and depressive symptom severity prior to a structured clinical interview and second experimental laboratory session. During this second experimental lab session, noninvasive electrical sensors were placed for physiological recordings to measure fluctuations in HF-HRV/RSA in participants randomized to a negative or neutral mood induction task. In addition to physiological data, participants completed self-report measures of mood and stress during baseline assessment, post-mood induction, and following a recovery period. Results indicated that perceived control was predictive of binge eating severity such that higher self-reported perceived control was associated with less severe binge eating symptoms. This association was significantly mediated by perceived stress and depressive symptoms, such that those with greater perceived control also experienced less perceived stress and reduced depressive symptoms, which then significantly predicted less binge eating severity. These associations remained significant across sex and history of major depressive disorder (MDD). No significant associations were observed between perceived control, binge eating severity, and mood, stress, or HF-HRV/RSA reactivity. Results from the current investigation suggest that perceived control may buffer individuals from stress and depressive symptoms and predict less severe binge eating symptoms. Importantly, perceived control is an adaptive variable that can be modified through experience (Surtees et al., 2010). In line with prior research, which suggests that perceived control may be a malleable treatment target and predictive of positive outcomes following CBT for anxiety and mood disorders (Doering et al., 2015), the current results propose that perceived control may be a universal treatment target across various binge eating populations.
... MIXED RESULTS OF TIME-LIMITED SMBCT AND COMET tion while simultaneously activating positive feelings with posture and facial expression and giving explicit verbal positive statements about their self-image (e.g., I am a smart person who can cope with a difficult situation) and listening to music connected to memories of positive self-image (Camras, Holland, & Patterson, 1993;Lange, Richard, Gest, Vries, & Lodder, 1998;Segal, Gemar, & Williams, 1999;Van der Does, 2002). Previous research has shown that COMET has a positive effect on self-image of patients with PDs and that it can effectively be used in a group format (Ekkers et al., 2011). ...
Waiting lists for psychotherapy for patients with personality disorders are increasing; there is an imbalance between the number of patients seeking help and the amount of therapy available. Thus, there is a need for time-limited treatments that are effective for specific patients and their specific problems. This pilot randomized controlled trial aimed to investigate the effectiveness of two 8-week group modules + treatment as usual (TAU): schema mindfulness-based cognitive therapy (SMBCT) and competitive memory therapy (COMET) with special attention to predictors and mediators of change. Patients (N = 58) were randomized to either SMBCT + TAU or COMET + TAU. The dropout rate was 34%. Time effects were found for both treatments, but neither was more effective than the other, and around 23% showed deterioration after treatment. Explorative analyses suggested that predictors for change were severity of psychological distress and a demanding and/or punitive attitude toward oneself at baseline. Global severity index change in the beginning of the treatment mediated schema changes later on in treatment. SMBCT + TAU and COMET + TAU might be mostly suitable for patients with high levels of symptom severity followed by high scores on parent modes. More research is needed to tailor these time-limited therapies to specific personality problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Given that cognitive-behavioral therapy (CBT) is associated with reduced cognitive reactivity (e.g. Segal et al., 1999), it is possible that the observed reduction in dysfunctional attitudes following mood-induction could be related to participant's treatment history. ...
The aim of the present study was to test predictions derived from the habit-goal framework of depressive rumination and investigate its relevance to cognitive reactivity –another well-known vulnerability factor to depression. Formerly depressed (FD; n=20) and never depressed (ND; n=22) participants completed self-report measures of rumination, cognitive reactivity and habitual characteristics of rumination (e.g. lack of awareness, control, intent). A standard mood-induction task was also used to measure cognitive reactivity and an outcome-devaluation task to measure general habit vs. goal-directed behavior control. Habitual characteristics of ruminative thoughts were greater in the FD group and were related to depressive brooding and cognitive reactivity, but not reflective pondering. Reliance on habit on the outcome-devaluation task, was strongly correlated with number of depression episodes, although group differences were not observed in general habit vs. goal-directed control. Habitual characteristics of rumination (e.g. greater automaticity) may explain reactivity and persistence of negative thoughts in depression. Habitual behavior control may contribute to inflexible responding and vulnerability for depression episodes.
... One possible explanation for the counter-intuitive finding, that low Neuroticism participants high in Extraversion experienced the greatest increases in PA, involves a consideration of mood reactivity. A number of studies have examined response to a negative mood prime as risk factor for depression (e.g., Lethbridge & Allen, 2008;Segal, Gemar, & Williams, 1999;Segal et al., 2006). In these studies, increases in sadness in response to a mood prime predicted increased symptoms of depression at a subsequent time. ...
The purpose of this investigation was two-fold: (1) to determine if a musical stimulus can successfully generate a positive mood induction and (2) to identify particular personality traits that may correlate with the response to this mood induction. Participants were recruited from social media websites (Facebook and Twitter), as well as from introductory psychology classes at a private university in the northeast, and completed online measures of the Big Five personality traits, positive, and negative affect. Participants were then asked to listen to a piece of music designed to induce a positive mood, followed by a subsequent assessment of both positive and negative affect. Results of our study show a complex pattern of interrelationships, consistent with the notion that both extraversion and neuroticism are characterized by mood reactivity. Future studies should attempt to replicate these findings.
... One possible explanation for the counter-intuitive finding, that low Neuroticism participants high in Extraversion experienced the greatest increases in PA, involves a consideration of mood reactivity. A number of studies have examined response to a negative mood prime as risk factor for depression (e.g., Lethbridge & Allen, 2008;Segal, Gemar, & Williams, 1999;Segal et al., 2006). In these studies, increases in sadness in response to a mood prime predicted increased symptoms of depression at a subsequent time. ...
... Besides limited knowledge on the causal relationship between CBT's procedures and CBT treatment processes, it remains unclear whether change in dysfunctional thinking is an actual change in the dysfunctional structures (accommodation model) or the deactivation of dysfunctional structures and activation of more functional structures that lead to less dysfunctional thinking (deactivation-activation model; Barber & DeRubeis, 1989;Brewin, 1989Brewin, , 2006. In favor of the (de)activation hypothesis (Brewin, 1989(Brewin, , 2006, studies have shown that former depressed patients have a certain cognitive vulnerability (Segal et al., 2006;Segal, Gemar, & Williams, 1999) that might predict the onset of a (recurrent) depressive episode (Alloy et al., 1999) and have suggested that CBT may reduce relapse by changing relationships to negative thoughts rather than changing beliefs in thought content (Teasdale et al., 2002). Moreover, it was suggested that relapse would be hard to explain if the old dysfunctional structures have been permanently changed (Brewin, 1989). ...
Insight into how cognitive behavioral therapy (CBT) works is urgently needed to improve depressive outcome. First, we discuss the role of learning in CBT for depression by reviewing evidence for learning processes involved in the development and maintenance of depression. Second, we investigate the role of learning capacity as a moderator by reviewing empirical evidence for the relation between (a) CBT procedures and learning processes, (b) learning processes and CBT treatment processes, and (c) learning processes and CBT outcome. We propose that learning capacity moderates the relation between CBT procedures and change in CBT treatment processes and explains why therapeutic procedures lead to process change and long-term success in some but not all patients. Third, we identify procedures that lead to successful therapeutic learning and describe how experimental studies help to better explain causal mechanisms of change and the role of learning capacity in CBT for depression.
... Garratt et al. (2007) argued that although pharmacotherapy may lead to reductions in maladaptive cognition, these reductions may be more superficial and unstable than the cognitive change produced by CBT. They referred to studies by Segal et al. (1999Segal et al. ( , 2006 that found that dysfunctional attitudes decreased similarly in depressed patients treated with CBT and pharmacotherapy, but patients treated with pharmacotherapy had greater negative cognition in response to induced negative mood than patients treated with CBT. This cognitive reactivity to depressed mood, in turn, was associated with a higher rate of relapse. ...
Background
Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model.
Methods
The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT ( n = 54) or ADM ( n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models.
Results
Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant.
Conclusions
The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.
... Circumstantial evidence for the hypothesis that cognitive therapy skills might act as a mechanism of change has been provided in a number of studies showing that the frequency and quality of cognitive therapy skills improve during treatment (Hundt, Mignogna, Underhill, & Cully, 2013;Lorenzo-Luaces et al., 2014). Moreover, cognitive therapy skills may explain why provocation of sad mood was associated with increased dysfunctional thinking in patients who received antidepressants compared to patients who received CBT, while both treatments have been associated with cognitive change (Barber & DeRubeis, 1989;Barber & DeRubeis, 2001;Garrat et al., 2007;Segal, Gemar, & Williams, 1999;Segal et al., 2006). However, the exact nature of the association between cognitive procedures, cognitive therapy skills, and treatment outcome is unclear. ...
Background
Isolating a therapeutic procedure might be a powerful way to enhance our understanding of how cognitive behavior therapy (CBT) works. The present study explored new methods to isolate cognitive procedures and to study their direct impact on hypothesized underlying processes and CBT outcome.
Method
The effects of a cognitive therapy skill acquisition procedure ( n = 36) were compared to no procedure ( n = 36) on cognitive therapy skills, dysfunctional thinking, distress, and mood in response to induced distress following a social stress test in healthy participants.
Results
Participants reported more cognitive therapy skills after the procedure that focused on the acquisition of cognitive therapy skills compared to no procedure, but there were no differences in dysfunctional thinking, distress, and mood between the groups.
Conclusions
By demonstrating an experimental approach to investigate mechanisms of change, including the pitfalls that come along with it, the present experiment provides a blueprint for other researchers interested in the underlying mechanisms of change in CBT for depression.
... Yoke" played at half speed (Segal, Gemar, & Williams, 1999), participants were asked to write down an anxious, stressful experience (see Sinha, Fuse, Aubin, & O'Malley, 2000). ...
Problematic alcohol use is associated with drinking alcohol to reduce negative mood states (negative reinforcement motive). Further, heavy drinking individuals tend to interpret ambiguous situations as alcohol-related (interpretive bias). The current experimental study aimed to examine the role of alcohol-related interpretive biases in negative-affect drinking. It was hypothesized that a single-session Cognitive Bias Modification of Interpretation (CBM-I) training condition (compared to a sham condition) would lead to less alcohol-related interpretations of negative affect situations, and less alcohol consumption while being in a negative mood state. The most pronounced effects were expected in individuals who drink alcohol to cope with anxiety. Moderate to heavy drinking university students (N = 134) were randomly assigned to a CBM-I or a sham condition. Interpretations were assessed during and after the training session. Drinking was assessed in a lab-based drink test and one week later using a self-report measure. With respect to alcohol-related interpretative bias, this bias was weaker in the CBM-I compared to the sham condition during the training session. This effect was not moderated by coping-anxiety motives, and did not generalize to another interpretation measure. No training effects were found on drinking behavior in the lab or on self-reported daily-level use. In sum, the CBM-I training condition was associated with lower alcohol-related interpretive bias scores during training. Generalization to another interpretation measure or to drinking behavior was not observed. Future research could explore providing multiple training sessions in order to strengthen the effects of the CBM-I training.
... Originally developed to explain depression vulnerability, the Differential Activation Hypothesis proposes that people vary in how their maladaptive psychological processes respond to negative mood. Some people endorse psychological processes that are more highly activated by negative mood, and they are more likely to be persistently depressed, whereas others have greater resistance to negative mood and are less likely to experience persistent depression (e.g., Segal, Gemar, & Williams, 1999;Segal et al., 2006;Werner-Seidler & Moulds, 2012;Yeung, Dalgleish, Golden, & Schartau, 2006). Negative mood-activated psychological processes are argued to emerge from 'configurations' of thought patterns and information processing biases that individuals rehearse during initial depressive episodes (Segal, Williams, Teasdale, & Gemar, 1996). ...
To what extent are death- and life-oriented psychological processes among suicidal individuals activated by mood? According to Teasdale's (1988) Differential Activation Hypothesis, we would expect that negative mood-activated psychological processes are maladaptive among suicide ideators (vs. non-ideators) and predictive of subsequent suicidal ideation. This, however, has never been prospectively studied. To address this knowledge gap, we conducted a prospective study assessing psychological risk factors via the Death/Life Implicit Association Test (IAT) and the Suicide Stroop task before and after a temporary negative mood induction. Suicidal ideation was assessed one and six months later. Results based on Death/Life IAT performance largely supported hypotheses, such that suicide ideators demonstrated significantly weaker implicit identification with life after (vs. before) the negative mood induction. Non-ideators demonstrated no significant change, maintaining strong identification with life irrespective of mood. Of note, this baseline interaction may have been accounted for by depressive symptoms. Identification with death (vs. life) predicted greater likelihood of suicidal ideation one month later, controlling for depressive symptoms and baseline suicidal ideation. Only negative mood-activated identification with death predicted suicidal ideation six months later. Suicide Stroop scores did not change as a function of mood or predict subsequent suicidal ideation. Death/Life IAT findings support the Differential Activation Hypothesis and suggest that suicide ideators' identification with life is more variable and easily weakened by negative mood relative to non-ideators. We encourage future work to consider the potential role of transient mood and the importance of measuring psychological processes that pertain to both death and life. (PsycINFO Database Record
... This may in turn have an effect on "positive" and "negative affect." Previous studies have shown that CBT has a good effect on positive and negative affect [61]. ...
Abstract Background To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout. Methods Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18–65 years and were on 50%–100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon’s rank sum and Wilcoxon’s sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen’s D. Results Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p
... Grübeln ist durch einen verbal-analytischen Verarbeitungsmodus ge-kennzeichnet und ist damit deutlich entfernt von einer erfahrungsbasierten Wahrnehmung des aktuellen Moments. Wissenschaftliche Studien liefern empirische Evidenz für diese Theorie: Das Rückfallrisiko bei ehemals Depressiven kann vorhergesagt werden durch die Leichtigkeit, mit der negative Kognitionen durch negative Stimmung aktiviert werden können (15,16). Außerdem erhöht die Tendenz zum Grübeln das Rückfallrisiko (12). ...
Jon Kabat-Zinn developed „mindfulness-based stress reduction“ (MBSR) in the second half
of the 1970s. Based on this approach, Segal, Williams and Teasdale (2002) developed
„mindfulness-based cognitive therapy“ (MBCT) to prevent depressive relapse. MBCT recently
has gained a lot of attention in cognitive-behavioral approaches. This paper presents
the historical and theoretical background of MBCT. Further, the implementation of this
group-focused concept is described, and the current state of research is addressed by presenting
current relevant studies and meta-analyses.
... situational analyses). In light of the previous finding of reduced cognitive reactivity after cognitive therapy in individuals who have recovered from depression (Segal et al., 1999), one might expect that improvements in emotion regulation skills may normalize both affective and cognitive reactivity after successful therapy, e.g. with CBASP. However, since this is the first experimental evidence for the theoretical framework of CD, the present results have to be considered preliminary and need to be replicated in larger samples. ...
Background:
Chronic depression (CD) is strongly associated with childhood maltreatment, which has been proposed to lead to inefficient coping styles that are characterized by abnormal affective responsiveness and dysfunctional cognitive attitudes. However, while this notion forms an important basis for psychotherapeutic strategies in the treatment of CD, there is still little direct empirical evidence for a role of altered affective and cognitive reactivity in CD. The present study therefore experimentally investigated affective and cognitive reactivity to two forms of negative mood induction in CD patients versus a healthy control sample (HC).
Methods:
For the general mood induction procedure, a combination of sad pictures and sad music was used, while for individualized mood induction, negative mood was induced by individualized scripts with autobiographical content. Both experiments included n = 15 CD patients versus n = 15 HC, respectively. Interactions between affective or cognitive reactivity and group were analyzed by repeated measurements ANOVAs.
Results:
General mood induction neither revealed affective nor cognitive reactivity in the patient group while the control group reported the expected decrease of positive affect [interaction (IA) affective reactivity x group: p = .011, cognitive reactivity x group: n.s.]. In contrast, individualized mood induction specifically increased affective reactivity (IA: p = .037) as well as the amount of dysfunctional cognitions in patients versus controls (IA: p = .014).
Limitations:
The experiments were not balanced in a crossover design, causal conclusions are thus limited. Additionally, the differences to non-chronic forms of depression are still outstanding.
Conclusions:
The results suggest that in patients with CD, specific emotional activation through autobiographical memories is a key factor in dysfunctional coping styles. Psychotherapeutic interventions aimed at modifying affective and cognitive reactivity are thus of high relevance in the treatment of CD.
... Por ejemplo, en pacientes previamente deprimidos la adherencia a actitudes disfuncionales aumenta tras una inducción de estado de ánimo triste (Miranda, Gross, Persons y Hahn, 1998), lo que a su vez predice riesgo de recaída (Segal, Gemar y Williams, 1999;Gemar, Segal, Sagrati y Kennedy, 2001). La posibilidad de que la reactividad cognitiva sea un rasgo característico de poblaciones en riesgo de desarrollar una depresión y no simplemente una característica de los que han padecido el trastorno (Scher et al., 2005) queda apoyada por los estudios realizados con hijos de madres deprimidas, considerados por ello de alto riesgo, que muestran un procesamiento de información negativa sesgado en comparación con hijos de madres no deprimidas (p.ej: Kujawa et al., 2011). ...
Mood deterioration in response to exercise cessation is well documented, but moderators of this effect remain unknown. This study tested the hypothesis that physically active individuals with higher levels of cognitive vulnerability (i.e., tendencies toward negative thought content and processes in response to stress or negative mood states) are at greater risk for increased anxiety and depressive symptoms when undergoing exercise cessation. Community adults meeting recommended physical activity guidelines ( N = 36) participated in a 4-week prospective, longitudinal study with 2 weeks each of maintained exercise and exercise cessation. Cognitive vulnerability measures included dysfunctional attitudes, brooding rumination, and cognitive reactivity (i.e., change in dysfunctional attitudes over a dysphoric mood induction). Anxiety and depression symptoms increased during exercise cessation. Brooding emerged as a risk factor for increases in tension scores on the Profile of Mood States–Brief during exercise cessation. Future studies should explore brooding as a mediator (i.e., potential mechanism) of exercise-induced mood deterioration.
The present research examined whether and which adaptive body image displays in peers can promote more adaptive body image in self. In two studies, female-identified undergraduates recalled a personally distressing body image event. In Study 1, participants (N = 158) then heard an alleged female-identified peer responding to her own distressing body image event with either self-compassion, self-esteem enhancement, or distraction. Participants across conditions reported increased body acceptance and body image-related self-compassion, and decreased body image distress, but changes did not vary by condition. Study 2 sought to determine which component(s) common to Study 1's conditions explained the benefits participants experienced. Participants (N = 207) listened to an alleged peer: describe body image distress with which she coped adaptively; express body image distress but no adaptive coping; or deny body image distress and relate positively to her body. Hearing a peer cope adaptively with body image distress yielded the greatest body image benefits, whereas hearing a peer deny body image distress was generally least helpful. Results suggest that learning how a peer copes adaptively with body image distress may be most helpful in the face of personal body image distress, and support the overarching theory that adaptive body image may be socially transmissible.
This study aimed to investigate the effectiveness of a depression management program based on cognitive behavioral therapy, focusing on Socially Prescribed Perfectionism, Intolerance of Uncertainty, Rumination. According to the criteria over CES-D score 16 or more, the treatment group (n=12) and the waiting-control group (n=12) were selected. The depression management program based on CBT consisting of 8 sessions was conducted for the treatment group. To test the effectiveness of the program, Socially Prescribed Perfectionism (HMPS), Depression (CES-D), Intolerance of Uncertainty (IUS), Rumination(RDQ) were measured at pre, post, and follow-up (6 months) tests. As a result of the study, in the treatment group, the dependent variables measured post and follow-up treatments were significantly decreased compared to pre-test, but there was no significant change in the waiting-control group. It means that the program is effective in reducing the levels of Socially Prescribed Perfectionism, Depression, Intolerance of Uncertainty, and rumination in the treatment group and maintaining the effect for 6 months. It suggests that the intervention for the Socially Prescribed Perfectionism, Intolerance of Uncertainty and rumination is useful for managing Depression in college students. Based on the research results, the limitations, suggestions, and significance of this study were discussed.
Background
Electroconvulsive therapy (ECT) is a potent option for treatment-resistant major depressive disorder (MDD). Cognitive models of depression posit that negative cognitions and underlying all-or-nothing negative schemas contribute to and perpetuate depressed mood. This study investigates whether ECT can modify negative schemas, potentially via memory reactivation, and whether such changes are related to MDD symptom improvement.
Method
Seventy-two patients were randomized to either an emotional memory reactivation electroconvulsive therapy (EMR-ECT) or control memory reactivation electroconvulsive therapy (CMR-ECT) intervention prior to ECT-sessions in a randomized controlled trail. Emotional memories associated with patients' depression were reactivated before ECT-sessions. At baseline and after the ECT-course, negative schemas and depression severity were assessed using the Dysfunctional Attitude Scale (DAS) and Hamilton Depression Rating Scale HDRS. Mediation analyses were used to examine whether the effects of ECT on HDRS-scores were mediated by changes in DAS-scores or vice versa.
Results
Post-ECT DAS-scores were significantly lower compared to baseline. Post-ECT, the mean HDRS-score of the whole sample (15.10 ± 8.65 [SD]; n = 59) was lower compared to baseline (24.83 ± 5.91 [SD]). Multiple regression analysis showed no significant influence of memory reactivation on schema improvement. Path analysis showed that depression improvement was mediated by improvement of negative cognitive schemas.
Conclusion
ECT is associated with improvement of negative schemas, which appears to mediate the improvement of depressive symptoms. An emotional memory intervention aimed to modify negative schemas showed no additional effect.
マインドフルネスは，様々な心理的問題に対して有効であることが示されている。しかし，その効果のメカニズムを説明するために，多くの心理学的概念が導入されているが，統一的な理解は得られていない。本論文では，様々な脳機能を説明できる可能性のある統一理論として近年注目されている予測符号化モデルの観点から，マインドフルネスのメカニズムを考察した。概観の結果，マインドフルネスの特徴は，（1）予測通りの感覚を生成しようとする能動的推論よりも，感覚に応じて予測を更新する知覚的推論による予測誤差の最小化が優勢であること，（2）注意によって感覚入力の精度を高めること，（3）過去の経験に重みづけないことによって，事前の予測の精度を下げること，であると考えられた。これらの特徴は、予測誤差を迅速に最小化し，世界を正確に把握することに繋がると考えられる。予測符号化モデルの観点からマインドフルネスを再定義することで、人間の知覚、行動、認知、感情を説明する統一的な視点から、マインドフルネスのメカニズムを理解できる可能性を議論する。
Background
The development of prophylactic interventions for major depressive disorder (MDD) is an important issue in clinical practice. We aimed to compare the relative efficacy of nonpharmacological interventions for relapse prevention in adult patients with MDD.
Methods
Randomized controlled trials investigating nonpharmachological interventions for relapse prevention were included. A Bayesian network meta-analysis was performed. Hazard ratios are reported as effect sizes with 95% credible intervals. Global inconsistency, local inconsistency, heterogeneity, and transitivity were evaluated. Confidence for the results comparing the active treatment with control conditions or antidepressant medicine (ADM) was assessed.
Results
Thirty-six trials were included. Most nonpharmacological interventions were various forms of psychotherapy; others were noninvasive neurostimulation techniques (3 studies with electroconvulsive therapy and 1 study with transcranial magnetic stimulation). Psychotherapy as a monotherapy following ADM or psychotherapy produced significantly better outcomes than control conditions, and there was no significant difference between psychotherapy and ADM. The combination of psychotherapy and ADM was superior to either treatment alone. The results were similar for patients with at least 3 previous episodes. Neurostimulation techniques were also superior to controls, either as a monotherapy or combined with ADM.
Conclusions
Our study provided evidence that psychotherapy as a monotherapy following ADM or psychotherapy was effective and performed as well as ADM for relapse prevention. Neurostimulation techniques also showed promising results but more studies are needed to confirm their efficacy. These findings may be informative for clinical practice and inspire future research.
This chapter describes A.T. Beck's cognitive behaviour therapy (CBT) for depression. Beck's is probably the most fully developed, comprehensively evaluated, and widely disseminated cognitive behavioural approach to depression. Additionally, CBT is an effective treatment for a range of acute psychiatric disorders, shows promise for severe mental illness and personality disorder, and is thus helpful not only with primary depression, but also with a range of comorbid conditions.
Cognitive Reactivity (CR), an established diathesis for depression, has been defined as the within-person strength of association between sad affect and dysfunctional attitudes. Watson and Tellegen (1985) proposed that sad affect is a combination of high negative affect (NA) and low positive affect (PA). The current study integrated the CR and the affect literatures by examining the differential and conjoint roles of cognitive reactivity to high negative affect (CR-highNA) and cognitive reactivity to low positive affect (CR-lowPA). In the current study, college student participants completed daily diary measures of CR-highNA, CR-lowPA, and CR to sadness (CR-Sad). Results showed that naturally occurring NA and PA accounted for the relation of sadness to dysfunctional cognitions. Further, the relation of depressive symptoms to CR-Sad was explained by high levels of CR-highNA and CR-lowPA. Born out of the integration of research on CR and affective structures, the current results have implications for both theory and treatment of depression.
The purpose of this study was to evaluate the internal consistency, factor structure, and validity of the Leiden Index of Depression Sensitivity-Revised (LEIDS-R) and a recent revision of the LEIDS-R (LEIDS-RR) in Norway. The LEIDS-R is a self-report inventory measuring cognitive reactivity. Cognitive reactivity is defined as the relative ease with which negative thinking is activated by mild low mood and has been shown to be a strong predictor of relapse of depression. Hospital employees and psychology students (N = 240) completed the LEIDS-R and measures of depression, repetitive negative thinking, and mindfulness. The results showed that Cronbach’s alpha was equally high for both the LEIDS-R and LEIDS-RR total score (α = .92), indicating good internal consistency. Confirmatory factor analysis of the LEIDS-R suggested an acceptable model fit for the original first-order six-factor model. Confirmatory factor analyses of the LEIDS-RR suggested the best fit for a bifactor five-factor model. Correlational analyses showed positive associations of the LEIDS-R and LEIDS-RR scales with depression and repetitive negative thinking and negative relationships with mindfulness. It is concluded that the Norwegian versions of the LEIDS-R and LEIDS-RR appear to be both reliable and valid for future use.
Supplementary Data Tables and Figures.
Objective: Individuals’ use of self-statements reflecting self-criticism, a sense of inadequacy, and low self-worth has been linked to the incidence, severity, and recurrence of major depressive disorder [de Graaf, L. E., Huibers, M. J. H., Cuijpers, P., & Arntz, A. (2010). Minor and major depression in the general population: Does dysfunctional thinking play a role? Comprehensive Psychiatry, 51(3), 266–274. doi:10.1016/j.comppsych.2009.08.006; Riso, L. P., du Toit, P. L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., … Ulmer, C. S. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112(1), 72–80. doi:10.1037/0021-843X.112.1.72]. The present study used an observer-rated measure, the Structural Analysis of Social Behavior [Benjamin, L. S. (1974). Structural Analysis of Social Behavior. Psychological Review, 81(5), 392–425. doi:10.1037/h0037024], to examine patients’ self-directed communication over the course of psychotherapy.
Method: Self-talk in early and late therapy sessions was examined using cases (N = 44) from the cognitive therapy arm of Jacobson and colleagues’ component study of cognitive therapy for depression [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (1996). A component analysis of cognitive–behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295–304. doi:10.1037/0022-006x.64.2.295, Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (2000). A component analysis of cognitive–behavioral treatment for depression. Prevention & Treatment, 3(1). doi:10.1037/1522-3736.3.1.323a]. We identified changes at treatment termination, and used hierarchical multiple regression to examine whether improvements in patient self-talk influenced treatment outcome up to 24 months post-termination.
Results: Trends indicate that patients used friendlier and less critical self-statements at the end of treatment. Decreased self-critical behaviour was associated with fewer symptoms at the end of treatment and up to one year later; increased self-acceptance was linked to symptom improvement a year and a half after termination.
Conclusion: Consistent with cognitive theory, reduced self-criticism was associated with better treatment outcomes. Longer-term improvement was linked to the development of friendlier and more accepting self-referential behaviour.
To provide a more powerful test of the diathesis-stress component of the reformulated theory of depression (Abramson, Seligman, & Teasdale, 1978), we extended and refined the Metalsky, Abramson, Seligman, Semmel, and Peterson (1982) study and examined whether the content of college students' attributional styles (hypothesized attributional diathesis) as measured at Time 1 interacted with the outcomes students received on a class midterm exam to predict their subsequent depressive mood responses. In addition, to test the mediation component of the theory, we examined whether the relation between the hypothesized attributional diathesis and failure students' subsequent depressive mood responses to their low midterm grades was mediated by the particular causal attributions these students made for their low grades. The results partially corroborated the current statement (Abramson, Alloy, & Metalsky, 1986; Abramson, Metalsky, & Alloy, 1986a, 1986b) of the diathesis-stress component of the theory. Whereas students' immediate depressive mood reactions were predicted solely by the outcomes they received on the class midterm exams, their enduring depressive mood reactions were predicted solely by the hypothesized Attributional Diathesis X Outcome on Midterm Exam interaction. The direction and form of the interaction were in line with prediction. The results fully corroborated predictions derived from the mediation component of the theory as they applied to students' enduring mood responses.
In this paper, we attempt to put forward an oft-ignored model for describing cognitive change during cognitive therapy for depression, while discussing the strengths and weaknesses of the three models of change described by Hollon, Evans, and DeRubeis. Along the way we point out some of the conceptual ambiguities regarding cognitive processes and contents as they have been applied in the cognitive therapy literature. We propose that short-term cognitive therapy works primarily through the teaching of compensatory skills. Our proposal is motivated, in part, by the paucity of differential effects of cognitive therapy when compared with antidepressant medications on existing cognitive measures, when at the same time there are reports of differential relapse prevention for these two treatments. In addition, we describe a set of features that a measure of compensatory skills should possess.
Advances in the conceptualization and measurement of life stress in the past 2 decades raise several questions concerning traditional diathesis-stress theories of psychopathology. First, comprehensive measures of life stress force investigators to become more precise about the particular stressful circumstances hypothesized to interact with diatheses. Second, the influence of the diathesis on a person's life is typically ignored, which results in several types of possible bias in the assessment of life stress. Finally, information is available on diatheses and stress for specific disorders to provide a foundation for more empirically based hypotheses about diathesis-stress interactions. This possibility is outlined for depression. Such an approach provides the basis for developing broader, yet more specific, frameworks for investigating diathesis-stress theories of psychopathology in general and of depression in particular.
In two studies we tested the hypothesis that endorsement of dysfunctional beliefs depends on current mood state for persons who are vulnerable to depression. The first study showed that reports of dysfunctional beliefs vary with spontaneous diurnal mood fluctuations in 47 depressed psychiatric patients. The effect of mood state was highly significant (p less than .01); dysfunctional thinking increased when mood was worst and decreased when mood was best. The second study conceptually replicated this finding in a population of asymptomatic subjects. As predicted, reports of dysfunctional beliefs varied as a function of mood state in 14 persons who had experienced a depressive episode but not in 27 who had never been depressed. These findings support the cognitive theory of depression, which proposes that dysfunctional beliefs are vulnerability factors for depression but also that reporting of dysfunctional beliefs depends on current mood state.
To test the hypothesis that self-report of dysfunctional attitudes is mood-state dependent, dysfunctional attitudes were assessed in 43 women before and after they received a depressed or elated mood induction. As predicted, the mood induction produced reliable changes in mood and in dysfunctional attitudes, although the increase in dysfunctional attitudes following the negative mood induction was not large enough to be statistically significant. We also tested the hypothesis, from the cognitive theory of depression, that subjects with previous episodes of depression would report more dysfunctional attitudes than would subjects without such a history. As predicted, subjects who reported previous episodes of depression endorsed more dysfunctional attitudes than did subjects who did not report such a history. However, this effect occurred only for subjects who were in a negative mood state when their dysfunctional attitudes were assessed. These findings support the proposition of the cognitive theory that dysfunctional attitudes are traits but suggest that these traits are mood-state dependent. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Detecting the effects of latent depressive schemas constitutes an important step toward validating A. T. Beck's (1967) tenet of the depressive cognitive style as a causal factor in the onset and relapse of major depression. The authors examined whether a sample of formerly clinically depressed individuals continued to exhibit a negatively biased information-processing style in the absence of concurrent depressed mood. As predicted, the scores of formerly depressed individuals on 2 questionnaires tapping dysfunctional thinking did not differ from those of never depressed individuals, but responses of formerly depressed individuals were negatively biased on 2 of 3 information-processing measures administered following a self-focus manipulation. These results provide evidence for the persistence of a depressive schema in individuals who have recovered from major depression.
A double-blind placebo-controlled cross-over study in which plasma tryptophan was manipulated by administration of a tryptophan-deficient amino acid mixture. In the placebo condition, all subjects received a nutritionally balanced amino acid mixture that contained tryptophan. To further standardize baseline amino acids, each subject was provided with a low-protein diet the day before amino acid challenges. Subjects were euthymic, healthy men aged 18 to 30 years with either a multigenerational family history of affective illness or no family history of psychiatric illness in the present or in the two previous generations. Each subject was screened with a structured clinical interview to rule out a personal history of psychiatric illness.
Plasma tryptophan was reduced by 89% 5 hours after the administration of the tryptophan-deficient amino acid mixture. Six of 20 subjects with a family history of affective illness and none of 19 subjects without a family history of psychiatric illness showed a lowering of mood of 10 or more points on the Profile of Mood States depression scale (P = .012, Fisher's Exact Test) 5 hours after tryptophan depletion. No significant mood changes were observed following the control treatment (balanced amino acid mixture) in either group.
Our data support the hypothesis that subjects with no prior depressive episodes but with a multigenerational family history of major affective disorder show a greater reduction in mood after tryptophan depletion. They are also consistent with theories that implicate deficient serotonergic function as one possible etiological factor in major depressive disorders.
Terms such as risk, risk factors, and especially the term cause are inconsistently and imprecisely used, fostering scientific miscommunication and misleading research and policy. Clarifying such terms is the essential first step. We define risk and a risk factor (protective factor) and their potency, set out the conceptual basis of the methods by which risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or variable marker or a causal risk factor. All definitions are based on the state of scientific knowledge (empirical documentation), rather than on hypotheses, speculations, or beliefs. We discuss common approaches and pitfalls and give a psychiatric research example. Imprecise reports can impede the search for understanding the cause and course of any disease and also may be a basis of inadequate clinical or policy decision-making. The issues in risk research are much too important to tolerate less than precise terminology or the less than rigorous research reporting that results from imprecise and inconsistent terminology.
In recent empirical trials testing causal mediational models of cognitive therapy for depression, researchers have found comparable change in cognition regardless of intervention, leading some to reject any mediational role for cognition. Such an interpretation is premature because alternative models exist that allow potential mediators to exhibit nonspecific change across diverse interventions yet still play a causal mediational role in one or all of those interventions. A failure to distinguish between the mediator's role as a consequence of the manipulation and its role as a potential cause of the dependent outcome is seen as contributory to this premature rejection. We suggest strategies that can facilitate the testing of causal mediational models.
The account of cognitive vulnerability to depression offered by Beck's cognitive model is summarised. As this account currently lacks consistent empirical support, an alternative, related, account is presented. This proposes that, once a person is initially depressed, an important factor that determines whether their depression remains mild or transient, or becomes more severe and persistent, is the nature of the negative cognitive processes and constructs that become active and accessible in the depressed state. These interact with the nature of environmental difficulties, available social support, and biological factors, to determine whether a depression-maintaining cognitive-affective vicious cycle will be set up.Results from studies specifically designed to test predictions from this account have yielded positive results. Findings consistent with the hypothesis have also been obtained in other prospective studies which have shown that cognitive measures, administered in the depressed state, predict the future course of depression independently of initial levels of depression.The hypothesis is elaborated to incorporate the demonstrated relationship of elevated neuroticism to risk and persistence of depression. Recent views on the nature of sex differences in rates of depression, and on the relationship of attributional style to depression are also compatible with the hypothesis. It is concluded that the hypothesis has encouraging preliminary support.SUMMARYTwo broad aspects of cognitive vulnerability to depression can be distinguished. The first is the tendency to evaluate certain types of life event in ways which will produce intense rather than mild depression. This is the aspect of vulnerability on which Beck's cognitive model appears to concentrate. There are considerable difficulties in assessing this aspect of Beck's model and it is not consistently supported by comparison of recovered depressed patients with control groups.The second aspect of cognitive vulnerability relates to the cognitive processes and constructs that become active and accessible once a person is in a state of depression. Within this approach, vulnerability to onset and vulnerability to persistence of depression can be roughly distinguished, depending on whether the focus is on the period when the depression has been present for only a brief period, or is mild, or whether depression has already existed for some time and reached at least moderate severity. The account presented here proposes that a crucial factor determining whether an initially mild or transient depressed state remains mild or soon disappears, or becomes more severe and persistent, is whether a vicious cycle based on a reciprocally reinforcing relationship between depressed mood and negative cognitive processing can become established. The probability that this cycle will become established is, in turn, a function of a complex interaction between the environmental difficulties facing a person, the support available to them, their biological state, and the nature of the cognitive processes and constructs that are active and accessible in the depressed state. The kind of cognitive process and constructs that are most active and accessible in the depressed state will be a function both of the patterns of cognitive processing that are characteristic of the person in their normal mood state (such as those related to neuroticism), and of the patterns of cognitive processing that become active in the depressed state. It is on these latter that the differential activation hypothesis concentrates. It suggests that individual differences in the cognitive processes and constructs that become active and accessible in the depressed' state can make an important contribution to whether an initial state of depression becomes more intense, or fades away, and whether, once established, depression of moderate severity persists a long time or a short time. In particular, it is proposed that processes and constructs related to global negative characterological evaluations of the self or that, in other ways, lead to interpretations of experience as highly aversive and uncontrollable are likely to act to intensify and maintain depression.Two investigations specifically designed to test predictions from the differential activation hypothesis yielded positive results. Further supportive evidence is available from a number of other studies which have examined the relationship between cognitive measures, administered in the depressed state, and the future course of depression. Such studies haverecurringly found that persistence or return of depression is associated with initially high scores on measures of negative cognition, and this association remains when the effects of initial depression level are partialled out.In addition to this encouraging preliminary empirical support, the differential activation hypothesis has the further attraction that it can incorporate into this account the well established finding that neuroticism is associated with risk of becoming depressed, and of depression persisting. Further, it is quite consistent with recent proposals related to sex differences in rates of depression, and to the relationship of attributional style to depression.
In this book Ian Gotlib and Constance Hammen provide the most up-to-date and comprehensive review of the psychological literature on depression currently available in a single volume. They bring together the literature examining cognitive functioning of depressed persons, and also review the social context of depression, including early experience, social support, marital functioning, and the adjustment of children of depressed parents. The authors also present the most recent information on cognitive and interpersonal treatments for depression. They draw on the research outlined in the book to present a conceptualization of depression that integrates cognitive and interpersonal factors into a comprehensive framework.
This book will be an invaluable resource for practitioners, researchers and students in a wide range of professions involved in the care of depressed people—clinical psychologists, psychiatrists, psychiatric nurses, social workers and many others. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In Study 1, pleasant and unpleasant personality trait words and abstract nouns were encoded in neutral mood and recalled in either induced depressed or induced happy mood, using 32 female and 32 male undergraduates assigned in equal numbers to 1 of the 4 conditions. Females recalled more pleasant than unpleasant words when in a happy mood and more unpleasant than pleasant words when in a depressed mood. Males failed to show this effect. Both sexes responded equally well to the induction procedures. There were no sex differences in pleasantness ratings of the words to be recalled. A prediction that differential effects of mood on recall would be greater for trait words than abstract nouns was not confirmed. In Study 2, everyday usage ratings by 36 Ss from Study 1 were obtained for the trait words from Study 1. Females gave higher usage ratings than males and, within the females, usage predicted the extent to which a word was preferentially recalled in a congruent mood state. Findings are discussed in relation to the associative network model of mood and memory, sex differences in depression, and cognitive vulnerability to depression. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The scale uses the differential between vocabulary and abstract-thinking levels as an index of deterioration. It was standardized for mental age on 1046 normal individuals. Reliability coefficients, obtained from 322 army recruits, are as follows: vocabulary test .87, abstract-thinking test .89, both combined .92. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of this paper is to provide an overview of developments in the area of relapse prevention for selected psychological disorders: problem drinking; smoking; obesity; and depression. Relapse prevention methods, including booster sessions, have been associated with mixed outcomes, although there are some encouraging findings, particularly in the treatment of obesity and alcohol problems. A number of recommendations are made for research and/or clinical practice. In the treatment of alcohol problems it is recommended that more attention be paid to reducing co-existent marital problems and mood disorders. In obesity, there is a need for evaluations of intensive, long-term therapist contact with the severely obese, particularly those with serious medical problems. Studies of the complete relapse prevention approach advocated by Marlatt and Gordon (1985) are needed in the evaluation of smoking cessation programmes. It is concluded that maintenance of gains in smoking, obesity and problem drinking comes at a considerable cost in time and therapist contact. To date, there has been little application of relapse prevention methods to depression, and further empirical work is needed to identify the determinants of relapse and the efficacy of specific maintenance-enhancement strategies. Consistent themes in the prediction of relapse are identified, including low social support, ongoing interpersonal difficulties, and low self-efficacy.
Most people suffering from major depressive disorder experience chronic symptoms, recurrence, or both. We speculate on how the process of diagnosis and cognitive therapy may produce changes that, over time, can affect the view of the self. In clinical practice and research, some of the most challenging questions involve how best to identify and design strategies to help patients and clinicians reduce the chance that depressions recur. Related and equally challenging questions involve how best to increase the time between episodes and how to decrease the length of depressive episodes when prophylactic treatment does not prevent a relapse or recurrence. In this article we describe how we have used the continuation/maintenance phase of cognitive therapy for depression to achieve these goals. We illustrate these concepts and processes with one case history. © 1997 John Wiley & Sons, Inc.
Cognitive models of depression typically emphasize cognitive schemas as important variables in the depression process. To
date, evidence of these schemas is difficult to detect in remitted depressed individuals unless they have specifically been
activated by factors such as negative moods. The present study tested one aspect of schema activation, attentional allocation,
in individuals who had previously experienced a major depressive episode. Using a dichotic listening task to assess attention
to negative and positive stimuli, results indicated no differences in non-mood-primed subjects. For subjects who had been
primed by a negative mood induction, formerly depressed individuals evidenced greater error rates for both negative and positive
stimuli, while never-depressed subjects evidenced decreased error rates for negative and positive stimuli. These results appear
to suggest a schema activation process that is emotionally diffuse but unique to individuals at risk for depression.
Cognitive models of depression have nominated specific risk factors for symptom onset or recurrence of affective disorder. The variables identified in these accounts are largely psychological in nature and reflect attitudinal-, attributional-, or expectancy-based predispositions for interpreting the meaning of events in a patient 's life. This diathesis is typically inoperative in the course of normative information processing, but is reactivated in concert with specific life stress that roughly matches the circumstances in which this vulnerability was initially acquired. While this model of risk is pivotal for cognitive accounts of depression, in that it allows for a specification of outcomes beyond the acute episode of depression, early attempts to assess its empirical adequacy yielded findings that were either equivocal or disconfirming. More recently, however, data from studies that have been explicit in ensuring that the constructs to be tested were activated prior to assessment have been more supportive. The present review evaluates this growing body of work, attempts to clarify the nature of the priming procedures used to achieve construct activation, and highlights some of the theoretical difficulties associated with testing populations in recovery. Finally, specific recommendations for determining the adequacy of procedures for priming vulnerability variables are offered.
Increasing interest in the relation between emotion and cognition has led to the development of a range of laboratory methods for inducing temporary mood states. Sixteen such techniques are reviewed and compared on a range of factors including success rate, the possibility of demand effects, the intensity of the induced mood, and the range of different moods that can be induced. Three different cognitive models (self-schema theory, semantic network theory, and fragmentation theory) which have been successfully used to describe long-term mood states, such as clinical depression, are elaborated to describe the process of temporary mood induction. Finally, the use of mood induction is contrasted with alternative methods (such as the study of patients suffering from depression) for investigating emotion.
The first part of this book examines the problem of depression, evidence about it and answers previously offered in the literature. The second part describes the Interacting Cognitive Subsystems model (ICS), its advocacy of two levels of meaning and the way it addresses emotion. The third part examines how the model handles mood and memory effects. The fourth part of the book discusses ICS, negative thinking and the maintenance of depression. Part five deals with ICS, depression and psychological treatment and the concluding part raises some broader issues concerning the application of psychology theories in real world contexts.
According to the cognitive view, the individual's negative and distorted thinking is the basic psychological problem in the depressive syndrome. The distorted cognitions are supported by maladaptive cognitive schemata, which involve immature "either-or" rules of conduct or inflexible and unattainable self-expectations. These schemata are probably acquired early in development and, if uncritically carried into adulthood, serve to predispose the individual to depression. Since these schemata are long-term identifiable psychological patterns that influence attitude and behavioral responses, they may constitute a cognitive dimension of the depression-prone individual's personality. The authors discuss the treatment implications of the cognitive approach to depression.
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episodes of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.
Recent developments in psychophysics termed statistical decision theory (or signal detection theory; SDT) and magnitude estimation (ME) are being applied to an increasing variety of previously recalcitrant problems in clinical psychology and medical decision making. The SDT method separates human decision making into a discrimination accuracy measure and a criterion or bias measure. This characteristic is helpful in analyzing confusing situations such as pain assessment, where any number of procedures or manipulations can affect the S's willingness to report pain, but leave unaffected the detectability of pain-producing stimuli. ME methods applied to personality research do not limit an individual's assessment of his or her personal reactions (e.g., degree of anxiety or intoxication) to a range of categories devised by the experimenter but allow each person to construct as sensitive and unique a scale as is required. These methods also show superior agreement with psychophysiological measures of such factors. It is suggested that ME and SDT represent a significant advance over current practices in terms of their greater objectivity and precision, parsimonious use of a single language for the laboratory and the clinic, and potential for the quantification of subtle covert psychological behaviors. Applications of SDT and ME to the assessment and understanding of pain, anxiety, psychoactive drugs, and medical decision making are described. (97 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Early clinical observations and recent systematic studies overwhelmingly document a greater role for psychosocial stressors in association with the first episode of major affective disorder than with subsequent episodes. The author postulates that both sensitization to stressors and episode sensitization occur and become encoded at the level of gene expression. In particular, stressors and the biochemical concomitants of the episodes themselves can induce the protooncogene c-fos and related transcription factors, which then affect the expression of transmitters, receptors, and neuropeptides that alter responsivity in a long-lasting fashion. Thus, both stressors and episodes may leave residual traces and vulnerabilities to further occurrences of affective illness. These data and concepts suggest that the biochemical and anatomical substrates underlying the affective disorders evolve over time as a function of recurrences, as does pharmacological responsivity. This formulation highlights the critical importance of early intervention in the illness in order to prevent malignant transformation to rapid cycling, spontaneous episodes, and refractoriness to drug treatment.
Patients successfully treated during a 3-month period with either imipramine hydrochloride pharmacotherapy, cognitive therapy, or combined cognitive-pharmacotherapy were monitored during a 2-year posttreatment follow-up period. Half of the patients treated with pharmacotherapy alone continued to receive study medications for the first year of the follow-up. All other patients discontinued treatment at the end of the acute treatment phase. Patients treated with cognitive therapy (either alone or in combination with medication) evidenced less than half the rate of relapse shown by patients in the medication--no continuation condition, and their rate did not differ from that of patients provided with continuation medication. It appears that providing cognitive therapy during acute treatment prevents relapse. Whether this preventive effect extends to recurrence remains to be determined.
Remitted depressed subjects (N = 59) were followed longitudinally to determine whether dependent or self-critical persons are more vulnerable to relapse after exposure to life events that have a bearing on interpersonal or achievement concerns. Regression analyses indicated that congruency effects, as measured by the occurrence of achievement-related adversity in the lives of self-critical subjects, accounted for a significant increment in relapse variance over each variable entered singly. When data from the 2 months just before relapse were analyzed, some evidence of congruency effects in dependent subjects experiencing interpersonal-related adversity was obtained. These findings highlight the dimensional qualities of life even impact and call for greater differentiation in modeling the activation of a diathesis and precipitation of depression after life stress.
In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.
Studies of relapse after recovery from unipolar depression are reviewed. Methodological deficiencies identified include (a) inadequate definitions of recovery and relapse; (b) incomplete descriptions of the samples; (c) inadequate inclusion and exclusion criteria; and (d) inadequate data analyses that do not take into account the changing composition of samples over follow-up. Despite the methodological problems, it is tentatively concluded that relapse after recovery from unipolar depression is frequent but less likely to occur the longer a person stays well and that relapse is more likely with a history of depressive episodes, recent stress, lack of social support, or persistent neuroendocrine dysregulation after recovery. Demographic variables that have consistently failed to demonstrate an association with relapse include gender, marital status, and socioeconomic status. Prevention of relapse with maintenance therapy is discussed, and recommendations for research on relapse are proposed.
This article provides a critical review of the empirical literature on the role of depression and elation in biasing mnemonic processing. Two classes of effects—state dependence and mood congruence—are examined. The latter, which involves the enhanced encoding and/or retrieval of material the affective valence of which is congruent with ongoing mood, is the more extensively researched of the two and is thus the focus of much of the present review. Though the support for claims of such a phenomenon is impressive in its size, consistency, and diversity, a number of questions remain. These include whether such effects are linked to mood states per se, and the possible role that such effects may play in the development of persistent depression.