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Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings
Abstract
In this review paper a modified cognitive neurophysiological model of Aaron T. Beck's cognitive formulation of anxiety and depression is proposed that provides an elaborated account of the cognitive and neural mediational processes of cognitive therapy (CT). Empirical evidence consistent with this model is discussed that indicates the effectiveness of cognitive therapy could be associated with reduced activation of the amygdalohippocampal subcortical regions implicated in the generation of negative emotion and increased activation of higher-order frontal regions involved in cognitive control of negative emotion. Future cognitive neuroscience research is needed on the unique brain substrates affected by CT and their role in facilitating symptom change. This future research would have important implications for improving the efficiency and efficacy of this treatment approach.
... They are also related to lower mindfulness in teaching among early years educators (Cheng et al., 2020;Ma et al., 2021). According to cognitive theory of anxiety and depression (Clark & Beck, 2010), when teachers experience greater teacher stress and psychological distress, they are more likely to be preoccupied with negative thoughts, judgment, worries, and rumination (Agyapong et al., 2022;Clark & Beck, 2010;Constantin et al., 2018), thereby undermining their quality of teaching (Sandilos et al., 2015). Consequently, wellness programs have been developed to enhance teachers' mental health, self-regulation, sleep quality, and other areas of functioning (e.g., Lever et al., 2017). ...
... They are also related to lower mindfulness in teaching among early years educators (Cheng et al., 2020;Ma et al., 2021). According to cognitive theory of anxiety and depression (Clark & Beck, 2010), when teachers experience greater teacher stress and psychological distress, they are more likely to be preoccupied with negative thoughts, judgment, worries, and rumination (Agyapong et al., 2022;Clark & Beck, 2010;Constantin et al., 2018), thereby undermining their quality of teaching (Sandilos et al., 2015). Consequently, wellness programs have been developed to enhance teachers' mental health, self-regulation, sleep quality, and other areas of functioning (e.g., Lever et al., 2017). ...
... For instance, early years practitioners may practice intrapersonal mindfulness by pausing and noticing their own judgments and emotions (e.g., anger), and then transition into the practice of interpersonal mindfulness by skilfully responding to a child's misbehavior. In the face of elevated psychological distress, however, practitioners may be less attentive to the present moment, have more judgments, and be more preoccupied with their negative experience (Clark & Beck, 2010). As a result, they may be less mindful at work in the early years context (Cheng et al., 2020;Ma et al., 2021). ...
This study investigated the relationship between compassion and mindfulness in teaching among early years practitioners, with low levels of psychological distress as a mediator. A total of 81 early years practitioners were recruited from the United Kingdom via mass emails and announcements on social media platforms. Findings based on path analysis indicated that lower psychological distress mediated the positive relation between compassion and intrapersonal mindfulness in teaching, after controlling for level of education, years of practice, and role of practitioner. More specifically, compassion was related to psychological distress, intrapersonal mindfulness, and interpersonal mindfulness in teaching, whereas psychological distress was related to intrapersonal mindfulness, but not interpersonal mindfulness in teaching. The present findings inform early years practitioners and researchers of a differential chain of processes between compassion, psychological distress, and mindfulness in teaching.
... These biases include selective attention to perceived threats, overestimation of the probability and severity of negative social outcomes, and biased interpretation of ambiguous social cues. Cognitive biases reinforce and maintain anxious thoughts and feelings for socially anxious individuals (Clark and Beck, 2010;Beck, 1979). ...
... Understanding how anxiety developed in the social context is important for the detection and intervention of social anxiety symptoms. Anxiety merged during social interaction can have a negative effect on social functioning (Stein and Stein, 2008;Clark and Beck, 2010). Taking the cognitive perspective, individuals prone to anxiety often have negatively biased beliefs, which can increase the likelihood of making erroneous judgments (Beck, 1979;Clark and Beck, 2010). ...
... Anxiety merged during social interaction can have a negative effect on social functioning (Stein and Stein, 2008;Clark and Beck, 2010). Taking the cognitive perspective, individuals prone to anxiety often have negatively biased beliefs, which can increase the likelihood of making erroneous judgments (Beck, 1979;Clark and Beck, 2010). Meanwhile, anxiety has been characterized as intolerance of uncertainty (Bishop, 2007;Aylward et al., 2019), which echoes studies identified that impaired adaptive learning abilities were prevalent in anxious individuals (Lamba et al., 2020;Hein et al., 2021). ...
... The cognitivebehavioral model of posttraumatic stress disorder posits that trauma survivors' negative, internal, stable appraisals about the cause (e.g., blaming their own character) and subsequent effects of trauma (e.g., fearing of social judgment), and their maladaptive (e.g., avoidance) coping, may underpin the development of posttraumatic stress symptoms (Ehlers and Clark, 2000;Budden, 2009). From a cognitive perspective, negative, character-based appraisals may also be relevant for depressive symptoms that develop following trauma exposure (Clark and Beck, 2010), and rumination and worry about such appraisals, thought to be a strategy to avoid aversive emotions (i.e., avoidance coping), may be relevant for general anxiety symptoms arising following trauma (Rutter and Brown, 2017). As such, there may be indirect links of AISA with posttraumatic stress, general anxiety, and depressive symptoms, through multiple AISA stigmarelated cognitive and behavioral mechanisms including self-blame appraisals, shame (appraisals regarding social condemnation), and maladaptive coping (low self-compassion, fear of self-compassion). ...
... Informed by cognitive-behavioral models (Ehlers and Clark, 2000;Clark and Beck, 2010), we aimed to ascertain the unique mediating effects of shame, low self-caring, high self-coldness, fear of selfcompassion, characterological and behavioral self-blame in the links of AISA with posttraumatic stress, general anxiety, and depressive symptoms by testing these mediators simultaneously. Posttraumatic stress, general anxiety, and depressive symptoms were also tested simultaneously to explore potential differential associations for each, because they may be comorbid but separable responses to AISA (Gong et al., 2019;Strickland et al., 2019). ...
... AISA survivors may also use worry and ruminative processes, both of which characterize general anxiety, to avoid shame, potentially explaining how shame may contribute to more severe AISA-related general anxiety symptoms (Cândea and Szentagotai-Tătar, 2018). Shame may explain the links between AISA and more severe depressive symptoms through shamerelated appraisals involving fear of social judgement, which may have negative implications for their sense of self, a central component of depression (Clark and Beck, 2010). Within cognitive-behavioral models of trauma, appraisals precede emotional responses, indicating the emotional component of shame may be most proximal to our outcomes; this is one possible reason why shame was the strongest mechanism in this study, consistent with Bhuptani and Messman (2023). ...
Introduction
Alcohol-involved sexual assault (AISA) survivors who were drinking at the time of the assault may be at risk of internalizing victim-blaming myths and stigma. Cognitive-behavioral models posit the link between AISA and negative emotional outcomes may be explained through maladaptive appraisals and coping – i.e., characterological and behavioral self-blame, shame, low self-compassion (i.e., high self-coldness, low self-caring), and fear of self-compassion.
Methods
Using a cross-sectional design and community sample of younger adults (N = 409 Canadians, M = 28.2 years old, 51.3% women), we examined these mechanisms’ unique effects in mediating the associations between AISA and posttraumatic stress, general anxiety, and depressive symptoms, respectively.
Results
In terms of gender differences, AISA was more common, self-coldness higher, and general anxiety symptoms more frequent in women, and fear of self-compassion was higher in men. Using structural equation modeling that controlled for gender and the overlap between outcomes, shame emerged as the strongest mediator linking AISA with all emotional outcomes. Fear of self-compassion also partially mediated the AISA-posttraumatic stress symptom association, self-coldness partially mediated the AISA-general anxiety symptom association, and characterological self-blame fully mediated the AISA-depressive symptom association.
Conclusion
Avoidance-based processes, ruminative−/worry-based cognitions, and negative self-evaluative cognitions may be distinctly relevant for AISA-related posttraumatic stress, general anxiety, and depressive symptoms, respectively, after accounting for the overarching mediation through shame. These internalized stigma-related mechanisms may be useful to prioritize in treatment to potentially reduce AISA-related negative emotional outcomes, particularly for AISA survivors with posttraumatic stress, general anxiety, and/or depressive symptoms.
... The average IQ (intellectual quotient) in men is 40-50, while women are usually less affected as they present a second unaffected copy of the X chromosome. A characteristic cognitive-behavioral phenotype is also recognisable: the 80% of males and the 40% of females meet criteria for attention-deficit hyperactivity disorder (ADHD), while anxiety is present in the 58%-86% of individuals [9]; obsessive-compulsive disorder has been also reported [9]. Other behavioural features include hypersensitivity to stimulation, social gaze avoidance and aggression; language deficits both in comprehension and in production are also common [23]. ...
... The average IQ (intellectual quotient) in men is 40-50, while women are usually less affected as they present a second unaffected copy of the X chromosome. A characteristic cognitive-behavioral phenotype is also recognisable: the 80% of males and the 40% of females meet criteria for attention-deficit hyperactivity disorder (ADHD), while anxiety is present in the 58%-86% of individuals [9]; obsessive-compulsive disorder has been also reported [9]. Other behavioural features include hypersensitivity to stimulation, social gaze avoidance and aggression; language deficits both in comprehension and in production are also common [23]. ...
... Other behavioural features include hypersensitivity to stimulation, social gaze avoidance and aggression; language deficits both in comprehension and in production are also common [23]. Furthermore, children and adults with FXS exhibit impairment in different domains of adaptive functioning, which can be considered as the ability to cope with everyday environmental demands and to live independently [12,9]. ...
Background and objectives:
Fragile X Syndrome (FXS) is the most common cause of inherited intellectual disability, caused by CGG-repeat expansions (> 200) in the FMR1 gene leading to lack of expression. Espansion between 55 and 200 triplets fall within the premutation range (PM) and can lead to different clinical conditions, including fragile X- primary ovarian insufficiency (FXPOI), fragile X-associated neuropsychiatric disorders (FXAND) and fragile X-associated tremor/ataxia syndrome (FXTAS). Although there is not a current cure for FXS and for the Fragile X-PM associated conditions (FXPAC), timely diagnosis as well as the implementation of treatment strategies, psychoeducation and behavioral intervention may improve the quality of life (QoL) of people with FXS or FXPAC. With the aim to investigate the main areas of concerns and the priorities of treatment in these populations, the Italian National Fragile X Association in collaboration with Bambino Gesù Children's Hospital, conducted a survey among Italian participants.
Method:
Here, we present a survey based on the previous study that Weber and colleagues conducted in 2019 and that aimed to investigate the main symptoms and challenges in American individuals with FXS. The survey has been translated into Italian language to explore FXS needs of treatment also among Italian individuals affected by FXS, family members, caretakers, and professionals. Furthermore, we added a section designated only to people with PM, to investigate the main symptoms, daily living challenges and treatment priorities.
Results:
Anxiety, challenging behaviors, language difficulties and learning disabilities were considered the major areas of concern in FXS, while PM was reported as strongly associated to cognitive problems, social anxiety, and overthinking. Anxiety was reported as a treatment priority in both FXS and PM.
Conclusion:
FXS and PM can be associated with a range of cognitive, affective, and physical health complications. Taking a patient-first perspective may help clinicians to better characterize the cognitive-behavioral phenotype associated to these conditions, and eventually to implement tailored therapeutic approaches.
... The evaluations individuals make about their relationships also play a role in maintaining their relationships. Emerging adults can critically evaluate their romantic relationships and whether the qualities and experiences of their romantic partners meet their own needs for closeness and commitment (Clark & Beck, 2010). As a result of the evaluations made, a series of thoughts that are constantly repeated in the minds of individuals may occur, and this situation is addressed with the concept of "rumination". ...
... Bireylerin ilişkileri hakkında yaptıkları değerlendirmeler de ilişkilerinin sürdürülmesinde etken olmaktadır. Beliren yetişkinler, romantik ilişkilerini eleştirel bir gözle değerlendirebilmekte ve romantik partnerlerinin nitelikleri ile deneyimlerinin kendi yakınlık ve bağlılık ihtiyaçlarını karşılayıp karşılamadığını ele alabilmektedirler (Clark ve Beck, 2010). Yapılan değerlendirmeler sonucu bireylerin zihninde sürekli tekrar eden bir dizi düşünce oluşabilmekte ve bu durum "ruminasyon" kavramıyla ele alınmaktadır. ...
Bu araştırmanın amacı, Senkans ve diğerleri (2015) tarafından geliştirilen “İlişkisel Ruminasyon Ölçeği”nin Türkçe’ye uyarlama, geçerlik ve güvenirlik çalışmasını yapmaktır. Araştırma Dokuz Eylül Üniversitesi lisans düzeyinde öğrenim gören gönüllü 161 kız (%52.8), 159 (%47.2) erkek öğrenci olmak üzere toplamda 320 katılımcı ile yürütülmüştür. Çalışma kapsamında öncelikle ölçeğin dil geçerliği incelenmiştir. Dil geçerliği çalışmasından sonra Doğrulayıcı Faktör Analizi (DFA) ile ölçeğin üç faktörlü yapısı incelenmiştir. Doğrulayıcı faktör analizi sonuçları, İlişkisel Ruminasyon Ölçeği’nin üç faktörlü yapısının doğrulandığını göstermiştir. Ölçeğin benzer ölçekler geçerliğini belirlemek için “Perseveratif Düşünce Ölçeği”nin alt boyutları ölçüt olarak kullanılmıştır. Ölçeğin güvenirliğini test etmek için test-tekrar test güvenirlik katsayısı ve iç tutarlılık katsayısından yararlanılmıştır. Ölçeğin Cronbach Alpha güvenirlik katsayısı romantik ilişki meşguliyeti ruminasyonu alt ölçeği için 0.81, ilişki belirsizliği ruminasyonu alt ölçeği için 0.80, ayrılma ruminasyonu alt ölçeği için 0.76 olarak hesaplanmıştır. Sonuç olarak elde edilen tüm bulgular, İlişkisel Ruminasyon Ölçeği’nin beliren yetişkinlerde geçerli ve güvenilir bir ölçme aracı olarak kullanılabileceğini göstermiştir.
... The CBT-based positive self-a rmation intervention is based on the combination of an integral aspect of CBT (cognitive restructuring) and self-a rmation theory (positive self-a rmation). CBT-based positive self-a rmations is a structured, collaborative therapeutic method aimed at teaching distressed individuals to recognize, examine, and modify faulty thoughts into more positive ones (Clark & Beck, 2010), and repeat those positive thoughts frequently to improve one's thoughts, feelings, and behaviors. In CBT-based positive self-a rmations, psychoeducation plays an important role, along with several phases of cognitive restructuring, including describing the situation, identifying the negative thoughts that transpired during the situation, identifying emotions that occur when experiencing these thoughts, discovering distorted thoughts or misconceptions that may be present in each thought, contesting each thought, and creating reasonable responses. ...
... The scale ranges from 12 to 48, with a greater score indicating an increased hope. Participants' perceptions of hope were classi ed into three categories: low (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), medium (31)(32)(33)(34)(35), and high (36-48). Participants who scored below 35 were quali ed to be included in this study. ...
This nine-week AB single case research study evaluated the degree to which CBT-based positive self-affirmations helped childhood sexual abuse (CSA) survivors increase their perceptions of hope and self-esteem. Participants included five females and one male, aged 24 to 46 years ( N = 6). CBT-based positive self-affirmations were effective in increasing hope perceptions in three participants, as well as self-esteem perceptions in another three participants with statistically significant improvement ( p < 0.05). The results of this study support the idea that CBT-based positive self-affirmations may be an effective intervention for CSA survivors. Implications and recommendations for counselors working with CSA survivors are discussed.
... Notably, gold-standard psychological treatments for these disorders explicitly teach regulatory strategies to patients to help them modify their affective experiences and reduce symptoms. For example, cognitive therapy for depression teaches cognitive reappraisal, which is an explicit and controlled affect regulation strategy (Clark and Beck, 2010). Exposure therapy, by contrast, aims to expose patients to feared but safe stimuli, which allows for extinction learning to occur (Craske and Mystkowski, 2006) -a more implicit regulation process. ...
... Sleep and cognitive reappraisal: One of the most well-studied explicit-controlled affect regulation strategy is cognitive reappraisal, L.D. Straus et al. which is when one consciously tries to reinterpret the situation that evoked an affective response to change affect (e.g., "My colleague is not angry with me but just tired"). This affect regulation strategy is particularly relevant in clinical contexts because cognitive distortions are common across mental health disorders (Yurica & DiTomasso, 2005) and because cognitive therapy is an intervention that deliberately teaches cognitive reappraisal to help address cognitive and affective symptoms of these disorders (Clark and Beck, 2010). ...
Impairments in sleep and affect regulation are evident across a wide range of mental disorders. Understanding the sleep factors that relate to affect regulatory difficulties will inform mechanistic understanding and aid in treatment. Despite rising interest, some research challenges in this area include integrating across different clinical and non-clinical literatures investigating the role of sleep architecture (measured with polysomnography) and experimentally manipulated sleep, as well as integrating more explicit versus implicit affect regulation processes. In this comprehensive review, we use a unifying framework to examine sleep's relationship with implicit-automatic regulation and explicit-controlled regulation, both of which are relevant to mental health (e.g., PTSD and depression). Many studies of implicit-automatic regulation (e.g., fear extinction and safety learning) demonstrate the importance of sleep, and REM sleep specifically. Studies of explicit-controlled regulation (e.g., cognitive reappraisal and expressive suppression) are less consistent in their findings, with results differing depending on the type of affect regulation and/or way that sleep was measured or manipulated. There is a clear relationship between objective sleep and affect regulation processes. However, there is a need for 1) more studies focusing on sleep and explicit-controlled affect regulation; 2) replication with the same types of regulation strategies; 3) more studies experimentally manipulating sleep to examine its impact on affect regulation and vice versa in order to infer cause and effect; and 4) more studies looking at sleep's impact on next-day affect regulation (not just overnight change in affect reactivity).
... Cognitive restructuring, a core technique of cognitivebehavioral therapy (CBT), offers a promising approach to addressing the irrational beliefs that undermine selfconfidence. This therapeutic technique involves identifying, challenging, and modifying negative thought patterns, thereby fostering more adaptive and constructive beliefs (Clark & Beck, 2010, 2012. By helping individuals reframe their negative perceptions, cognitive restructuring promotes emotional regulation, increases self-efficacy, and facilitates positive behavioral changes (Molero-zafra et al., 2022). ...
Adolescents often struggle with low self-confidence, exacerbated by negative thought patterns and irrational beliefs that hinder their social and emotional development. This study explores the effectiveness of cognitive restructuring, a core component of cognitive-behavioral therapy (CBT), in enhancing self-confidence among adolescents. The intervention focused on identifying, challenging, and replacing negative thoughts with constructive alternatives. A single-subject case study design was employed, with pretest and posttest measures on the Self-Confidence Scale to assess changes. Results indicated a significant increase in self-confidence scores, from 72 (low confidence) to 97 (moderate confidence). Qualitative data revealed behavioral improvements, such as reduced hesitation in social interactions and increased willingness to express opinions. The subject's belief in irrational thoughts, like fearing social judgment, was reduced, demonstrating cognitive restructuring’s role in shifting negative perceptions. This study highlights the transformative potential of cognitive counseling in fostering adolescent self-confidence. By addressing irrational beliefs and encouraging adaptive thinking, cognitive restructuring not only improved the subject’s self-esteem but also promoted positive social behavior. These findings align with existing literature, emphasizing the value of CBT-based interventions in promoting mental well-being. The study underscores the importance of integrating cognitive restructuring techniques into educational and counseling programs to support adolescents facing self-confidence challenges. However, its single-case design limits generalizability, warranting further research with larger, diverse samples. This approach offers a promising pathway for practitioners to help adolescents develop resilience and a healthier self-concept.
... Na podstawie taksonomii poznawczej, modele depresji zostały podzielone na trzy główne oparte na podejściach: przetwarzaniu informacji, poznaniu społecznym oraz modelu poznawczo-behawioralnym i tak zostaną zaprezentowane. Każde z tych podejść koncentrowało się na różnych aspektach konstruktów poznawczych, takich jak struktura systemu poznawczego, operacje poznawcze czy wytwory poznawcze (Popiel i in., 2022;Pużyński, 2009 (Clark i Beck, 2010;Golonka i in., 2024). Według tej 20 teorii, to wczesne negatywne doświadczenia mogą prowadzić do ukształtowania trwałych, dysfunkcyjnych przekonań i schematów poznawczych, które zwiększają podatność jednostek na wystąpienie depresji (Popiel i in., 2022;Radziwiłłowicz, 2018). ...
This work evaluates the impact of a bibliotherapeutic intervention based on cognitive – behavioral
therapy principles on the mental health of Polish individuals residing in Norway. The research employed
a mixed – methods approach combining qualitative analysis – through partially structured interviews with
participants and observations within the emigrant environment – with quantitative measures using
standardized psychometric tests (PSS – 10, BDI – II, STAXI – 2) administered to an experimental group
(n = 5) and a control group (n = 103). Results indicate a potential reduction in depressive symptoms
following the intervention, alongside increased emotional awareness, enhanced anger regulation, and
decreased stress levels. Qualitative findings further revealed that bibliotherapy facilitated improved
recognition and reinterpretation of negative thought patterns, contributing to an elevated sense of self –
worth and more effective adaptation to life in emigration. These findings suggest that the intervention
represents a promising self – help tool for supporting migrant mental health; however, further studies
involving larger samples are necessary to fully validate the observed effects.
Streszczenie
Praca koncentruje się na ocenie wpływu interwencji biblioterapeutycznej opartej na założeniach terapii
poznawczo-behawioralnej na zdrowie psychiczne osób polskiego pochodzenia mieszkających w
Norwegii. Badania przeprowadzono łącząc analizę jakościową – opartą na częściowo
ustrukturyzowanych wywiadach z uczestniczkami oraz obserwacjach w środowisku emigracyjnym – z
podejściem ilościowym wykorzystującym standaryzowane testy psychometryczne (PSS-10, BDI-II,
STAXI-2) w grupie badanej (n = 5) oraz kontrolnej (n = 103). Wyniki wskazują na możliwą tendencję do
redukcji objawów depresyjnych po zastosowaniu interwencji, przy jednoczesnym wzroście świadomości
emocjonalnej oraz poprawie zdolności do regulacji złości i obniżeniu stresu. Analiza jakościowa
ujawniła, że biblioterapia umożliwiła uczestniczkom lepsze rozpoznanie i reinterpretację negatywnych
schematów myślowych, co przełożyło się na wzrost poczucia własnej wartości i skuteczniejszą adaptację
do warunków życia na emigracji. Wnioski z pracy sugerują, iż interwencja ta stanowi obiecujące
narzędzie wsparcia samopomocowego w zakresie zdrowia psychicznego migrantów, jednakże dalsze
badania na większych próbach są konieczne w celu pełnej weryfikacji uzyskanych efektów.
... For instance, according to Beck's cognitive theory, depression stems from distorted thinking patterns, particularly negative beliefs about oneself, the world, and the future (Beck et al., 1979;Beck, 2008). Indeed, over the past decades, research consistently revealed biases in beliefs as a mechanism underlying depression and its maintenance (Clark & Beck, 2010;Dozois & Beck, 2008;Gagne et al., 2022). These theories guided assessment, intervention, and prevention efforts in depression (Disner et al., 2011;Hollon et al., 2002;Young et al., 2008). ...
Background
Prior studies have found that depression is linked to alterations in belief updating, but the effect size of this association was heterogeneous and unclear. This preregistered systematic review and meta-analysis examines studies that measured depressive symptoms and alterations in belief updating, in both updating-to-positive and updating-to-negative information directions. Method
The PsycINFO, MEDLINE, Embase, Web of Science and Cochrane Library electronic databases were searched for studies examining belief updating and depressive symptomatology, resulting in retrieval of 33 papers (N = 3431 individuals). Risk of bias was assessed using an adapted version of the Downs and Black checklist and risk for publication bias was assessed visually with funnel plots, as well as statistically with Egger’s test and Duval and Tweedie’s trim-and-fill procedure. Random effects models were used for calculating pooled effect sizes.ResultsWe found evidence for a small, significant association (r = -0.11) between depressive symptoms and deficits in updating-to-positive information, but not for updating-to-negative information. Heterogeneity in both models was low. Exploratory subgroup analyses pointed to significant differences in the updating-to-positive direction based on the paradigm used, but this was not significant in the updating-to-negative direction. There were few concerns regarding the risk of bias and no evidence suggesting publication bias. Conclusions
Depression is linked to a specific deficit in updating beliefs in response to positive, disconfirming information, whereas no association was found with updating beliefs in response to negative information.
... For example, cognitive behavioral therapy (CBT) could effectively challenge pessimistic future expectations and mitigate guilt sensations. 80 Support groups or family therapy could assist in regulating nervousness and offer a secure environment for students to articulate their apprehensions and anxieties. Additionally, physical activity programs could be beneficial in alleviating motor symptoms and improving overall mental well-being. ...
Purpose
Network analysis is a statistical method that explores the complex interrelationships among variables by representing them as nodes and edges in a network structure. This study aimed to examine the interconnections between family functioning, anxiety, and depression among vocational school students through network analysis approach.
Participants and Methods
A sample of 2728 higher vocational school students participated in a survey utilizing the Family APGAR Index Questionnaire (APGAR), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Meanwhile, a network analysis was conducted to investigate the interrelationships between family functioning, anxiety, and depression symptoms among the higher vocational school students.
Results
The network analysis revealed that node APGAR2 (“Partnership”) exhibited the highest strength, followed by node GAD5 (“Restlessness”); node GAD7 (“Negative future anticipation”), PHQ9 (“Suicidal ideation”), and PHQ6 (“Guilty”) were bridge nodes linking family functioning, anxiety and depressive symptoms in the sample. The results of the Network comparisons test between male and female indicated that the edge weights and global strength did not exhibit a statistically significant difference.
Conclusion
These results emphasized that certain anxiety symptoms and family functioning nodes are more central than others, and thus play a more critical role in the family functioning-anxiety-depression network, which highlight potential targeting symptoms to be considered in future interventions.
... For example, we argue that it might help in understanding mechanisms of change during treatment. For quite a few existing therapeutic strategies that appear to be at least moderately successful, mechanisms of change are not completely understood (e.g., cognitive behavioral therapy, CBT; [66], [67]). The apparent success of CBT might be understood as an attempt at reducing strong connectivity (e.g., by challenging a patient's irrational assumptions) between certain symptoms (e.g., between depressed mood and suicidal thoughts), or even breaking the connections altogether. ...
In this paper, we characterize major depression (MD) as a complex dynamical system in which symptoms (e.g., insomnia and fatigue) are directly connected to one another in a network structure. We hypothesize that individuals can be characterized by their own network with unique architecture and resulting dynamics. With respect to architecture, we show that individuals vulnerable to developing MD are those with strong connections between symptoms: e.g., only one night of poor sleep suffices to make a particular person feel tired. Such vulnerable networks, when pushed by forces external to the system such as stress, are more likely to end up in a depressed state; whereas networks with weaker connections tend to remain in or return to a healthy state. We show this with a simulation in which we model the probability of a symptom becoming active as a logistic function of the activity of its neighboring symptoms. Additionally, we show that this model potentially explains some well-known empirical phenomena such as spontaneous recovery as well as accommodates existing theories about the various subtypes of MD. To our knowledge, we offer the first intra-individual, symptom-based, process model with the potential to explain the pathogenesis and maintenance of major depression.
... Geringere Erziehungskompetenzen oder ein dysfunktionaleres Erziehungsverhalten, etwa bei depressiven Eltern, werden von vielen anderen Studien bereits belegt [10][11][12][13]. Des Weiteren stimmen die hier belegten Zusammenhänge mit den schon früh postulierten [17] und später auch durch neurobiologische Befunde unterstützten [34] Zusammenhängen zwischen Depression und Angststörungen und deren Einfluss auf negative Kognitionen überein. Negative Kognitionen umfassen neben der negativen Sicht der Welt und der Zukunft auch eine negative Sicht auf das Selbst. ...
Zusammenfassung
Hintergrund
Ein psychisch belastetes Familienumfeld kann ein Risiko für die gesunde und altersgerechte Entwicklung von Säuglingen und Kleinkindern darstellen. Ungeklärt ist, wie weit psychische Belastungen aktuell in der Gesamtpopulation von Eltern mit kleinen Kindern verbreitet sind und ob der Anteil psychisch belasteter Eltern in den zurückliegenden Jahren multipler gesellschaftlicher Krisen angestiegen ist. Zudem ist unklar, wie sich Zusammenhänge zwischen der psychischen Belastung der Eltern, deren Erziehungskompetenzen sowie der frühkindlichen Entwicklung aktuell darstellen.
Methoden
In der bundesweiten, repräsentativen Befragung „Kinder in Deutschland – KiD 0–3 2022“ dokumentierten 258 Kinderärztinnen und -ärzte im Rahmen einer Vorsorgeuntersuchung die Entwicklung von 7818 Säuglingen und Kleinkindern. Die Eltern der Kinder beantworteten u. a. Fragen zu ihren psychischen Belastungen (Angst und Depressivität) und ihren Erziehungskompetenzen. Die Prävalenzen von 2022 wurden mit Ergebnissen der Vorgängerstudie aus dem Jahr 2015 verglichen.
Ergebnisse
2022 berichtete etwa ein Fünftel aller Eltern (21,5 %) eine moderate bis klinisch bedeutsame psychische Belastung (2015: 15,7 %). Psychisch belastete Eltern äußerten signifikant häufiger Zweifel an der eigenen elterlichen Kompetenz als Eltern ohne psychische Belastung. Ärztinnen und Ärzte dokumentierten bei Kindern, deren Eltern klinisch bedeutsame psychische Belastungen berichteten, signifikant häufiger Hinweise auf eine Regulationsstörung und eine Entwicklungsverzögerung.
Diskussion
Die Ergebnisse verdeutlichen die in den letzten Jahren zunehmende Relevanz psychischer Belastungen bei Eltern mit kleinen Kindern. Der Befund, dass psychische Belastungen der Eltern mit kindlichen Entwicklungsstörungen einhergehen, verdeutlicht einmal mehr die Notwendigkeit, Familien von Beginn an gezielt zu unterstützen.
... Second, according to the neurophysiological model, depression is linked to various functional and structural brain abnormalities, primarily characterized by dysregulation of the hypothalamic-pituitary-adrenal axis and diminished monoamine neurotransmission. These alterations can negatively impact cognitive function, emotional processing, and behavioral performance (Clark & Beck, 2010;Palazidou, 2012). There is strong empirical evidence supporting the connection between depressive symptoms and cognitive impairment in older adults (e.g., Donovan et al., 2017;Gatchel et al., 2019). ...
Although the link between mental health issues and physical functioning is established, research on the patterns of depression trajectories and their long-term impact on functional disabilities in middle-aged and older individuals remains scarce. This study leverages four waves of data from middle-aged and older Chinese adults to investigate how different trajectories of depression affect functional disabilities. Data from four waves of the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018), encompassing 3,126 participants aged 45 and older at baseline, were analyzed. Growth mixture modeling identified distinct patterns of depression trajectories. Bivariate and multivariable linear regression analyses were then applied to examine the long-term effects of these depression trajectories on functional disabilities. Depression trajectories among participants were categorized into four groups: persistently severe (7.7%), increasing (18.6%), decreasing (15.1%), and stable asymptomatic (58.6%). All observed relationships between depression trajectories and functional disabilities were statistically significant. Specifically, those with persistently severe, increasing, or decreasing depressive symptoms reported greater functional disabilities compared to stable asymptomatic individuals. Notably, respondents with increasing or decreasing depressive symptoms showed fewer functional disabilities than those with persistently severe symptoms, with decreasing symptoms associated with lesser disabilities than increasing symptoms. Clinical practitioners and social workers need to intensify efforts to alleviate the impact of chronic depression on daily functioning among middle-aged and older adults. Public health policymakers should prioritize resource allocation towards those with persistently severe depression and functional disabilities in this age group.
... Poor sleep quality can lead to increased irritability (40,41), reduced cognitive function (42), and a diminished ability to cope with Frontiers in Public Health 09 frontiersin.org stress (43,44), all of which can heighten anxiety (45)(46)(47). Conversely, improving sleep quality can enhance mood, cognitive function, and stress resilience, potentially mitigating anxiety symptoms. These findings underscore the importance of addressing sleep quality as a therapeutic target in this population. ...
Introduction
Visual impairment, encompassing low visual acuity and visual field loss, significantly impacts the older adult population worldwide, leading to increased disability and mortality risks. Recent studies suggest a strong association between visual impairment and anxiety, particularly among older adults. This study aims to explore the relationship between visual impairment and anxiety symptoms in older adult individuals in China, and to investigate potential mediating factors.
Methods
Data for this study were derived from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,702 participants aged 65 and older. Visual impairment was assessed through self-reported visual function, while anxiety symptoms were measured using the 7-item Generalized Anxiety Disorder scale (GAD-7). Additional assessments included sleep quality and duration, exercise status, and dietary diversity. Logistic regression models and mediation analysis were employed to explore associations and mediating effects.
Results
The findings indicate that visual impairment is significantly associated with increased anxiety symptoms among the older adult (OR = 1.51, 95% CI: 1.32–1.72, p < 0.001). Mediation analysis revealed that sleep quality, dietary diversity score (DDS), and plant-based DDS significantly mediated the relationship between visual impairment and anxiety. In contrast, sleep duration, exercise, and animal-based DDS did not show significant mediating effects.
Conclusion
Visual impairment is a crucial predictor of anxiety symptoms in the older adult. Improving sleep quality and promoting a diverse plant-based diet may mitigate anxiety symptoms in this population. Interventions targeting these areas could enhance the mental health and quality of life of older adult individuals with visual impairment.
... Currently, there are various treatments for cognitive dysfunction, including gene therapy (Manfredi-Lozano et al. 2022), immunotherapy (Patel et al. 2021), Chinese medicine (Zheng et al. 2021;Ding et al. 2022) and psychotherapy (Rostamzadeh et al. 2022). Although the above treatments are effective in improving cognitive function, there are side effects such as Invasive injury (Lee et al. 2019), toxicity (Constantinidou et al. 2019), Negative emotion (Clark and Beck 2010). Nowadays, exercise is widely used to prevent and treat a variety of disorders, including psychiatric, metabolic, cardiovascular, and pulmonary diseases (Pedersen and Saltin 2015;Li et al. 2023). ...
Background
Morphine withdrawal leads to serious cognitive deficits in which dynorphins are directly involved. Recently, exercise has been shown to prevent and improve cognition dysfunction in a variety of ways. Meanwhile, exercise can regulate the endogenous opioid peptides including dynorphins. However, it remains unclear whether exercise influences cognitive dysfunction caused by morphine withdrawal via dynorphins. In the current study, we investigate the physiological mechanism of exercise prevention and improvement aganist cognition dysfunction caused by morphine withdrawal.
Methods
Male, adult C57BL/6 mice were randomly divided into 5 groups : Saline control (WT), exercise (EXE), morphine withdrawl (MW), exercise + morphine withdrawl (EMW), morphine withdrawl + exercise (MWE). We established aerobic exercise prevention/improvement models, and conducted behavioral tests including Open field test (OFT), Temporal order memory test (TOM) and Y-maze. Through Western Blotting and immunofluorescence staining, we detected endogenous opioid peptides in hippocampus and mPFC.
Results
Compared with MW group, EMW group and MWE group showed the same performance as WT group in TOM and Y-maze, with correct object recognition and memory ability. In Western Blotting and immunofluorescence staining experiments, it indicated that EMW group reduced the expression of PDYN and its fluorescence intensity in hippocampus; MWE group reduced the expression of OPRK1 and its fluorescence intensity in mPFC.
Conclusion
Our data suggest that aerobic exercise can both prevent and improve cognitive dysfunction caused by acute morphine withdrawal via respectively down-regulating PDYN in the hippocampus and down-regulating OPRK1 in the mPFC. They may become new targets for drugs development in the future.
... There exists a relationship between cognitive level and depression, though it is not a simple and direct causal connection (Halahakoon et al., 2019). Cognitive level refers to an individual's capacity to process, comprehend, and assess information, whereas depression is a mood disorder characterized by persistent and severe frustration (Clark and Beck, 2010). Individuals with low cognitive levels are prone to negative cognitive bias, entailing negative interpretations and evaluations of things and situations. ...
Introduction
The world population is rapidly aging, and depression mainly affects middle-aged and older adults with chronic diseases and cognitive impairments. The sample for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS) public database. The sample size for inclusion was 12,767. There were 6,773 females and 5,994 males, with an overall low level of education. This study aims to provide a theoretical and practical reference basis for the clinical non-pharmacological treatment of depression in middle-aged and older adults (age ≥ 50 years) with chronic diseases. Additionally, the study seeks to promote the development of mental health interventions for middle-aged and older adults (age ≥ 50 years) with chronic diseases, ultimately enhancing the sense of well-being and quality of life for this demographic.
Methods
Cognitive functioning and depressive symptoms of the study participants were assessed using the Mini-Mental State Examination Scale (MMSE) and the short version of the Center for Epidemiological Studies Depression Scale (CESD-10).
Results and discussion
Binary logistic regression results showed that among middle-aged and older adults (age ≥ 50 years) with chronic diseases, participation in physical activity [OR = 1.397; 95% CI (1.181–1.651); p < 0.05] was more effective than participation in social activities [OR = 0.997; 95% CI (0.924–1.076); p < 0.05] for preventing depression. Those with cognitive impairment [OR = 1.206; 95% CI (1.089–1.335); p < 0.05] were more likely to experience depression than those without cognitive impairment. Activity participation (physical activity and social activity) had a more significant effect on mild and moderate depression compared to no depression, and cognitive level had a more pronounced effect on moderate depression [OR = 1.491; 95% CI (1.278–1.740); p < 0.05] and major depression [OR = 2.231; 95% CI (1.282–3.884); p < 0.05]. Within the specific cohort of middle-aged and older adults (age ≥ 50 years) with chronic diseases, both activity participation and cognitive level exert a significant influence on the prevention and intervention of depression. Engagement in physical activity, participation in social activities, and enhanced cognitive functioning emerged as protective factors against depression. Therefore, the policy-maker should strengthen the prevention and treatment of depression in a comprehensive manner through the promotion of physical and social activities and the enhancement of cognitive level, so as to safeguard the mental health of middle-aged and older adults with chronic diseases.
... The former age inclusion criterion was dictated by the known physiological and hormonal changes occurring after the age of 45 (Crandall et al., 2023;McKinlay, 1996;Rymer & Morris, 2000). Exclusion criteria were medical treatment, regular use of drugs or medication, and diagnosis of a psychiatric disorder, as these factors are known to influence emotional and physiological processes at both the self-report and objective levels (Clark & Beck, 2010;Edgar et al., 2007;Kin et al., 2007;Wirth & Gaffey, 2013). Concerning sample size, guidelines for network models in psychology are still in their infancy (Hevey, 2018). ...
Emotion is an episode involving changes in multiple components, specifically subjective feelings, physiological arousal, expressivity, and action tendencies, all these driven by appraisal processes. However, very few attempts have been made to comprehensively model emotion episodes from this full componential perspective, given the statistical and methodological complexity involved. Recently, network analyses have been proposed in the field of emotion and cognition as an innovative theoretical and statistical framework able to integrate several properties of emotions. We therefore addressed the call for more multi-componential evidence by modeling the network of a comprehensive list of emotion components drawn from the Component Process Model of Emotion. Five-hundred students were confronted with mildly ambiguous scenarios from everyday life, and reported on their situational appraisals and emotion responses. Network analyses were applied to the emotion components related to a positive and a negative scenario to explore 1) how the components organize themselves into networks and dimensions; 2) which components are the most central within networks and dimensions; and 3) the patterns of components relation between and within dimensions. A three-dimensional solution emerged in both scenarios. Additionally, some appraisals and responses appeared to be differentially relevant and related to each other in both scenarios, highlighting the importance of context in shaping the strength of emotion component relations. Overall, we enriched the field of affective science by exploring the connections between emotion components in three novel ways: by using network analyses, by integrating them into a multi-componential framework, and by providing context to our emotion components. Our results can also potentially inform applied research, where understanding the interconnections and the centrality of components could aid the personalization of interventions.
... For instance, chair workwhich has its roots in psychodrama (Moreno, 1946) and Gestalt therapy (Perls et al., 1951)has become a hallmark of emotion-focused therapy (Greenberg, 2002), employing two-chair dialogues to address aspects of depression, interpersonal distress (Paivio & Greenberg, 1995) and symptoms associated with childhood trauma (Paivio et al., 2010). Cognitive-behavioral therapy (Clark & Beck, 2010) utilizes two-chair dialogues to address self-criticism (van Maarschalkerweerd et al., 2021), indecision (Clarke & Greenberg, 1986), and problematic anger (Conoley et al., 1983). Compassion-focused therapy (Gilbert, 2010) employs chair work to apply compassion to various aspects of the self, reducing selfcriticism and promoting the development of a compassionate self in patients whose high levels of self-criticism significantly impact well-being and lead to pathological symptoms, such as depressive experiences (Bell et al., 2020). ...
Experiential techniques are essential tools for therapists adhering to the principles of the Unified Protocol. We investigate their central role in psychotherapy, irrespective of the therapist’s orientation, and how they act as fundamental catalysts for the change of patients with diverse diagnoses. In this context, we present a rationale for the use of experiential methods in various therapeutic approaches, substantiating their effectiveness and safety with empirical evidence. Furthermore, we illustrate a clinical case in which experiential techniques were employed through metacognitive interpersonal therapy to assist the patient in accessing the inner world and accelerating personal transformation. We emphasize how these techniques enable swifter and more manageable change, without harmful effects on the therapeutic relationship. Drawing from research and clinical examples, we discuss how the application of experiential techniques in metacognitive interpersonal therapy aligns with certain aspects of the Unified Protocol and can be considered an essential component of therapy, regardless of the therapist’s preferred approach and the patient’s diagnosis.
... In the general population, psychological interventions for depression have been informed by cognitive theories (Clark & Beck, 2010) that maintain negative representations about one's self, past, and future can bias perception and thinking in a way that serves to reinforce these representations to the detriment of mood (e.g., Beck et al., 1979). Indeed, extensive work on the development and maintenance of depression highlights an important role for cognitive factors such as "dysfunctional" attitudes or beliefs (Beck, 1991), and mood-congruent biases in perception and interpretation (Joormann & Gotlib, 2006;Wenzlaff & Bates, 1998), executive function (EF) (Murphy et al., 2012;Murphy et al., 2013) and memory (Dalgleish & Werner-Seidler, 2014;Harmer et al., 2009). ...
... Negative interpretations of problems and situations lead individuals to believe that they cannot overcome their psychological difficulties which are prone to active one's cognitive distortions (2) . Modification of distorted cognition, and their related attitudes, beliefs, and information processing biases is a core mechanism leading to psychopathological symptom reduction (3) . Cognitive therapy helps patients to identify, test, and alter their distorted cognition. ...
The purpose of the study was to develop a scale for assessing cognitive distortions in Bangladesh and establishing psychometric properties for Bangladeshi population. The scale was named as Bangladesh Cognitive Distortion Scale (BCDS). Items were constructed through three stages of intensive expert evaluation where 128 respondents participated and both item analysis and factor analysis were undertaken. Finalized BCDS with 39 items was administered to 478 respondents to calculate its psychometric properties. Concurrent validity of BCDS was found 0.828 by calculating correlation between the score of BCDS and clinician’s subjective rating. Predictive validity considering anxiety and depression scale was found 0.756 and 0.841, respectively. Convergent validity (0.670) was confirmed through the correlation between the DAS and BCDS and divergent validity was established by the discriminate value (F=649.564, α<0.01) of clinical and non-clinical groups. Internal consistency reliability of BCDS (Cronbach Alpha- 0.962 and test-retest- 0.890) was found very high. The cut-off point for measuring cognitive distortion by BCDS was found 56 with sensitivity 87% and specificity 88%. According to the percentile norm, total score 56 to 72, 73 to 91, 92 to 109, 110 and above represents the mild, moderate, severe, and profound levels of cognitive distortions respectively. BCDS not only will help both clinicians and researchers to assess cognitive distortions within a short time but also could be used as a valid and reliable outcome measure in cognitive behavior therapy. Dhaka Univ. J. Biol. Sci. 33(2): 97-109, 2024 (July)
... According to the effect of neuroticism on DA, trait anxiety personality triggers DA. A study [39] found that life stress, negative automatic thoughts, and dysfunctional attitudes cause psychological distress. Long-term accumulation of negative mental states can easily trigger fear and unease about death. ...
Purpose
This study aimed to investigate death anxiety (DA) in caregivers of patients with advanced cancer and identify associated factors in the context of Chinese culture.
Methods
Caregivers (N = 588) of advanced cancer patients in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of the Templer Death Anxiety Scale (C-T-DAS), the Quality-of-Life Scale, the State–Trait Anxiety Scale, and the Social Support Rating Scale. Data were analyzed in SPSS (IBM Corp, Armonk, NY, USA) using descriptive statistics, Pearson’s correlation test, and linear regression.
Results
Respondents returned 588 (93.03%) of the 632 questionnaires. The total C-T-DAS score was 7.92 ± 2.68 points. The top-scoring dimension was “Stress and pain” (3.19 ± 1.29 points), followed by “Emotion” (2.28 ± 1.31 points) and “Cognition” (1.40 ± 0.94 points). In contrast, the lowest-scoring dimension was “Time” (1.06 ± 0.77 points). Factors associated with DA (R² = 0.274, F = 13.348, p < 0.001) included quality of life (QoL), trait anxious personality, social support, caregiver length of care, caregiver gender, and patients’ level of activities of daily living (ADL).
Conclusions
Our results demonstrated high levels of DA in caregivers of patients with advanced cancer. Generally, female caregivers and those with low social support had high DA. Caregivers caring for patients with low ADL levels or with a low QoL and trait anxious personality reported high DA. Certain associated factors help to reduce caregivers DA. Social interventions are recommended to improve the end-of-life transition and trait anxious personality as well as quality of life for caregivers.
... We found that, although most patients existed functional alterations of emotional memory, only a low proportion of the patients shared the consistent extreme deviation for any single brain region ( Figure S5). (61), and its weakening have been hypothesized to underlie of recovery (62,63). A recent study implicated that emotional regulation during emotion perception could be used to reduce negative emotional memory and therefore improve depressive symptoms (34). ...
Objective
Emotional dysfunctions are prevalent across various psychiatric disorders, leading to diverse emotional problems. Disrupted emotional episodic memory is a prominent deficit and may underlie various affective symptoms in clinical phenotypes. However, diagnosis-specific of neurodiverse disruptions remain elusive.
Methods
We used task-based functional magnetic resonance imaging (fMRI) and a normative modelling framework to establish a reference for functional activation during emotional episodic memory, drawing from a large dataset of healthy individuals (n = 409). Individualized deviations from this reference were evaluated using a clinical dataset of 328 participants, which included 168 healthy controls and patients with major depressive disorder (MDD, n = 56), bipolar disorder (BD, n = 31), and schizophrenia (SZ, n = 73). Regional deviations were mapped to four large-scale emotional regulation networks and used to predict affective symptoms across different mental disorders.
Results
We constructed a verifiable normative model of functional activation during emotional episodic memory to parse clinical heterogeneity. Diagnosis-specific regional deviations were enriched in the non-overlapping large-scale emotional regulation networks: MDD showed enrichment in emotion regulation network related to emotion perception and generation, BD in cognitive appraisal and emotional reactivity, and SZ in working memory and response inhibition. Individualized deviations significantly predicted affective symptom in distinct disorder, and specific emotional regulation network showed maximum feature weight.
Conclusions
These findings have potential implications for the understanding of dissociable neuropathological patterns of affective symptoms and improving individualized clinical diagnosis and treatment in psychiatric disorders.
... However, unlike the effectiveness observed in exposure-based treatments for patients with anxiety disorders [61], daily exposure to the visual, olfactory, and harmless consequences of consuming food alone does not appear to reduce avoidant behaviour in individuals with ARFID [62,63]. Potential hypotheses as to why exposures do not improve food selectivity in ARFID may include cognitive factors that impede experiential learning [64]. ...
Plain English summary
Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. Individuals with ARFID exhibit limited food intake and variety, often due to a lack in eating, without the primary goal of weight loss. The limited understanding of avoidant and restrictive eating poses challenges in terms of effective treatment and management, which directly impacts the growth and development of children and adolescents, as well as their nutrition and psychosocial well-being. ARFID is a relatively recent diagnostic classification, representing a burgeoning field of study. The identification of diagnostic criteria and the pursuit of new knowledge in this area have only recently begun. Consequently, assessment tools and treatment strategies are still in the process of development and validation. This narrative review explored the neurobiological perspective of ARFID using the three-dimensional model, examined its etiology and risk factors, evaluated clinical screening and evaluation tools, discussed common clinical complications, and presented different types of nutritional, behavioural, and pharmacological interventions used in ARFID treatment.
... The main focus of CBT is to recognize faulty and disturbed thinking patterns and eventually substitute them to change an individual's actions. An individual's cognitions have a cumulative influence on one's emotions, actions, and responsibilities towards his surroundings (Clark & Beck, 2010). ...
Current Research explored relationship between Socio economic status, Social Isolation and Depression among caregivers of individuals with physical disability.A group of 170 participants was selected using purposive sampling, with occasional utilization of the snowball technique to gather data. The sample included both married and unmarried individuals of both genders. Data collection involved the administration of three scales: the Macarthur SSS scale, comprising 2 items to gauge socioeconomic status; the LSNS, containing 10 items to assess social isolation; and the Hamilton Depression scale, consisting of 21 items to measure depression. Data was analyzed through SPSS. Values of Correlation depicts that there exists a notably weak positive correlation(r=.132, p<0.001) between socioeconomic status and social isolation, alongside a notably strong negative correlation (r=-.413, p<0.001) between socioeconomic status and depression. The significant relationship between depression and the socioeconomic status of caregivers of physically disabled individuals expounds the relationship between caregiving responsibilities, limited opportunities for personal advancement, and heightened risk of psychophysiological ailments due to social isolation and neglect of health. This interconnectedness highlights the need for comprehensive support systems addressing the multifaceted challenges faced by caregivers, to mitigate adverse effects on their well-being and quality of life
... Additionally, learning to manage negative thoughts and worries, cognitive restructuring strategies can be employed to attempt and adjust other procrastination-reinforcing (irrational) cognitions into more positive evaluations. Cognitive restructuring can alter negative emotional and thinking patterns, aiding individuals in viewing problems from a positive and realistic perspective, thereby finding strategies to address anxiety issues [56,57]. ...
Objective: The importance of good sleep for energy recovery and overall physical and mental health cannot be overstated. However, the increasing competitiveness of society, diversifying lifestyles, and the rapid spread of the internet and electronic devices have significantly impacted people’s sleep patterns, particularly through bedtime procrastination. Therefore, this study aims to investigate the relationship and underlying mechanisms between sleep determination, anxiety, and bedtime procrastination among the Chinese population. Method: The study utilized data from a national survey—the China Residents’ Sleep Condition Survey (November 2021, with 6,037 participants). By constructing mediation and moderation models, it analyzed the relationship and mechanisms between sleep determination and bedtime procrastination, highlighting the dual role of anxiety: as a mediator between sleep determination and bedtime procrastination, and as a moderator of their relationship. Results: There was a negative correlation between sleep determination and bedtime procrastination; anxiety was related to an increase in bedtime procrastination behaviors; In the interplay between sleep determination and pre-bedtime procrastination, the regulatory effect of anxiety is found to be more pronounced than its intermediary role, with anxiety significantly diminishing the inverse relationship between sleep determination and procrastination before bedtime. Conclusion: Bedtime procrastination can lead to sleep issues, thus reducing sleep quality. Enhancing sleep determination or alleviating pre-sleep anxiety can help inhibit bedtime procrastination behaviors. Intervening and reducing bedtime procrastination is one of the effective measures to improve sleep quality.
... Considering that preoperational thinking includes components such as snapshot perspective, prelogical thinking, and lack of perceived functionality, these findings also demonstrate the importance of understanding the cognitive behavioral theory's emphasis on the cognitive aspect of depression. Negative and unrealistic thought patterns about one's thoughts, world, and future are known to play a central role in the cognitive behavioral theory approach to depression and anxiety (Beck, 2002;Clark and Beck, 2010). CBT aims to recognize and replace these negative thought patterns with more realistic and positive ones. ...
It has been suggested by various cognitive behaviour theorists that the perceptual and cognitive characteristics of the preoperational cognitive stage, defined by Piaget as the second stage of cognitive development, manifest themselves in chronic depression and various personality disorders. Although individuals have a formal level of functioning in their work life, they may experience regression to the preoperational domain due to an event in the interpersonal domain. In this study, the relationships between preoperational thinking and psychiatric symptoms (depression and anxiety) and personality traits were analysed. The sample consisted of 61 patients and 102 healthy individuals (104 women, 55 men). Sociodemographic form, Personality Belief Questionnaire-Short Form (PBQ-SF), The Luebeck Preoperational Thinking Recording Scale (LQPT) and Patient Health Questionnaire -9 (PHQ-9) were applied to the participants. The study results revealed a diverse predictive role of LQPT scores across different personality traits. LQPT is highly predictive for traits like Histrionic and Dependent, moderately predictive for Borderline, Obsessive-Compulsive, and Antisocial, less predictive for Paranoid, Passive-Aggressive, and Narcissistic, and not predictive for schizoid personality traits. The results of this study also showed a significant relationship between an increase in general psychiatric symptoms (depression and anxiety) and an increase in preoperational thinking levels. It was also found that preoperational thinking was significantly higher in patients with psychiatric disorders (GAD, OCD, depression, panic disorder). These findings support the results of previous research that provide a new interpretation of Piaget's work on the preoperational stage in the context of personality and psychiatric symptoms in adults.
This chapter explores the multifaceted theories of cognitive development, emphasizing foundational contributions by Piaget and Vygotsky. It examines Piaget’s constructivist approach, highlighting sequential stages of development from infancy to adolescence, such as the Sensorimotor and Formal Operational Periods. These stages are tied to the interplay of neural and environmental factors, establishing a lifelong foundation for cognitive growth. The chapter also evaluates Vygotsky’s systemic perspective, where cognitive functions emerge from the interaction of biological and social systems, emphasizing the role of culture, language, and social context in development. Additional discussions include the evolution of moral reasoning, drawing distinctions between Piaget’s and Kohlberg’s frameworks, and the influence of education and parental involvement on moral and cognitive growth. The chapter underscores how early childhood environments shape intelligence, emotional regulation, and moral judgement, offering critical insights for educators and policymakers to foster optimal developmental outcomes.
While stress is known to contribute to depression, the specific impact of interpersonal stress on depression among Chinese adolescents remains underexplored. The present study investigates the mechanisms underlying this association, focusing on whether social anxiety mediates the relationship between interpersonal stress and depression and whether hope moderates these effects. Respondents included 814 adolescents in China. PROCESS macro in SPSS was used to test moderation and mediation relationships. Results revealed that interpersonal stress negatively influenced adolescents’ social anxiety levels, exacerbating depressive symptoms. Additionally, hope buffered the impact of interpersonal stress on depression. Our study explored the role of social anxiety and hope in the relationship between interpersonal stress and depression to investigate the psychological processes underlying this correlation. The findings have important implications for mental health interventions targeting Chinese adolescents. The contributions and implications of this study were discussed.
Liver-qi stagnation-type depression, marked by irritability and emotional imbalance, often responds inadequately to medication alone. This study explored the efficacy of combining acupuncture at the 13 ghost points with cognitive therapy for this condition. Conducted at our hospital from January 2022 to January 2023, the study involved 76 patients with liver-qi stagnation-type depression, divided into an observation group (acupuncture + cognitive therapy) and a control group (fluoxetine tablets), with 38 patients in each group. We assessed clinical efficacy, Hamilton Depression Scale (HAMD) scores, Self-Rating Depression Scale (SDS) scores, Traditional Chinese Medicine (TCM) syndrome scores, liver-qi stagnation syndrome main symptom scores, and serum levels of 5-hydroxytryptamine (HT), vasoactive intestinal peptide (VIP), and cAMP response element-binding protein (CREB) before and after treatment. The observation group achieved a total effective rate of 81.58%, significantly higher than the control group ( P < 0.05). Both groups showed significant reductions in HAMD and SDS scores, TCM syndrome scores, and liver-qi stagnation syndrome principal symptom scores posttreatment, with the observation group demonstrating superior improvements ( P < 0.05). Serum levels of 5-HT, VIP, and CREB also increased significantly in both groups, with greater changes in the observation group ( P < 0.05). The results suggest that the combination of acupuncture and cognitive therapy is more effective than fluoxetine alone in treating liver-qi stagnation-type depression, improving both clinical symptoms and physiological indicators.
The emotional cascade model (ECM) proposes a significant perspective on the development of borderline personality disorder (BPD), suggesting that experiencing multiple emotional cascades leads to the emergence and progression of BPD over time. The ECM proposed by Selby et al. (Behav Res Ther 46(5):593–611, 2008) provides a broad model for understanding the association between aversive negative emotional states and a wide array of dysregulated behaviors and is a unique one to explain the interplay between emotion dysregulation and behavioral dysregulation. Emotional cascades have been introduced according to a real-time phenomenon, in which there is an event, an emotional cascade, and dysregulated behaviors. According to the ECM, the core psychopathology in BPD is eventuated from emotional cascades. The emotional cascade suggests the association between unpleasantly aversive emotions and behavioral dysregulation is elucidated by a vicious self-perpetuating cycle of rumination, negative thoughts, and negative emotion. These emotional cascades occur more frequently and intensely in BPD individuals in comparison with other externalizing disorders, such as eating disorders. In line with the ECM, there is a reciprocal association between negative emotion and ruminative processes which leads to a “cascade of emotion,” which is commenced via an emotion-elicited event. This event entails an individual to ruminate intensely, which contributes to exacerbating the intensity of emotion. While the intensity of emotion rises, it becomes a hard task for an individual with BPD to elude from emotional experience through distracting attention, and in turn, an individual’s attention may be focused on emotional stimuli. Therefore, a positive feedback loop between rumination and negative affect will be generated.
A junior/senior high school counselor used an innovative psychoeducational group counseling curriculum based on cognitive behavioral therapy to meet the social/emotional needs of identified students. This article provides a summary and evaluation of the small group plan conducted via practitioner research. Results indicated that, although participants’ overall feelings of anxiety did not significantly improve, the curriculum enabled study participants to meet defined learning objectives. We discuss implications for school counselors.
Метою статті є узагальнення динаміки змін, що відбулись у смисловому полі категорії «цінності» та визначення ролі їх у розв’язанні проблеми прийняття рішень. Завданням статті є: а) охарактеризувати вже реалізовані напрямки наукових досліджень категорії «цінності»; б) виявити сенси категорії «цінності», що актуалізовані в сучасному психологічному і міждисциплінарному дискурсі; в) оцінити перспективи використання виявлених сенсів категорії «цінності» у вирішенні проблеми прийняття рішень. Методи. Серед методів дослідження використано історичний, системний і міждисциплінарний підходи, що дозволило характеризувати нові значення у смисловому полі категорії «цінності», а також принцип єдності практичного і теоретичного знання. Результати. Проведено аналіз наукових підходів трансценденталізації і суб’єктивізації в дослідженні цінностей, що виявив стигматизовані смислові значення категорії «цінності», які не відповідають сучасним науковим запитам щодо причин вибору програшних рішень. Натомість, в лоні психологічної науки і на міждисциплінарному тлі розгортається напрямок досліджень, пов’язаний із біо-психічним аспектом цінностей. До нього відносимо дослідження, що фокусуються на динамічній, процесуальній природі цінностей. Остання уможливлює вивчення порушень зв’язку між свідомою і несвідомою сферами, внаслідок чого виникають переважно неусвідомлені епіфеномени як то: деформації реальності, когнітивні викривлення, умовні цінності, неконтрольовані дії, імпортування психіки, ідеалізоване «Я», тощо. Висновки. Сучасне смислове поле категорії «цінності» доповнюється новими значеннями, пов’язаними з процесуальністю цінностей на біо-психічному рівні: оцінювання, здобуття цінностей, вибір як індивідуальна траєкторія життя, творення цінностей, умовність цінностей, кореляції свідомої і несвідомої сфер в процесі оцінювання. Очевидно, що нові значення смислового поля категорії «цінності» мають евристичний потенціал щодо вирішення нагальних питань з практики прийняття рішень.
Bayesian network analysis, a sophisticated branch of machine learning, is a powerful method for unraveling intricate causal relationships in observational datasets. Based on principles from Bayesian statistics, this approach goes beyond mere pattern recognition, delving into the realm of causation by modeling the probabilistic conditional dependencies among variables. This chapter discusses the logic of using Bayesian network analysis as a causal discovery tool in social science research, explaining underlying assumptions necessary for identifying possible causal structures. In essence, Bayesian networks serve as graphical representations of conditional dependencies among variables, encapsulating a visual manifestation of the cause-and-effect dynamics inherent in the data. This distinctive capability makes Bayesian network analysis invaluable in discerning causal structures, shedding light on the factors that drive observed patterns and phenomena, facilitating a clear understanding of the intricate web of relationships, enabling researchers and practitioners to derive meaningful insights, and making informed decisions based on a nuanced understanding of the causal mechanisms at play. We also discussed assessing the Bayesian network model fit using the structure equation modeling approach and how to make inferences and predictions based on the identified structure. Bayesian network analysis finds application across diverse fields, such as healthcare, finance, and environmental science. This chapter used a real-world example to illustrate the utility of the Bayesian network in exploring how adverse social events impact our mental health, identifying factors influencing the onset of mood disorder symptoms, and offering a foundation for targeted interventions.
The concept of macromolecules, which is applied to synthetic and natural polymers, allows for various contemporary polymeric materials and inventive uses. A dynamic structure of macromolecules called the extracellular matrix (ECM) maintains tissues and organs functioning. The cell therapy procedure known as wound healing involves depositing ECM components such as collagen, fibronectin, and laminin. The clinical assessment and management of wounds remain challenging despite the introduction of numerous therapeutic regimens because of their laboriously prolonged treatment requirements and complex wound‐healing mechanisms using macromolecules of a specific type, such as proteins, carbohydrates, lipids, and nucleic acids. Additionally, proteins affect the wound site's mechanical characteristics, such as tensile strength, elasticity, and permeability, which impact the effectiveness and success of wound healing. The main goal of this article is to give a current overview of how therapeutic alternatives have evolved using cutting‐edge innovative techniques for the healing and treatment of wounds. In this article, we have covered different types of macromolecules, how diet affects the wound, what causes wounds, and how macromolecules can help, and how to treat wounds.
Purpose
Patients with brain cancer and painful symptoms of the disease experience heavy pressure and negative inner experiences, leading to a sense of stigma. Therefore, this study assessed the level of stigma in patients with brain cancer and analyzed the risk factors for stigma to analyze the underlying relationships among depression, social support, low self-esteem, and stigma.
Methods
Patients completed the Social Impact Scale, Self-rating Depression Scale, Rosenberg Self-Esteem Scale, Herth Hope Index, Social Support Rating Scale, and Self-Perceived Burden Scale. Multiple linear regression analysis was used to identify factors independently associated with stigma. Parallel mediation analysis was used to evaluate the mediating role of the relationship between psychoemotional factors and stigma.
Results
A multivariate linear regression analysis demonstrated significant associations between age (β = − 0.189, P = 0.002), treatment (β = 0.184, P = 0.003), self-esteem (β = − 0.128, P = 0.046), depression (β = 0.273, P < 0.001), hope (β = − 0.217, P = 0.003), and self-perceived burden (β = 0.260, P < 0.001) with brain cancer. It was observed that the social support received by brain cancer patients directly impacted their stigma (total effect, − 0.851, P = 0.001). Additionally, this relationship was influenced by depression and self-esteem through two distinct pathways.
Conclusion
Increased stigma among brain cancer patients was found to be associated with severe depression, feelings of inferiority, diminished hope, and a heavy perceived burden. The structural equation modeling (SEM) revealed that social support negatively influenced stigma through depression and self-esteem. It is imperative to grasp patients’ inner needs, implement psychological interventions, and cultivate a cancer-friendly social environment to prevent stigmatization and discrimination based on their patient status.
Objectives
The aim of the research was to examine whether cognitive-emotional regulation factors influence the expression of automatic thoughts.
Methods
A cross-sectional survey was conducted online on 144 general population respondents (average age 37 years). Three questionnaires were applied: 1) The Cognitive Emotional Regulation Questionnaire (CERQ) measures the expression of 9 cognitive emotion regulation strategies: self-blame, acceptance, rumination, positive refocusing, redirection to planning, positive reappraisal, putting in perspective, catastrophizing and blaming others. Each refers to thoughts after experiencing a threatening or stressful life event. The questionnaire consists of 36 items. 2) Automatic Thoughts Questionnaire (ATQ) - by answering 30 items, the frequency of automatic negative thoughts are measured. 3) A socio-demographic questionnaire was used to collect information about the age, gender and education of the respondents.
Results
The frequency of negative automatic thoughts is significantly positively correlated with self-blame, catastrophizing and rumination, blaming others, and acceptance. The results of the linear regression analysis showed that the model explained 48.3% of the total variance of automatic thoughts. Individual predictors that made the most significant unique contribution to the model are self-blame (beta=.43, p<0,01) and catastrophizing (beta=.27, p<0,01).
Conclusions
Almost half of the negative automatic thoughts can be explained by factors of cognitive-emotional regulation. Negative automatic thoughts generate emotions, while with cognitive regulation the individual tries to consciously or unconsciously influence emotions. Self-blame and catastrophizing are the most significant predictors of negative automatic thoughts.
This study aimed to assess the implementation of COVID-19 health protocols by the Bureau of Jail Management and Penology (BJMP) at Manila City Jail and to determine the impact of the pandemic on Persons Deprived of Liberty (PDLs) and jail officers in terms of family, psychological, physical, and infrastructure factors. The study involved 50 PDLs and 50 jail officers, and used a quantitative research approach. The findings revealed that the BJMP had strictly implemented COVID-19 health protocols within the jail, such as mandatory mask-wearing, temperature checks, social distancing, and sanitization measures. However, the COVID-19 outbreak still significantly impacted the PDLs and jail officers. In terms of family, the pandemic caused high levels of fear for the safety of family members, affected family relationships, and limited visitation and communication. Psychologically, the respondents experienced high levels of worry about the virus spreading due to overcrowding, and feeling scared of potential COVID-19 symptoms. Regarding physical and infrastructure factors, the jail had insufficient hygiene supplies and poor environmental conditions that increased virus transmission. While there were substantial differences between PDLs and jail officers in their assessments of the pandemic's impact on family, no significant differences were found in their psychological and physical/infrastructure assessments. The study recommends that the BJMP continue implementing strict health protocols, provide peer support networks and counseling services to address mental health, and organize regular sanitization campaigns to mitigate the spread of COVID-19 and other infectious diseases within the jail. Overall, the findings highlight the significant challenges faced by PDLs and jail officers during the pandemic, underscoring the need for comprehensive strategies to protect the health and well-being of these vulnerable groups.
This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
Objective: In controlled treatment trials, 40%–60% of unmedicated depressed individuals respond to cognitive behavior therapy (CBT). The authors examined whether pretreatment neural reactivity to emotional stimuli accounted for this variation. Method: Unmedicated depressed individuals (N=14) and never depressed comparison subjects (N=21) underwent fMRI during performance of a task sensitive to sustained emotional information processing. Afterward, depressed participants completed 16 sessions of CBT. Results: Participants whose sustained reactivity to emotional stimuli was low in the subgenual cingulate cortex (Brodmann’s area 25) and high in the amygdala displayed the strongest improvement with CBT. Conclusions: The presence of emotion regulation disruptions, which are targeted in CBT, may be the key to recovery with this intervention.
The present paper aimed (1) to review the literature to examine the effectiveness of CBT as treatment for PDA and (2) to evaluate whether the efficacy of CBT treatments is related to the change to cognitive processes that are postulated to be important in the cognitive models of PDA. A literature review of CBT studies in the area of PDA was conducted using both descriptive and quantitative (meta-analysis) procedures. In all, 35 studies published between 1969 and 1996 were included. The results show that CBT is an effective treatment for PDA. However, the contribution of cognitive processes to this disorder and the role that they play in the successful outcome of CBT remain unclear and in need of further empirical investigation. At present, CBT treatment provides limited support to validate the cognitive models of PDA.
A tendency to orient attention toward threatening stimuli may be involved in the etiology of anxiety disorders. In keeping with this, both psychological and pharmacological treatments of anxiety reduce this negative attentional bias. It has been hypothesized, but not proved, that psychological interventions may alter the function of prefrontal regions supervising the allocation of attentional resources.
The current study examined the effects of a cognitive training regime on attention. Participants were randomly assigned to one of two training conditions: "attend-threat" training, which increases negative attentional bias, or "avoid-threat" training, which reduces it. The behavioral effects of training were assessed using a sample of 24 healthy participants. Functional magnetic resonance imaging data were collected in a further 29 healthy volunteers using a protocol that allowed the influence of both stimuli valence and attention to be discriminated.
Cognitive training induced the expected attentional biases in healthy volunteers. Further, the training altered lateral frontal activation to emotional stimuli, with these areas responding specifically to violations of the behavioral rules learned during training. Connectivity analysis confirmed that the identified lateral frontal regions were influencing attention as indexed by activity in visual association cortex.
Our results indicate that frontal control over the processing of emotional stimuli may be tuned by psychological interventions in a manner predicted to regulate levels of anxiety. This directly supports the proposal that psychological interventions may influence attention via an effect on the prefrontal cortex.
Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed.
Acute administration of an antidepressant increases positive affective processing in healthy volunteers, an effect that may be relevant to the therapeutic actions of these medications. The authors investigated whether this effect is apparent in depressed patients early in treatment, prior to changes in mood and symptoms.
In a double-blind, placebo-controlled, between-groups randomized design, the authors examined the effect of a single 4-mg dose of the norepinephrine reuptake inhibitor reboxetine on emotional processing. Thirty-three depressed patients were recruited through primary care clinics and the community and matched to 31 healthy comparison subjects. Three hours after dosing, participants were given a battery of emotional processing tasks comprising facial expression recognition, emotional categorization, and memory. Ratings of mood, anxiety, and side effects were also obtained before and after treatment.
Depressed patients who received placebo showed reduced recognition of positive facial expressions, decreased speed in responding to positive self-relevant personality adjectives, and reduced memory for this positive information compared to healthy volunteers receiving placebo. However, this effect was reversed in patients who received a single dose of reboxetine, despite the absence of changes in subjective ratings of mood or anxiety.
Antidepressant drug administration modulates emotional processing in depressed patients very early in treatment, before changes occur in mood and symptoms. This effect may ameliorate the negative biases in information processing that characterize mood and anxiety disorders. It also suggests a mechanism of action compatible with cognitive theories of depression.
This commentary reviews key theoretical, methodological, and clinical issues raised by recent research on cognitive bias modification (CBM). The authors identify the major ways in which the new work reported within this special section extends earlier CBM research. In particular, they note that it considers a wider range of participants, includes a greater diversity of symptoms measures, and targets for change a broader array of processing biases than previously has been the case. Furthermore, they point out that the present work develops and employs a more diverse arsenal of bias modification procedures, in some cases delivered across extended periods of time within naturalistic settings. They also draw attention to methodological limitations associated with the current studies, offering recommendations concerning how future CBM research might profitably build upon these exciting new directions while overcoming such limitations. Finally, they evaluate the theoretical and applied implications of the reported findings, discussing their capacity to illuminate the causal contributions made by cognitive bias to emotional vulnerability and their promise concerning the potential therapeutic value of CBM as a clinical tool.
Research suggests that individuals with generalized anxiety disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. Participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of words. The authors trained attention by including a contingency between the location of the probe and the nonthreat word in one group (Attention Modification Program; AMP) and not in the other (attention control condition; ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self-report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety.
Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.
Evidence from diverse literatures supports the viewpoint that two modes of self-regulation exist, a lower-order system that responds quickly to associative cues of the moment and a higher-order system that responds more reflectively and planfully; that low serotonergic function is linked to relative dominance of the lower-order system; that how dominance of the lower-order system is manifested depends on additional variables; and that low serotonergic function therefore can promote behavioral patterns as divergent as impulsive aggression and lethargic depression. Literatures reviewed include work on two-mode models; studies of brain function supporting the biological plausibility of the two-mode view and the involvement of serotonergic pathways in functions pertaining to it; and studies relating low serotonergic function to impulsiveness, aggression (including extreme violence), aspects of personality, and depression vulnerability. Substantial differences between depression and other phenomena reviewed are interpreted by proposing that depression reflects both low serotonergic function and low reward sensitivity. The article closes with brief consideration of the idea that low serotonergic function relates to even more diverse phenomena, whose natures depend in part on sensitivities of other systems.
Assessments of anterior cingulate cortex in experimental animals and humans have led to unifying theories of its structural organization and contributions to mammalian behaviour. The anterior cingulate cortex forms a large region around the rostrum of the corpus callosum that is termed the anterior executive region. This region has numerous projections into motor systems, however, since these projections originate from different parts of anterior cingulate cortex and because functional studies have shown that it does not have a uniform contribution to brain functions, the anterior executive region is further subdivided into 'affect' and 'cognition' components. The affect division includes areas 25, 33 and rostral area 24, and has extensive connections with the amygdala and periaqueductal grey, and parts of it project to autonomic brainstem motor nuclei. In addition to regulating autonomic and endocrine functions, it is involved in conditioned emotional learning, vocalizations associated with expressing internal states, assessments of motivational content and assigning emotional valence to internal and external stimuli, and maternal-infant interactions. The cognition division includes caudal areas 24' and 32', the cingulate motor areas in the cingulate sulcus and nociceptive cortex. The cingulate motor areas project to the spinal cord and red nucleus and have premotor functions, while the nociceptive area is engaged in both response selection and cognitively demanding information processing. The cingulate epilepsy syndrome provides important support of experimental animal and human functional imaging studies for the role of anterior cingulate cortex in movement, affect and social behaviours. Excessive cingulate activity in cases with seizures confirmed in anterior cingulate cortex with subdural electrode recordings, can impair consciousness, alter affective state and expression, and influence skeletomotor and autonomic activity. Interictally, patients with anterior cingulate cortex epilepsy often display psychopathic or sociopathic behaviours. In other clinical examples of elevated anterior cingulate cortex activity it may contribute to tics, obsessive-compulsive behaviours, and aberrent social behaviour. Conversely, reduced cingulate activity following infarcts or surgery can contribute to behavioural disorders including akinetic mutism, diminished self-awareness and depression, motor neglect and impaired motor initiation, reduced responses to pain, and aberrent social behaviour. The role of anterior cingulate cortex in pain responsiveness is suggested by cingulumotomy results and functional imaging studies during noxious somatic stimulation. The affect division of anterior cingulate cortex modulates autonomic activity and internal emotional responses, while the cognition division is engaged in response selection associated with skeletomotor activity and responses to noxious stimuli. Overall, anterior cingulate cortex appears to play a crucial role in initiation, motivation, and goal-directed behaviours.(ABSTRACT TRUNCATED AT 400 WORDS)
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
This article reviews the theoretical and empirical literature associated with the mediators and moderators of change in cognitive therapy (CT) of depression. Covariation between change in cognition and change in depression, specific effects for cognitive versus behavioral components of CT, specific effects for CT versus other treatments, moderating influence of nonspecific and technical aspects of the therapeutic environment, and moderating influence of client characteristics are reviewed. The clinical implications of prior research and suggestions for future research on identifying the critical ingredients of change in CT of depression are discussed.
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.
Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been extensively used to explore the functional neuroanatomy of cognitive functions. Here we review 275 PET and fMRI studies of attention (sustained, selective, Stroop, orientation, divided), perception (object, face, space/motion, smell), imagery (object, space/motion), language (written/spoken word recognition, spoken/no spoken response), working memory (verbal/numeric, object, spatial, problem solving), semantic memory retrieval (categorization, generation), episodic memory encoding (verbal, object, spatial), episodic memory retrieval (verbal, nonverbal, success, effort, mode, context), priming (perceptual, conceptual), and procedural memory (conditioning, motor, and nonmotor skill learning). To identify consistent activation patterns associated with these cognitive operations, data from 412 contrasts were summarized at the level of cortical Brodmann's areas, insula, thalamus, medial-temporal lobe (including hippocampus), basal ganglia, and cerebellum. For perception and imagery, activation patterns included primary and secondary regions in the dorsal and ventral pathways. For attention and working memory, activations were usually found in prefrontal and parietal regions. For language and semantic memory retrieval, typical regions included left prefrontal and temporal regions. For episodic memory encoding, consistently activated regions included left prefrontal and medial temporal regions. For episodic memory retrieval, activation patterns included prefrontal, medial temporal, and posterior midline regions. For priming, deactivations in prefrontal (conceptual) or extrastriate (perceptual) regions were consistently seen. For procedural memory, activations were found in motor as well as in non-motor brain areas. Analysis of regional activations across cognitive domains suggested that several brain regions, including the cerebellum, are engaged by a variety of cognitive challenges. These observations are discussed in relation to functional specialization as well as functional integration.
Neurofunctional changes underlying effective antianxiety treatments are incompletely characterized. This study explored the effects of citalopram and cognitive-behavioral therapy on regional cerebral blood flow (rCBF) in social phobia.
By means of positron emission tomography with oxygen 15-labeled water, rCBF was assessed in 18 previously untreated patients with social phobia during an anxiogenic public speaking task. Patients were matched for sex, age, and phobia severity, based on social anxiety questionnaire data, and randomized to citalopram medication, cognitive-behavioral group therapy, or a waiting-list control group. Scans were repeated after 9 weeks of treatment or waiting time. Outcome was assessed by subjective and psychophysiological state anxiety measures and self-report questionnaires. Questions were readministered after 1 year.
Symptoms improved significantly and roughly equally with citalopram and cognitive-behavioral therapy, whereas the waiting-list group remained unchanged. Four patients in each treated group and 1 waiting-list patient were classified as responders. Within both treated groups, and in responders regardless of treatment approach, improvement was accompanied by a decreased rCBF-response to public speaking bilaterally in the amygdala, hippocampus, and the periamygdaloid, rhinal, and parahippocampal cortices. Between-group comparisons confirmed that rCBF in these regions decreased significantly more in treated groups than control subjects, and in responders than nonresponders, particularly in the right hemisphere. The degree of amygdalar-limbic attenuation was associated with clinical improvement a year later.
Common sites of action for citalopram and cognitive-behavioral treatment of social anxiety were observed in the amygdala, hippocampus, and neighboring cortical areas, ie, brain regions subserving bodily defense reactions to threat.
Functional imaging studies of major depressive disorder demonstrate response-specific regional changes following various modes of antidepressant treatment.
To examine changes associated with cognitive behavior therapy (CBT).
Brain changes underlying response to CBT were examined using resting-state fluorine-18-labeled deoxyglucose positron emission tomography. Seventeen unmedicated, unipolar depressed outpatients (mean +/- SD age, 41 +/- 9 years; mean +/- SD initial 17-item Hamilton Depression Rating Scale score, 20 +/- 3) were scanned before and after a 15- to 20-session course of outpatient CBT. Whole-brain, voxel-based methods were used to assess response-specific CBT effects. A post hoc comparison to an independent group of 13 paroxetine-treated responders was also performed to interpret the specificity of identified CBT effects.
A full course of CBT resulted in significant clinical improvement in the 14 study completers (mean +/- SD posttreatment Hamilton Depression Rating Scale score of 6.7 +/- 4). Treatment response was associated with significant metabolic changes: increases in hippocampus and dorsal cingulate (Brodmann area [BA] 24) and decreases in dorsal (BA 9/46), ventral (BA 47/11), and medial (BA 9/10/11) frontal cortex. This pattern is distinct from that seen with paroxetine-facilitated clinical recovery where prefrontal increases and hippocampal and subgenual cingulate decreases were seen.
Like other antidepressant treatments, CBT seems to affect clinical recovery by modulating the functioning of specific sites in limbic and cortical regions. Unique directional changes in frontal cortex, cingulate, and hippocampus with CBT relative to paroxetine may reflect modality-specific effects with implications for understanding mechanisms underlying different treatment strategies.
In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months.
Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals.
Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition.
Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy.
There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population.
To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial.
Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60).
Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn.
Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder.
Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy.
The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission.
At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction.
Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.
The capacity to control emotion is important for human adaptation. Questions about the neural bases of emotion regulation have recently taken on new importance, as functional imaging studies in humans have permitted direct investigation of control strategies that draw upon higher cognitive processes difficult to study in nonhumans. Such studies have examined (1) controlling attention to, and (2) cognitively changing the meaning of, emotionally evocative stimuli. These two forms of emotion regulation depend upon interactions between prefrontal and cingulate control systems and cortical and subcortical emotion-generative systems. Taken together, the results suggest a functional architecture for the cognitive control of emotion that dovetails with findings from other human and nonhuman research on emotion.
The question of the self has intrigued philosophers and psychologists for a long time. More recently, distinct concepts of self have also been suggested in neuroscience. However, the exact relationship between these concepts and neural processing across different brain regions remains unclear. This article reviews neuroimaging studies comparing neural correlates during processing of stimuli related to the self with those of non-self-referential stimuli. All studies revealed activation in the medial regions of our brains' cortex during self-related stimuli. The activation in these so-called cortical midline structures (CMS) occurred across all functional domains (e.g., verbal, spatial, emotional, and facial). Cluster and factor analyses indicate functional specialization into ventral, dorsal, and posterior CMS remaining independent of domains. Taken together, our results suggest that self-referential processing is mediated by cortical midline structures. Since the CMS are densely and reciprocally connected to subcortical midline regions, we advocate an integrated cortical-subcortical midline system underlying human self. We conclude that self-referential processing in CMS constitutes the core of our self and is critical for elaborating experiential feelings of self, uniting several distinct concepts evident in current neuroscience.
A growing body of evidence supports the use of cognitive behavior therapy for the treatment of schizophrenia. A course of cognitive behavior therapy, added to the antipsychotic regimen, is now considered to be an appropriate standard of care in the United Kingdom. The objective of this article is to offer a broad perspective on the subject of cognitive behavior therapy for schizophrenia for the American reader.
The authors summarize current practice and data supporting the use of cognitive behavior therapy for schizophrenia.
Five aspects of cognitive behavior therapy for schizophrenia are addressed: 1) evidence from randomized clinical trials, 2) currently accepted core techniques, 3) similarities to and differences from other psychosocial interventions for schizophrenia, 4) differences between the United States and United Kingdom in implementation, and 5) current directions of research.
The strength of the evidence supporting cognitive behavior therapy for schizophrenia suggests that this technique should have more attention and support in the United States.
In controlled treatment trials, 40%-60% of unmedicated depressed individuals respond to cognitive behavior therapy (CBT). The authors examined whether pretreatment neural reactivity to emotional stimuli accounted for this variation.
Unmedicated depressed individuals (N=14) and never depressed comparison subjects (N=21) underwent fMRI during performance of a task sensitive to sustained emotional information processing. Afterward, depressed participants completed 16 sessions of CBT.
Participants whose sustained reactivity to emotional stimuli was low in the subgenual cingulate cortex (Brodmann's area 25) and high in the amygdala displayed the strongest improvement with CBT.
The presence of emotion regulation disruptions, which are targeted in CBT, may be the key to recovery with this intervention.
• We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessivecompulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/ hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessivecompulsive disorder symptoms.
The authors describe the use of cognitive behaviour therapy with a group of 12 patients (aged 16–65 yrs) with schizophrenia from Sheffield and Bassetlaw, Nottinghamshire, who participated in a pilot study between 1991 and 1993 and a 5–10-yr follow-up of Bassetlaw patients who were first managed using basic techniques of cognitive behaviour therapy between 1984 and 1989. The styles and methods used, the clinical themes emerging, and outcome data is described and compared with other recent studies.
Evaluation of cognitive behaviour therapy in schizophrenia is still in its early phases but positive results are emerging from controlled studies. The long-term outcome looks promising especially when patients are managed from first episode. The clinical themes described here are speculative but may be useful in management and training. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Argues that the variety of ways in which cognitive processes in depression have been conceptualized warrant the presentation of 6 models. The cross-sectional model states that the systematic negativity that pervades the cognitive processes is a necessary (but not sufficient) component of depression. The structural model stipulates that certain negatively biased schemas become hypervalent in depression and produce a systematic bias in the abstraction and interpretation of data. The stressor-vulnerability model stipulates that specific patterns of schemas make a person sensitive to specific stressors. The reciprocal-interaction model focuses on interaction with key figures. The psychobiological model integrates cognitive processes and biological processes as different sides of the same coin. The evolutionary model views depression as an atavistic mechanism or program that may have been adaptational in a prehistoric environment but is not adaptive in our current milieu. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: An area of recent interest in psychiatric research is the application of neuroimaging techniques to investigate neural events associated with the development and the treatment of symptoms in a number of psychiatric disorders.
Objective: To examine whether psychological therapies modulate brain activity and, if so, to examine whether these changes similar to those found with relevant pharmacotherapy in various mental disorders.
Methods: Relevant data were identified from Pubmed and PsycInfo searches up to July 2005 using combinations of keywords including ‘psychological therapy’, ‘behaviour therapy’, ‘depression’, ‘panic disorder’, ‘phobia’, ‘obsessive compulsive disorder’, ‘schizophrenia’, ‘psychosis’, ‘brain activity’, ‘brain metabolism’, ‘PET’, ‘SPECT’ and ‘fMRI’.
Results: There was ample evidence to demonstrate that psychological therapies produce changes at the neural level. The data, for example in depression, panic disorder, phobia and obsessive compulsive disorder (OCD), clearly suggested that a change in patients' symptoms and maladaptive behaviour at the mind level with psychological techniques is accompanied with functional brain changes in relevant brain circuits. In many studies, cognitive therapies and drug therapies achieved therapeutic gains through the same neural pathways although the two forms of treatment may still have different mechanisms of action.
Conclusions: Empirical research indicates a close association between the ‘mind’ and the ‘brain’ in showing that changes made at the mind level in a psychotherapeutic context produce changes at the brain level. The investigation of changes in neural activity with psychological therapies is a novel area which is likely to enhance our understanding of the mechanisms for therapeutic changes across a range of disorders.
Measures of attention and implicit memory for threatening words were obtained from anxious patients before and after psychological treatment, and compared with data from non-anxious control Ss collected over the same period. Findings confirmed the expectation that the presence of threatening distractors would be associated with greater interference with the performance of anxious patients than with that of controls, in both color-naming and attentional search tasks, but failed to confirm the previous finding of related differences in priming on a word completion task. Treatment significantly reduced selective interference effects in anxious patients, and abolished evidence of differences between the treated patients and controls. It is suggested that cognitive bias effects in anxiety may either depend on state factors alone, or may represent a more enduring individual difference that becomes apparent only when vulnerable individuals are primed by mood state or stressful events.
Although the cognitive model of depression has evolved appreciably since its first formulation over 40 years ago, the potential interaction of genetic, neurochemical, and cognitive factors has only recently been demonstrated. Combining findings from behavioral genetics and cognitive neuroscience with the accumulated research on the cognitive model opens new opportunities for integrated research. Drawing on advances in cognitive, personality, and social psychology as well as clinical observations, expansions of the original cognitive model have incorporated in successive stages automatic thoughts, cognitive distortions, dysfunctional beliefs, and information-processing biases. The developmental model identified early traumatic experiences and the formation of dysfunctional beliefs as predisposing events and congruent stressors in later life as precipitating factors. It is now possible to sketch out possible genetic and neurochemical pathways that interact with or are parallel to cognitive variables. A hypersensitive amygdala is associated with both a genetic polymorphism and a pattern of negative cognitive biases and dysfunctional beliefs, all of which constitute risk factors for depression. Further, the combination of a hyperactive amygdala and hypoactive prefrontal regions is associated with diminished cognitive appraisal and the occurrence of depression. Genetic polymorphisms also are involved in the overreaction to the stress and the hypercortisolemia in the development of depression--probably mediated by cognitive distortions. I suggest that comprehensive study of the psychological as well as biological correlates of depression can provide a new understanding of this debilitating disorder.
Posttraumatic stress disorder (PTSD) may develop from impaired extinction of conditioned fear responses. Exposure-based treatment of PTSD is thought to facilitate extinction learning (Charney, 2004). Fear extinction is mediated by inhibitory control of the ventromedial prefrontal cortex (vmPFC) over amygdala-based fear processes (Phelps, Delgado, Nearing, & LeDoux, 2004; Quirk, Russo, Barron, & LeBron, 2000). Most neuroimaging studies of PTSD reveal reduced vmPFC activity (particularly in rostral anterior cingulate cortex, or rACC; Lanius et al., 2001; Shin et al., 2005), and some find increased amygdala activity during threat processing (Shin et al., 2005). In addition, increased amygdala activity during fear conditioning and reduced vmPFC activity during extinction have been reported in PTSD (Bremner et al., 2005).
Although PTSD patients show increased orbitofrontal and medial prefrontal activity following treatment with serotonin reuptake inhibitors (SSRIs; Fernandez et al., 2001; Seedat et al., 2004), no studies have investigated neural networks before and after exposure-based treatment of PTSD. We report the first such study. We hypothesized that symptom reduction would be associated with increased rACC activity and reduced amygdala activity during fear processing.
Cognitive theories of depression posit that people's thoughts, inferences, attitudes, and interpretations, and the way in which they attend to and recall information, can increase their risk for depression. Three mechanisms have been implicated in the relation between biased cognitive processing and the dysregulation of emotion in depression: inhibitory processes and deficits in working memory, ruminative responses to negative mood states and negative life events, and the inability to use positive and rewarding stimuli to regulate negative mood. In this review, we present a contemporary characterization of depressive cognition and discuss how different cognitive processes are related not only to each other, but also to emotion dysregulation, the hallmark feature of depression. We conclude that depression is characterized by increased elaboration of negative information, by difficulties disengaging from negative material, and by deficits in cognitive control when processing negative information. We discuss treatment implications of these conclusions and argue that the study of cognitive aspects of depression must be broadened by investigating neural and genetic factors that are related to cognitive dysfunction in this disorder. Such integrative investigations should help us gain a more comprehensive understanding of how cognitive and biological factors interact to affect the onset, maintenance, and course of depression.
Few studies have examined associations between depressive symptoms and alterations in neural systems that subserve cognitive control. Cognitive control was assessed with an exogenous cueing task using happy, sad, and neutral facial expressions as cues among women with mild to moderate symptoms of depression and a non-depressed control group while functional magnetic resonance imaging (fMRI) measured brain activity. Amygdala and medial/orbital prefrontal cortex (PFC) response to valid emotion cues did not differ as a function of depression symptoms. However, significant depression group differences were observed when task demands required cognitive control. Participants with elevated depression symptoms showed weaker activation in right and left lateral PFC and parietal regions when shifting attentional focus away from invalid emotion cues. No depression group differences were observed for invalid non-emotional cues. Findings suggest that mild to moderate depression symptoms are associated with altered function in brain regions that mediate cognitive control of emotional information.
Social anxiety disorder (SAD) is characterized by distorted negative self-beliefs (NSBs), which are thought to enhance emotional reactivity, interfere with emotion regulation, and undermine social functioning. Cognitive reappraisal is a type of emotion regulation used to alter NSBs, with the goal of modulating emotional reactivity. Despite its relevance, little is known about the neural bases and temporal features of cognitive reappraisal in patients with SAD.
Twenty-seven patients with SAD and 27 healthy control subjects (HCs) were trained to react and to implement cognitive reappraisal to downregulate negative emotional reactivity to NSBs, while undergoing functional magnetic resonance imaging and providing ratings of negative emotion experience.
Behaviorally, compared with HCs, patients with SAD reported greater negative emotion both while reacting to and reappraising NSBs. However, when cued, participants in both groups were able to use cognitive reappraisal to decrease negative emotion. Neurally, reacting to NSBs resulted in early amygdala response in both groups. Reappraising NSBs resulted in greater early cognitive control, language, and visual processing in HCs but greater late cognitive control, visceral, and visual processing in patients with SAD. Functional connectivity analysis during reappraisal identified more regulatory regions inversely related to left amygdala in HCs than in patients with SAD. Reappraisal-related brain regions that differentiated patients and control subjects were associated with negative emotion ratings and cognitive reappraisal self-efficacy.
Findings regarding cognitive reappraisal suggest neural timing, connectivity, and brain-behavioral associations specific to patients with SAD and elucidate neural mechanisms that might serve as biomarkers of interventions for SAD.
Consistent research evidence supports the existence of threat-relevant cognitive bias in anxiety, but there remains controversy about which stages of information processing are most important in the conferral of cognitive vulnerability to anxiety. To account for both theoretical and empirical discrepancies in the literature, an integrative multi-process model is proposed wherein core assumptions of dual-systems theories from social and cognitive psychology are adapted to explain attentional and interpretive biases in the anxiety disorders. According to the model, individual differences in associative and rule-based processing jointly influence orientation, engagement, disengagement, and avoidance of threat-relevant stimuli, as well as negatively-biased interpretation of ambiguous stimuli in anxious populations. By linking anxiety-related symptoms to basic principles of information processing, the model parsimoniously integrates different kinds of cognitive biases in anxiety, providing a useful framework for future research and clinical intervention.
We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessive-compulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessive-compulsive disorder symptoms.
Patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) and normal controls (n = 17) were tested twice, about 2 months apart, on a modified Stroop colour-naming task, which presented anxiety-related, depression-related and neutral words in masked and unmasked exposure conditions. GAD patients received cognitive behaviour therapy in the test-retest interval, and were also retested at follow-up, about 20 months after initial testing. GAD patients showed interference in colour-naming negative words across both masked and unmasked conditions before treatment, but not post-treatment, compared with controls. Reduced interference effects of masked threat words over time correlated with reduced ratings of anxious thoughts at post-treatment, and at follow-up, in GAD patients. Thus, the preconscious bias for threat information in GAD appears to vary over time in association with changes in anxious thoughts and worries.
Information processing was examined in a sample of social phobic individuals using a revised version of the Stroop color-naming task. In the first of two experiments, the response latencies of social phobics and matched community controls were compared when color-naming socially threatening words, physically threatening words and color words. Social phobics demonstrated greater response latencies regardless of type of stimulus word and additional interference in color-naming social threat words compared to the control group. The second experiment examined the cognitive structural change that has been hypothesized to accompany successful treatment of individuals with an anxiety disorder. Social phobics who were treated with cognitive-behavioral group therapy, phenelzine or pill placebo were classified as treatment responders or nonresponders, and their latencies to color-naming on the Stroop task were compared. Treatment responders showed a significant reduction in latencies to color-name social threat words (vs matched control words) while nonresponders did not. This effect was not demonstrated with color words or physically threatening words. Clinical implications and future research directions are discussed.
Though many neuroscientific methods have been brought to bear in the search for functional specializations within prefrontal cortex, little consensus has emerged. To assess the contribution of functional neuroimaging, this article reviews patterns of frontal-lobe activation associated with a broad range of different cognitive demands, including aspects of perception, response selection, executive control, working memory, episodic memory and problem solving. The results show a striking regularity: for many demands, there is a similar recruitment of mid-dorsolateral, mid-ventrolateral and dorsal anterior cingulate cortex. Much of the remainder of frontal cortex, including most of the medial and orbital surfaces, is largely insensitive to these demands. Undoubtedly, these results provide strong evidence for regional specialization of function within prefrontal cortex. This specialization, however, takes an unexpected form: a specific frontal-lobe network that is consistently recruited for solution of diverse cognitive problems.
The present report used functional magnetic resonance imaging (fMRI) to examine the neural correlates of thought suppression. Subjects were imaged while alternately (i) attempting to suppress a particular thought, (ii) attempting to suppress all thoughts, or (iii) thinking freely about any thought. Suppression of a particular thought, when compared to the free-thought control condition, revealed greater activation in the anterior cingulate. When the task of suppressing all conscious thoughts was compared to free-thought, a more distributed network of brain regions, including the anterior cingulate and the insula, was activated. These findings are consistent with previous research on cognitive control and may provide potential insights into psychological disorders involving recurring, intrusive thoughts.
The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.
Functional neuroimaging studies have implicated hyperactivity of the frontal cortex in obsessive-compulsive disorder (OCD); however, relationships between abnormal brain activity, clinical improvement, and neuropsychological function have not been clarified in OCD. To clarify the pathophysiology of this disorder, regional changes in brain function were examined during administration of cognitive and symptom provocation tasks in patients with OCD before and after treatment.
Ten outpatients with OCD participated in the study. Functional magnetic resonance imaging (fMRI) was performed before and after treatment. Stroop and symptom provocation tasks were administered during fMRI. Each patient was randomly allocated to receive either pharmacotherapy with fluvoxamine 200 mg/day (n = 4) or behavior therapy (n = 6) for 12 weeks.
After 12-week treatment, mean (+/- SD) total score on the Yale-Brown Obsessive-Compulsive Scale decreased from 29.00 +/- 3.59 to 14.60 +/- 9.22, representing symptomatic improvement from moderate to mild. After symptom improvement, symptom provocation-related activation in the orbitofrontal, dorsolateral-prefrontal, and anterior cingulate cortices decreased. Conversely, Stroop task-related activation in the parietal cortex and cerebellum increased.
After improvement of OCD with either fluvoxamine or behavioral therapy, hyperactivation of the frontal lobe related to a symptom-provocative state decreases, and posterior brain activity related to action-monitoring function increases.
Dual process models offer powerful accounts of cognitive phenomena in social and personality psychology but they have not been widely adapted to clinical phenomena. This review presents a dual process model of cognitive vulnerability to unipolar depression. According to dual process theories, humans possess two modes of information processing. An associative mode involves quick, effortless processing that rests on well-learned associations. A reflective mode involves slow, effortful processing that rests on symbolic rule-based inferences. Whereas the associative mode occurs automatically, the reflective mode operates when expectancies are violated and sufficient cognitive resources are available to respond. A cognitive vulnerability to depression is observed when negatively biased associative processing is uncorrected by reflective processing. The circumstances when this is likely to occur are reviewed. New insights and implications for assessment, etiology, and treatment of cognitive vulnerability to depression are discussed.
Cognitive vulnerability is a central concept in cognitive theories of unipolar depression. This idea suggests that negative cognitive factors emerge during stressful situations, and that this cognitive reactivity is critical for the onset, relapse, and recurrence of depression. The number of empirical investigations that model the diathesis-stress nature of cognitive reactivity has substantially increased within the last decade. This review examines this literature, with a focus on priming and longitudinal designs. Extant research supports the concept of cognitive vulnerability to depression among adults, and support is accruing for the validity of this concept among children. Research that examines direct links between cognitive vulnerability and depression onset, relapse, and recurrence and the attachment origins of cognitive vulnerability is also accruing, although at a slower pace.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Recent studies suggest that cognitive and behavioral interventions have enduring effects that reduce risk for subsequent symptom return following treatment termination. These enduring effects have been most clearly demonstrated with respect to depression and the anxiety disorders. It remains unclear whether these effects are a consequence of the amelioration of the causal processes that generate risk or the introduction of compensatory strategies that offset them and whether these effects reflect the mobilization of cognitive or other mechanisms. No such enduring effects have been observed for the psychoactive medications, which appear to be largely palliative in nature. Other psychosocial interventions remain largely untested, although claims that they produce lasting change have long been made. Whether such enduring effects extend to other disorders remains to be seen, but the capacity to reduce risk following treatment termination is one of the major benefits provided by the cognitive and behavioral interventions with respect to the treatment of depression and the anxiety disorders.
A thorough investigation of the neural effects of psychotherapy is needed in order to provide a neurobiological foundation for widely used treatment protocols. This paper reviews functional neuroimaging studies on psychotherapy effects and their methodological background, including the development of symptom provocation techniques. Studies of cognitive behavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistent in showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similar effects were observed after successful intervention with selective serotonin reuptake inhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms of psycho- and pharmacotherapy. These findings are discussed in the context of current neurobiological models of anxiety disorders. Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects. Further studies with larger patient numbers, use of standardised imaging protocols across studies, and ideally integration with molecular imaging are needed to clarify the remaining contradictions. This effort is worthwhile because functional imaging can then be potentially used to monitor treatment effects and aid in the choice of the optimal therapy. Finally, recent advances in the functional imaging of hypnosis and the application of neurofeedback are evaluated for their potential use in the development of psychotherapy protocols that use the direct modulation of brain activity as a way of improving symptoms.
Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse.
To examine whether mood-linked changes in dysfunctional thinking predict relapse in recovered patients who were depressed.
In phase 1 of this study, patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. In phase 2, patients who achieved clinical remission underwent sad mood provocation and were then observed with regular clinical assessments for 18 months.
Outpatient psychiatric clinics at the Centre for Addiction and Mental Health, Toronto, Ontario.
A total of 301 outpatients with major depressive disorder, aged 18 to 65 years, participated in phase 1 of this study and 99 outpatients with major depressive disorder in remission, aged 18 to 65 years, participated in phase 2.
Occurrence of a relapse meeting DSM-IV criteria for a major depressive episode as assessed by the longitudinal interval follow-up evaluation and a Hamilton Depression Rating Scale score of 16 or greater.
Patients who recovered through antidepressant medication showed greater cognitive reactivity following the mood provocation than those who received cognitive behavior therapy. Regardless of type of prior treatment, the magnitude of mood-linked cognitive reactivity was a significant predictor of relapse over the subsequent 18 months. Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated.
The vulnerability of remitted depressed patients for illness relapse may be related to the (re)activation of depressive thinking styles triggered by temporary dysphoric states. This is the first study to link such differences to prognosis following successful treatment for depression. Further understanding of factors predisposing to relapse/recurrence in recovered patients may help to shorten the potentially lifelong course of depression.