Behaviour Research and Therapy最新文献

Objective

Rumination is a major risk factor for the onset and recurrence of depressive episodes and has been associated with deficits in updating working memory content. This randomized controlled trial examines whether training updating-specific cognitive control processes reduces daily ruminative thoughts in clinically depressed individuals.

Methods

Sixty-five individuals with a current major depressive episode were randomized to 10 sessions of either cognitive control training (N = 31) or placebo training (N = 34). The frequency and negativity of individuals’ daily ruminative thoughts were assessed for seven days before training, after training, and at a 3-month follow-up using experience sampling methodology. Secondary outcomes were depressive symptoms, depressed mood, and level of disability.

Results

Cognitive control training led to stronger improvements in the trained task than placebo training. However, cognitive control training did not lead to greater reductions in the frequency or negativity of daily ruminative thoughts than placebo training. There were no training-specific effects on participants' depressive symptoms or level of disability.

Conclusions

The robustness of the present null-findings, combined with the methodological strengths of the study, suggest that training currently depressed individuals to update emotional content in working memory does not affect the frequency or negativity of their daily ruminative thoughts.

Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8–12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.

Given that emotion regulation difficulties confer risk for poor responses to stress, they may predict who is at risk for adverse psychological reactions to major, chronic stressors such as the COVID-19 pandemic. Specific adverse reactions to the pandemic may include more severe traumatic stress, anxiety, and excessive safety behavior use (i.e., hand washing). While emotion regulation difficulties may be a diathesis for adverse reactions to chronic stressors, the context(s) by which they may confer elevated risk is unclear. Accordingly, the present longitudinal study examined the interaction between pre-pandemic emotion regulation difficulties and early pandemic perceived stress in predicting subsequent COVID-related traumatic stress, anxiety, and safety behavior use over 32 weeks of the pandemic. Community adults (N = 145) who completed a measure of emotion regulation in 2016 as part of a larger study were recontacted at the start of the pandemic (March 2020) and assessed every two weeks for 32 weeks. Consistent with a diathesis-stress model, the interaction between difficulties in emotion regulation and perceived stress was significant in predicting COVID-19 anxiety (p = 0.003, d = 0.52) such that at high, but not low, levels of perceived stress, difficulties in emotion regulation in 2016 significantly predicted higher COVID-19 anxiety in 2020. The interaction between difficulties in emotion regulation in 2016 and perceived stress early in 2020 approached significance in predicting COVID-19 traumatic stress (p = 0.073, d = 0.31) and safety behavior use (p = 0.069, d = 0.31). These findings highlight that current perceived stress is an important context that potentiates the effects of preexisting emotion regulation difficulties on the emergence of anxiety-related symptoms during COVID-19, which has important implications for diathesis-stress models of adverse reactions to chronic stressors.

Previous work has shown that adults suffering from major depressive disorder (MDD) can increase their amygdala reactivity while recalling positive memories via real-time neurofeedback (rt-fMRI-nf) training, which is associated with reduction in depressive symptoms. This study investigated if this intervention could also be considered for patients suffering from MDD who do not respond to standard psychological and pharmacological interventions, i.e., treatment resistant (TR-MDD).

15 participants received 5 neurofeedback sessions. Outcome measures were depressive symptoms assessed by BDI scores up to 12 weeks following acute intervention, and amygdala activity changes from initial baseline to final transfer run during neurofeedback sessions (neurofeedback success).

Participants succeeded in increasing their amygdala activity. A main effect of visit on BDI scores indicated a significant reduction in depressive symptomatology. Percent signal change in the amygdala showed a learning curve during the first session only. Neurofeedback success computed by session was significantly positive only during the second session. When examining the baseline amygdala response, baseline activity stabilized/asymptoted by session 3.

This proof-of-concept study suggests that only two neurofeedback sessions are necessary to enable those patients to upregulate their amygdala activity, warranting a future RCT. Over the course of the rtfMRI-nf intervention, participants also reported reduced depressive symptomatology.

Clinical trial registration number: NCT03428828 on ClinicalTrials.gov.

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.

The extended process model of emotion regulation provides a framework for understanding how emotional experiences and emotion regulation (ER) mutually influence each other over time. To investigate this reciprocal relationship, 202 adults completed a ten-day experience-sampling survey capturing levels of negative affect (NA) experience and use of ten ER strategies in daily life. Residual dynamic structural equation models (DSEMs) were used to examine within-person cross-lagged and autoregressive effects of NA and ER (strategy use and between-strategy variability). Results showed that NA predicted lower between-strategy variability, lower subsequent use of acceptance and problem-solving, but higher subsequent use of rumination and worry. Moreover, reappraisal and between-strategy variability predicted lower subsequent NA levels, while expressive suppression and worry predicted higher subsequent NA levels. Stable autoregressive effects were found for NA and for maladaptive ER strategies (e.g., rumination and worry). Exploratory correlation analyses revealed positive associations between NA inertia and maladaptive ER strategies. Together, these findings provide evidence of a dynamic interplay between NA and ER. This work deepens how we understand the challenges of applying ER strategies in daily life. Future clinical and translational research should consider these dynamic perspectives on ER and affect.

Contextual renewal of reward anticipation may be one potential mechanism underlying relapse in eating and substance use disorders. We therefore tested retrieval cues, a method derived from an inhibitory retrieval-based model of extinction learning to attenuate contextual renewal using an appetitive conditioning paradigm. A pilot study was carried out in Experiment 1 to validate a differential chocolate conditioning paradigm, in which a specific tray was set up as a conditioned stimulus (CS) for eating chocolate (unconditioned stimulus, US). Using an ABA renewal design in Experiment 2, half of the participants were presented with a retrieval cue in the acquisition phase (group AC) and the other half in the extinction phase (group EC). Presentation of the retrieval cue in the EC was associated with reduced renewal of US-expectancy, while there was a clear renewal effect for US-expectancy in the AC. One limitation was the difference in cue presentations between both groups due to the number of trials in acquisition and extinction. Experiment 3 therefore aimed at replicating the results of Experiment 2, but with fewer cue presentations for the EC to match the AC. No significant group differences were observed indicating no effect of the retrieval cue. Theoretical and clinical implications in light of the differing results are discussed.

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear.

Avoidance of pain has been argued to be key factor leading pain events to chronic disability. In this respect, research has focused on investigating the working mechanisms of avoidance's acquisition. Avoidance of painful stimuli has been traditionally studied using a combination of Pavlovian and Instrumental procedures. However, such approach seems to go against real-life scenarios where avoidance is commonly acquired more readily. Using a novel pain avoidance paradigm, we tested whether pain avoidance can be installed in absence of associations between a cue and pain omission, and whether such avoidance differs between pain patients and healthy controls. Participants first learned to avoid painful stimuli by pressing a grip bar. Then, they passively encountered pairings of one geometrical shape with pain and of another geometrical shape without pain. Lastly, participants encountered the geometrical shapes while being able to use the grip bar. Results showed that participants pressed the bar more vigorously when encountering the previously pain-related shape compared to the pain-unrelated shape. This effect did not seem to differ between pain patients and healthy control. Our study could inspire a new way in measuring avoidance in pain, possibly paving the way to better understanding how avoidance is installed in chronic pain.