Spanish-language measures of mania and depression

Efforts to better understand bipolar spectrum disorders across ethnic groups are often hampered by the lack of commonly used self-report instruments to assess mania and depression in individuals who speak languages other than English. This article describes the translation into Spanish of 2 self-report measures of manic symptoms (i.e., the Internal State Scale and the Hypomanic Personality Scale) and 2 self-report measures of depression (i.e., the Inventory to Diagnose Depression and the Inventory to Diagnose Depression, Lifetime version). The authors translated these measures into Spanish and assessed their psychometric properties among bilingual college students (N = 88). Results suggest that the Spanish versions have psychometric properties comparable to the English versions of the instruments.     

Life events as predictors of mania and depression in bipolar I disorder

To date, few prospective studies of life events and bipolar disorder are available, and even fewer have separately examined the role of life events in depression and mania. The goal of this study was to prospectively examine the role of negative and goal-attainment life events as predictors of the course of bipolar disorder. One hundred twenty-five individuals with bipolar I disorder were interviewed monthly for an average of 27 months. Negative and goal-attainment life events were assessed with the Life Events and Difficulties Schedule. Changes in symptoms were evaluated using the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Scale. The clearest results were obtained for goal-attainment life events, which predicted increases in manic symptoms over time. Negative life events predicted increases in depressive symptoms within regression models but were not predictive within multilevel modeling of changes in depressive symptoms. Given different patterns for goal attainment and negative life events, it appears important to consider specific forms of life events in models of bipolar disorder.     

Relational-developmental therapy group for postnatal depression

Postnatal depression has been estimated to affect as many as 30% of childbearing women. Emerging evidence offers reason to believe that psychoanalytically-oriented group treatment may be beneficial for some women with postnatal depression. This study was designed to evaluate the effectiveness of one model of analytic group therapy for this clinical population. Our findings suggest that the women had a positive response to the group treatment. The particulars of the psychoanalytic group approach, here referred to as relational-developmental, are described in detail and an analysis is offered about why this approach may be beneficial. Also discussed are limitations of the research design and suggestions for studying a relational-developmental group-centered prevention program for children at-risk from postnatal depression.     

Cognitive responses to failure and success relate uniquely to bipolar depression versus mania

This project examined cognitive responses to failure and success and their association with depression and mania within bipolar disorder. Many cognitive variables that are associated with unipolar depression have been found to be involved in bipolar disorder, more specifically bipolar depression. This research was the first to examine tendencies to hold high standards, engage in self-criticism, and generalize from failure to an overall sense of self-worth. In Study 1, undergraduates were screened for risk of mood disorders and completed structured diagnostic interviews. History of bipolar spectrum disorders and history of depression had separate associations with negative generalization. The association of generalization with bipolar spectrum disorders was accounted for by current depressive symptoms. For Study 2, the authors developed a measure of the tendency to engage in positive generalization following success experiences. In a sample of 276 undergraduates, this measure related uniquely to risk for mania. Results of these 2 studies suggest that responses to failure are associated with a history of depression, whereas responses to success are associated with a risk for mania. Implications for future research and clinical work are discussed.     

The neuropsychology of depression and its implications for cognitive therapy

The past few years have witnessed a growing interest in the specialty of neuropsychology as well as continued support for cognitive therapy of depression. The purpose of this paper is the examination of the neuropsychology of depression and its implications for A. T. Beck's cognitive theory and therapy of depression ([1963] Thinking and Depression: Idiosyncratic Content and Cognitive Distortions,Archives of General Psychiatry, Vol. 9, pp. 324–333; [1964] Thinking and Depression,Archives of General Psychiatry, Vol. 10, pp. 561–571; [1967]Depression: Clinical, Experimental, and Theoretical Aspects, New York: Harper & Row). Specifically, the neuropsychological and cognitive theory and therapy literatures related to depression are reviewed followed by an antegration of these areas. Neuropsychological evidence is presented that both supports cognitive theory and therapy of depression and helps explain why such therapy may prove ineffective in treating depression. Implications for clinical practice, including neuropsychological assessment of depressives, and potential future research directions are also provided.     

Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.     

Prediction of outcome with group cognitive therapy for depression

This paper tested a social-cognitive model of depressive episodes and their treatment within a predictive study of treatment response. Clinically depressed volunteers were given self-efficacy questionnaires and other measures before and after they were treated with cognitive therapy, and their progress was monitored over the succeeding 12 months. Improvements in depression during treatment were closely associated with self-efficacy regarding control of mood and with self-monitored levels of negative cognition. Remission over the following 12 months was predicted by the initial response to treatment, by a shorter duration of the episode prior to treatment, and by a post-treatment assessment of self-efficacy regarding control of negative cognition. Self-efficacy remained a significant predictor after post-treatment depression scores and episode duration were entered in a prediction equation. However, a programme of additional treatment based on the depression model did not result in improved depression status. Apart from the failure of the additional treatment, the results are consistent with a social-cognitive model of depressive episodes that emphasises the role of self-efficacy and skills regarding control of negative moods.     

Treatment outcome of a group cognitive therapy program for depression

A 12-session group program of cognitive therapy, designed by the first author, was evaluated with 35 persons suffering from major or minor depressive disorders. Effect-size scores were generated using the method of Nietzel, Russel, Hemmings, and Gretter (1987) and compared with cut-off points calculated using the method of Jacobson and Revenstorf (1988) and the norms established by Nietzel et al. (1987) in their meta-analysis. The effects of the Group Cognitive Therapy Program were found to be clinically significant according to the criteria of Jacobson and colleagues (Jacobson and Revenstorf, 1988; Jacobson, Follette and Revenstorf, 1984) for 73% of patients. It is concluded that the Group Cognitive Therapy Program is a clinically efficacious and cost-effective treatment for persons suffering from nonpsychotic, primary, unipolar depression.     

Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression

The psychological consequences of traumatic stress may last even into old age. In persons in their 60s and 70s who had been victims of political detention and torture four decades ago, we compared the outcome of narrative exposure therapy (NET) to that of psychoeducation (PED) only. From a group of 59 former political detainees, 18 who fulfilled the full PTSD criteria according to the Composite International Diagnostic Interview (CIDI) were offered and accepted participation in the treatment study. The participants were randomly assigned to either one session of PED (n=9) or five sessions of NET (n=9). Symptoms of PTSD (CIDI) and depression (Beck Depression Inventory, BDI) were assessed prior to treatment and after a 6-month follow-up. NET but not PED produced a significant reduction in post-traumatic symptoms and depression scores. Four out of 9 of those who completed NET, compared to 8/9 of those within the PED group, still had PTSD 6 months after the treatment had ended. These results indicate that NET may lead to the alleviation of post-traumatic and depression symptoms even when the conditions persist for excessive time periods.     

Effects of cognitive therapy for depression on daily stress-related variables

This study used a daily diary design to evaluate depressed patients' changes on daily stress-related variables during cognitive therapy (CT). Patients completed daily diaries on two week-long occasions: after the intake interview and again after the sixth session of CT. Patients also completed a measure of depressive symptoms before every treatment session. After six sessions of CT, patients reported a significant reduction in: (a) depressive symptoms; (b) daily sad affect (SA); (c) daily negative thoughts associated with the day's most stressful event; and (d) SA reactivity to daily stressors. In addition, patients reported a significant increase in: (e) daily positive affect (PA); and (f) SA reactivity to daily negative thoughts. The results suggest that CT has its intended effects on the daily lives of depressed adults, and highlight the value of a daily diary methodology for research on CT.     

Proneness to hypomania/mania symptoms or depression symptoms and asymmetrical frontal cortical responses to an anger-evoking event

The behavioral approach system (BAS) reflects the propensity to respond to signals of reward, including stimuli associated with safety and goal-oriented attack (e.g., anger). Hypomania/mania has been posited to involve increased BAS activity. In contrast, depression has been posited to involve decreased BAS activity. Building on past research, which suggests that increased left frontal cortical activity is a neurophysiological index of BAS activity, the present research tested the hypotheses that proneness toward hypomania/mania symptoms would be related to increased relative left frontal activity and that proneness toward depression symptoms would be related to decreased relative left frontal activity in response to an anger-evoking event. Results from 67 individuals who had completed a measure of proneness toward these affective symptoms and were exposed to an anger-evoking event supported the hypotheses.     

Anxiety symptom focus in sessions of cognitive therapy for depression

The comorbid patient presents an especially difficult problem to a therapist who is attempting to implement a short-term, focused therapy. The current study investigates the effect of comorbid anxiety on cognitive therapy for depression. Participants were a subset of patients (N=24) assigned to the cognitive therapy arm of a large, randomized, controlled trial of treatment for depression. From intake assessments, patients were classified as having low or high levels of comorbid anxiety. Two videotapes of each patient's therapy sessions were coded. Irrespective of intake anxiety level, more time and effort spent addressing anxiety in session was found to predict less improvement in both depression and anxiety symptoms over the course of treatment.     

Valence specific response reversal deficits and risk for mania

Response reversal deficits are well documented in bipolar disorder (BD). Although frequently construed as an index of reward processing abnormalities, these response reversal deficits might simply result from more general cognitive inflexibility. Given that both are implicated in BD, our goal was to more carefully test whether reversal learning deficits are specific to reward processing or reflect more general cognitive inflexibility. To more carefully assess deficits, a novel variant of the response reversal task was used to separate responses to in reward versus punishment feedback. In addition, while response reversal deficits are well documented in BD, it is still unknown if these deficits are observable in people at risk for the disorder, whose performance would be unconfounded by medication use and illness course. To assess the presence of premorbid response reversal deficits, we tested students at risk for developing BD, as defined by the well-validated Hypomanic Personality Scale. Undergraduates (n?=?99) were randomly assigned to complete either a reward only or a punishment only version of a response reversal task. Mania risk was related to difficulty reversing responses following reward, but not punishment feedback. Findings suggest that a deficit in response reversal may be an index of reward dysregulation in BD, and that this deficit can be observed even in those at high risk for the development of BD.     

Effectiveness of cognitive-behavioral therapy for adolescent depression: a benchmarking investigation

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.