Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression

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.     

Mood induced cognitive and emotional reactivity, life stress, and the prediction of depressive relapse

This study examined a group of participants who were fully remitted from a previous episode of major depressive disorder, and evaluated the role of cognitive and emotional reactivity to a mood challenge, and life stress in the prediction of relapse. Fifty-two participants were evaluated during remission, and their reactivity (i.e., change in dysfunctional attitudes and emotional state) to a depressed mood induction was evaluated. The cohort was followed up 12 months after the initial assessment. Thirty-five percent of the sample experienced a relapse during the follow-up period. Relapse was predicted by higher rates of life stress, and lower levels of emotional reactivity (specifically less reduction in happiness) to the mood induction during the initial assessment. Cognitive reactivity to the mood induction did not predict relapse, nor did the interaction between cognitive reactivity and life stress. These findings are discussed in terms of recent literature suggesting that depression is associated with insensitivity to emotion context, such that depressed individuals display blunted emotional responses to affective stimuli, including sadness-inducing stimuli. These findings suggest that insensitivity to emotional context may also be a characteristic of euthymic individuals at risk of relapse.     

The Implicit Relational Assessment Procedure as a Measure of Implicit Depression and the Role of Psychological Flexibility

A broad implicit measure of depressive emotional reactions was created by mapping the content of the depression scale from the Depression Anxiety and Stress Scale (DASS) on to the Implicit Relational Assessment Procedure (IRAP). Participants were asked to relate pairings of antecedents and emotional reactions that followed the formula “When X happens . . . I feel Y.” Groups of participants representing the low and high extremes of normative levels of depressive symptoms completed an IRAP before and after a sad mood–induction procedure. At baseline both groups produced a positive emotional response bias on the IRAP. After the sad mood induction, the “normal” group showed no change, whereas the “mild/moderate” depression group showed a significant decrease in the positivity of their emotional responses. A similar pattern of differential change was found when groups were created using scores on the AAQ-II. The findings are related to the broader literature on cognitive reactivity and implications for future research are considered.     

Cognitive reactivity, dysfunctional attitudes, and depressive relapse and recurrence in cognitive therapy responders

Dysfunctional attitudes can foreshadow depressive relapse/recurrence. Priming mood, through induction paradigms, is hypothesized to activate dysfunctional attitudes. Cognitive reactivity (CR) refers to mood-linked increases in dysfunctional attitudes after priming. Here we explored the extent to which CR as well as residual, unprimed, dysfunctional attitudes predicted depressive relapse/recurrence among depressed patients who responded to acute phase cognitive therapy (CT). Consenting adults, aged 18–70, with recurrent major depressive disorder (n = 523) participated in a two-site randomized controlled trial examining the durability of continuation phase treatments. Patients received 16–20 sessions of CT. Among the 245 incompletely remitted responders, 213 agreed to undergo a mood induction paradigm. After 8 months of continuation phase treatments, participants were followed an additional 24 months. Although the mood induction significantly lowered mood in 80% of responders, the expected CR was not evident. By contrast, higher unprimed dysfunctional attitudes following CT did predict relapse/recurrence over 20 and 32 months post-randomization. The findings of this large longitudinal study of incompletely remitted CT responders challenge the notion that it is necessary to prime mood in order to maximize dysfunctional attitudes’ prediction of relapse and/or recurrence. While findings cannot be generalized beyond CT responders, they emphasize the clinical importance of reducing dysfunctional attitudes in preventing depression.     

5-HTTLPR,HTR1A,and HTR2A cumulative genetic score interacts with mood reactivity to predict mood-congruent gaze bias

Genetic variation within the serotonin system has been associated with biased attention for affective stimuli and, less consistently, with vulnerability for major depressive disorder. In particular, 5-HTTLPR, HTR1A (rs6295), and HTR2A (rs6311) polymorphisms have been linked with biased cognition. The present study developed a serotonergic cumulative genetic score (CGS) that quantified the number of risk alleles associated with these candidate polymorphisms to yield a single CGS. The CGS was then used to model genetic influence on the relationship between reactivity to a negative mood induction and negatively biased cognition. A passive-viewing eye-tracking task was administered to 170 healthy volunteers to assess sustained attention for positive, dysphoric, neutral, and threatening scenes. Participants were then induced into a sad mood and readministered the passive-viewing task. Change in gaze bias, as a function of reactivity to mood induction, was the primary measure of cognitive vulnerability. Results suggest that, although none of the individual genes interacted with mood reactivity to predict change in gaze bias, individuals with higher serotonin CGS were significantly more likely to look toward dysphoric images and away from positive images as mood reactivity increased. These findings suggest that a CGS approach may better capture genetic influences on cognitive vulnerability and reaffirm the need to examine multilocus approaches in genomic research.     

Self-esteem and depression revisited: implicit positive self-esteem in depressed patients?

The cognitive behavioural model of depression holds that negative cognitions related to the self have etiological importance for the maintenance and relapse of depression. This has been confirmed by research using questionnaires. Recent research using the Implicit Association Test, however, showed positive implicit self-esteem in formerly depressed participants, even after negative mood induction [Gemar, Segal, Sagrati, & Kennedy (2001). Mood-induced changes on the implicit association test in recovered depressed patients. Journal of Abnormal Psychology, 110, 282-289]. These results are not in line with cognitive theory of depression. Since this could be an artifact of the specific procedure that was used, we investigated implicit self-esteem of currently depressed participants and healthy controls using three different paradigms: The Implicit Association Test, the Name Letter Preference Task, and the Extrinsic Affective Simon Task. The results of the three experiments are unequivocally indicative of positive implicit self-esteem in currently depressed patients. However, it remains an intriguing question what exactly these indirect measures assess.     

Risk factors for nonsuicidal self‐injury in Japanese college students: The moderating role of mood regulation expectancies

Self‐injurious behavior is increasing among college students, and is common in both psychiatric and nonclinical populations. People's engaging in self‐injury is associated with childhood maltreatment, poor negative mood regulation expectancies, and depression. During times of distress, maltreated children without healthy coping strategies tend to have impairment in mood regulation, which contributes to engaging in self‐injury. This study investigated differences between nonsuicidal self‐injury (NSSI) and non‐self‐injury groups in history of childhood maltreatment, negative mood regulation expectancies, and depression in a sample of Japanese college students. We also assessed risk factors for self‐injurious behavior, including mood regulation expectancies as a moderator of the relationship between childhood maltreatment and NSSI. Participants were 313 undergraduate students, who completed anonymous self‐report questionnaires—Deliberate Self‐Harm Inventory, Child Abuse and Trauma Scale, Negative Mood Regulation Scale, and short version of the Center for Epidemiological Studies–Depression Scale. Ten percent (n = 31) of all participants had injured themselves. Consistent with past literature, participants with self‐injury history reported more severe childhood maltreatment, poorer mood regulation expectancies, and more depression, compared to non‐self‐injurers. Frequency of NSSI positively correlated with childhood maltreatment and depression, and negatively correlated with negative mood regulation expectancies. Regression analysis revealed that stronger expectancies for negative mood regulation interacted with maltreatment to predict self‐injury: More maltreatment was associated with more self‐injury, particularly among those with weaker expectancies. Results suggested childhood maltreatment, low expectancies for negative mood regulation, and depression predicted self‐injury. Consistent with our moderation hypothesis, strong expectancies for negative mood regulation buffered the effects of childhood maltreatment, reducing the risk for self‐injury.     

Mood Induction in Children: Effect of the Affective Valence of a Text on Phonological Working Memory

The influence of mood on working memory capacity has been investigated in adults, albeit with conflicting results, but remains relatively unexplored in children. The present study examined the effect of a mood induction procedure on phonological working memory capacity in fourth and fifth graders. An initial working memory span test was followed first by a collective mood induction procedure, then by a second working memory span test. Results showed an effect of mood induction procedure on phonological working memory performances, with decreasing scores in the case of negative mood. These results suggest that, in certain contexts and situations, negative emotion has an impact on children’s cognitive abilities.     

Activation of latent self-schemas as a cognitive vulnerability factor for depression: The potential role of implicit self-esteem

To date, only two studies have investigated implicit self-esteem in depressed individuals. Surprisingly, both studies found evidence not in line with the cognitive theory of depression. We wanted to test whether these findings are replicable by investigating implicit self-esteem using the Implicit Association Test in currently depressed (CD), never depressed controls (ND), and formerly depressed individuals (FD). The latter two groups were tested before and after a negative mood induction. The results are in line with the previous two studies suggesting no difference in implicit self-esteem between CD patients and ND controls. Moreover, before mood induction, FD individuals evidenced a higher implicit self-esteem as compared to the two other groups. Compared to ND participants, FD individuals showed a significant drop in implicit self-esteem after the negative mood induction procedure, but this was due to the higher implicit self-esteem of FD before the mood induction. These results are discussed in the light of new perspectives on implicit self-esteem and depression.     

Cognitive vulnerability to depression in never depressed subjects

The purpose of this study was to investigate whether dysfunctional cognitions could be measured in never-depressed individuals after a sad mood prime, and if these dysfunctional cognitions would predict future depression. Subjects were first screened for current or past depression. Never-depressed subjects were randomly assigned to a prime or no-prime condition and completed the Dysfunctional Attitudes Scale. After one month, subjects completed the Beck Depression Inventory. The mood induction was successful in producing a sad mood, but had no effect on accessibility of dysfunctional cognition. Dysfunctional cognitions did predict depressive symptoms one month later, for the women in the sample, but not the men. These results were actually stronger for the unprimed subjects. The results provide some support for the cognitive diathesis-stress model, and suggest that cognitive vulnerability to depression may exist prior to a clinically significant depressive episode. However, mood priming does not appear to be a useful strategy with never-depressed subjects.     

Is manipulation of mood a critical component of cognitive bias modification procedures?

This paper investigates whether changes in mood state are an important component of cognitive bias modification (CBM) procedures. In a novel CBM procedure participants read either positive or negative statements relating to social issues for 5 min. Interpretation bias was measured by means of a scrambled sentence test, which was presented both before and after the CBM procedure. Participants who read the positive statements made more positive resolutions to the scrambled sentences, while participants who read the negative statements made more negative resolutions. Thus, the appropriate positive and negative interpretative biases were induced by the CBM procedure. However, significant mood changes also occurred following CBM. In Experiment 2, a musical mood induction procedure was presented with depressing or elating music. As before, a scrambled sentence test was presented both before and after the musical mood induction. Mood changed in accordance with the valence of the music to the same extent as with CBM. Critically however, performance on the scrambled sentence task did not change for both groups. This demonstrates that a change in mood state is not sufficient for a change in cognitive bias to occur.     

Cognitive reactivity as outcome and working mechanism of mindfulness-based cognitive therapy for recurrently depressed patients in remission

Major depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy (MBCT) with treatment-as-usual (TAU) on cognitive reactivity in recurrently depressed patients (N?=?115). Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group (d?=?.51). The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminary evidence that cognitive reactivity is a working mechanism of MBCT.     

Effects of Rumination and Mindful Self-Focus Inductions During Daily Life in Patients With Remitted Depression: An Experimental Ambulatory Assessment Study

Rumination has been proposed as an important risk factor for depression, whereas mindful attention is considered a protective form of self-focusing. Experimental studies have demonstrated differential effects of these modes when induced in the lab. However, their impact on daily life processes is poorly understood, particularly in individuals vulnerable to depressive relapses. The aim of our study was to examine short- and longer-term effects of repeated brief rumination and mindful self-focus inductions during daily life on momentary mood, cognitions, and cortisol in patients with remitted depression (rMDD) as well as in healthy individuals, and to identify their potential differential effects in these groups. The study involved repeated short ambulatory inductions of a ruminative or a mindful self-focus during daily life with additional assessments of momentary mood, rumination, self-acceptance, and cortisol over 4 consecutive days in a sample of patients with rMDD (n = 32, ≥2 lifetime episodes, age 19–55 years) and matched healthy controls (n = 32, age 21–54 years). Multilevel models revealed differential immediate effects of the two induction modes on all momentary mood and cognitive outcomes (all p’s < .001), but not on cortisol. Detrimental effects of rumination over mindful self-focus inductions were particularly strong for cognitions in the patient group. Longer-term effects of the inductions over the day were lacking. This study underlines immediate deteriorating effects of an induced ruminative compared to a mindful self-focus on momentary mood and cognitions during daily life in patients with rMDD and in healthy individuals. The observed stronger rumination-related reactivity in patients suggests heightened cognitive vulnerability. Understanding rumination- and mindfulness-based mechanisms of action in real-life settings can help to establish mechanism-based treatment options for relapse prevention in depression.     

Unilateral Facial Contractions Produce Mood Effects on Social Cognitive Judgements

Abstract

This study demonstrates that left and right unilateral facial contractions have similar effects on the expression of ethnic stereotypes as do negative and positive moods induced by more conventional means. Subjects who con tracted the left side of their face (negative mood inducer) were more likely to express negative stereotypes of ethnic groups than were subjects who contracted the right side of their face (positive mood inducer). This parallels previous findings obtained using two standard mood inductions: the Veltens mood induction procedure; and a musical mood induction procedure. Given that unilateral facial contractions manipulate mood without cognitive involvement, this mood induction may have advantages over previously used procedures, the effects of which are subject to cognitive mediation explanations. In addition, these results suggest that, at least for the expression of ethnic stereotypes, mood's influence on cognition does not depend on a cognitive component of mood induction.     

Teasdale's differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour

Teasdale's differential activation hypothesis (DAH) has been proposed as one account of cognitive vulnerability to depression. This view holds that important factors determining whether one's initial depression becomes more severe or persistent are the degree of activation, and content, of negative thinking patterns that become accessible in the depressed state. This phenomenon has been referred to as cognitive reactivity. Empirical support for the predictions of this model derives from a combination of cross-sectional and prospective studies. In this article, we evaluate this evidence with the goal of determining whether mood-induced cognitive reactivity can be considered a risk factor for depressive relapse/recurrence. Our review demonstrates sufficient evidence to consider cognitive reactivity as a potential causal risk factor for depressive relapse/recurrence. Furthermore, we extend the application of this model to the problem of suicidal relapse/recurrence including a review of preliminary support for this approach.     

Mood and memories of parental rearing styles: A comparison of mood effects on questionnaire-cued and free recall of autobiographical memories

The relationship between memories of childhood experiences (e.g., adverse parenting) and adult depression often found raises questions of interpretation. On the one hand, both laboratory studies and clinicians' experiences suggest that subjects in a depressed mood frequently show a negative bias in perceptions and memories. Negative childhood memories in depressed persons might, therefore, be interpreted as epiphenomena of depressed mood instead of etiological factors. On the other hand, memories of childhood experiences seem remarkably stable across changes in depressed mood, especially when memories are elicited by means of standardized questionnaires. In the mood and memory literature several explanations for this stability are offered. For one thing, highly structured cues to elicit memories (such as in questionnaires) are hypothesized to be less susceptible to mood bias than unstructured memory cues (such as in free recall procedures). On the other hand, resource allocation theorists suggest that childhood memories, being well established and rehearsed, are relatively impervious to mood bias no matter how they are elicited. In this study we examined whether different methods of eliciting childhood memories (i.e., free recall and questionnaire-cued) are differentially susceptible to mood bias. To this aim, we used a mood induction procedure to induce depressed, neutral, and elated mood and assessed childhood memories both before and after the mood induction using both questionnaires and free recall to elicit memories. Results suggested that memories elicited by means of free recall as well as by means of questionnaire-cued recall were susceptible to depressed and elated mood bias. The implications for research addressing the link between childhood experiences and depression are discussed.     

Daily affective reactivity as a prospective predictor of depressive symptoms

Daily affective reactivity refers to the within-subject relationship between daily stress and daily mood. Most stress researchers have conceptualized daily affective reactivity as a dependent variable to be predicted by individual difference variables such as personality and psychopathology. In contrast, in our recent research, we have conceptualized daily affective reactivity as an independent variable that can predict depressive symptoms. In this article, we summarize three studies that relied on a daily process methodology and multilevel modeling to assess affective reactivity in the context of daily stressful events. Two of the studies (Cohen, Butler, Gunthert, & Beck, 2005; Gunthert, Cohen, Butler, & Beck, 2005) sampled adult outpatients in cognitive therapy and evaluated the predictive role of daily affective reactivity in treatment outcome (depression reduction). A third study (O'Neill, Cohen, Tolpin, & Gunthert, 2004) evaluated the predictive role of college students' daily affective reactivity in the development of depressive symptoms. We consider the strengths and weaknesses of a daily process methodology for research on depression in both clinical and nonclinical samples.     

Cognitive reactivity mediates the relationship between neuroticism and depression

Although neuroticism has long been established as an important risk factor for depression, the mechanisms through which this temperamental predisposition translates into the occurrence of symptoms are still relatively unclear. This study investigated cognitive reactivity, i.e. the ease with which particular patterns of negative thinking are reactivated in response to mild low mood, as a potential mediator. Individuals with (N = 98) and without a previous history of depression (N = 83) who had provided neuroticism scores six years previously were assessed for cognitive reactivity and current symptoms of depression using self-report questionnaires. Tendencies to respond to mild low mood with ruminative thinking mediated the relation between neuroticism and current symptoms of depression in both groups. Reactivation of hopelessness and suicidal thinking occurred as an additional mediator only in those with a history of previous depression. The results suggest that neuroticism predisposes individuals to depression by generally increasing the likelihood of ruminative responses to low mood. In those with a history of depression in the past, neuroticism additionally increases risk of recurrence by facilitating reactivation of previously associated patterns such as suicidal thinking and hopelessness. These findings suggest potential targets for interventions to help preventing the occurrence, or recurrence of depression in those who due to their temperamental predisposition are at an increased risk.     

Recalling happy memories in remitted depression: A neuroimaging investigation of the repair of sad mood

Major depressive disorder (MDD) is a recurrent mood disorder. The high rate of recurrence of MDD suggests the presence of stable vulnerability factors that place individuals with a history of major depression at an increased risk for the onset of another episode. Previous research has linked the remitted state, and therefore increased vulnerability for depressive relapse, with difficulties in the use of pleasant autobiographical memories to repair sad mood. In the present study, we examined the neural correlates of these difficulties. Groups of 16 currently euthymic, remitted depressed individuals and 16 healthy (control) women underwent functional magnetic resonance imaging (fMRI) during sad mood induction and during recovery from a sad mood state through recall of mood-incongruent positive autobiographical memories. Sad mood was induced in participants by using film clips; participants then recalled positive autobiographical memories, a procedure previously shown to repair negative affect. During both the sad mood induction and automatic mood regulation, control participants exhibited activation in the left ventrolateral prefrontal cortex (vlPFC) and cuneus; in contrast, remitted participants exhibited a decrease in activation in these regions. Furthermore, exploratory analyses revealed that reduced activation levels during mood regulation predicted a worsening of depressive symptoms at a 20-month follow-up assessment. These findings highlight a dynamic role of the vlPFC and cuneus in the experience and modulation of emotional states and suggest that functional anomalies of these brain regions are associated with a history of, and vulnerability to, depression.