Effects of contingencies of self‐worth and sensitivity to indebtedness on optimistic bias in seeking help for depression

The occurrence of the optimistic bias in seeking help for depressive symptoms has been attributed to the threat‐to‐self and equity theories. The current study tested the hierarchical relationships between contingencies of self‐worth (CSW), self‐esteem (SE), sensitivity to indebtedness (SI), and optimistic bias in seeking formal/informal help for depression. An online questionnaire survey was conducted with Japanese university students (n = 1000). Results from structural equation modeling analysis revealed the mediating effect of CSW on SE and optimistic bias. SI was positively related to optimistic bias in symptom recognition and informal help‐seeking. The results suggest that both CSW and SI are responsible for the occurrence of optimistic bias in seeking help for depression. Cognitive patterns in recognizing personal and others' depressive symptoms and needs for seeking help were discussed.     

Depressive symptoms interfere with post-rehabilitation exercise: Outcome expectancies and experience as mediators

The aim of the study was to examine the relationship between depressive symptoms and physical exercise by unveiling how outcome expectancies regarding exercise and positive exercise experience could mediate between depressive symptoms and exercise. A longitudinal study included 178 cardiac and orthopedic rehabilitation patients in Germany. Patients responded to psychometric scales at two points in time with a six-week interval, assessing depressive symptoms (Time 1), outcome expectancies regarding exercise (Time 1), exercise experiences (Time 2), and exercise behavior (Times 1 and 2). Depressive symptoms were negatively related to physical exercise (r?=-?0.18), to positive outcome expectancies (r?=-?0.23), and to positive exercise experiences (r?=-?0.26). In a multiple-step mediation model, expectancies and experiences mediated between depressive symptoms and exercise. In total, 15% of the exercise variance was accounted for. Outcome expectancies and a lack of positive experience seem to partly explain why depressed individuals are less likely to exercise.     

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

Patients’ beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of [a] biochemical causes and [b] need for medication) and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients’ biological beliefs about depression could increase CT efficacy.     

Personal efficacy, external locus of control, and perceived contingency of parental reinforcement among depressed, paranoid, and normal subjects

Bandura (1982) suggested that judgments of personal efficacy and outcome expectancies (i.e., locus of control) jointly affect behavior. We hypothesized that different combinations of these two sets of beliefs would characterize the thought structures of normal subjects and of psychiatric patients suffering from distinctly different disorders. Normal subjects, depressed subjects, and paranoid subjects completed scales with which we measured beliefs in personal efficacy and beliefs that outcomes are controlled either by chance or by powerful others, as well as a scale with which we assessed perceived contingency of parental reinforcement. The major findings were as follows: Normals judged themselves to be more efficacious than did psychiatric subjects; whereas depressives expected outcomes to be controlled by chance, paranoids expected outcomes to be under the control of powerful others; among the normals, outcome expectancies were strongly associated with personal efficacy, but among the psychiatric patients, these beliefs were unrelated; depressives and paranoids equally reported more noncontingent parental reinforcement than did normals; and perceived contingency of parental reinforcement was predictive of outcome expectancies but not of personal efficacy. The data suggest that low personal efficacy may be a distinguishing characteristic of all psychiatric patients, whereas outcome expectancies may determine the specific nature of the psychiatric disorder.     

Stages of Change in Smoking Cessation: A Comparison of Expectancies Among Precontemplators and Contemplators

Previous research has shown that smokers progress through a series of stages of change as they attempt to quit their habit. This study evaluated smokers in the precontemplation and contemplation stages in order to explore how we can effectively facilitate positive stage transition. Precontemplators (n = 71) and contemplators (n = 30) were compared in terms of two types of expectancies: self-efficacy beliefs and response outcome expectancies. Stage of change was defined according to both categorical and continuous dimensions, each of which led to different results. The findings are discussed in terms of their potential applications to smoking cessation programs and their implications regarding the stage model of change.     

Coping-related expectancies and dispositions as prospective predictors of coping responses and symptoms

We used Rotter's (1954, 1982) social learning theory and Kirsch's (1985, 1999) response expectancy extension thereof to clarify distinctions between coping-related expectancies (beliefs about the outcomes of coping efforts) and coping dispositions (tendencies to use particular coping responses), specifically focusing on the role of generalized expectancies for negative mood regulation (NMR) as a predictor of individual differences in coping and well-being. Two studies using structural equation modeling provided support for direct and indirect associations between NMR expectancies and symptoms of depression. In Study 1 NMR expectancies predicted situational avoidance coping responses and symptoms of depression and anxiety, independent of dispositional avoidance coping tendencies. In Study 2, NMR expectancies were associated with depressive symptoms, concurrently and prospectively, independent of dispositional optimism and pessimism. Both studies indicated that NMR expectancies are more strongly associated with depressive symptoms than with symptoms of anxiety and physical illness. Results underscore the importance of distinguishing between expectancies and other personality variables related to coping.     

Parental reports of global physical health at ages 3 and 6 predict self‐reported depressive symptoms 17 years later

Research studies testing longitudinal relations between childhood physical health measures and adulthood sub‐clinical depressive symptoms are rare. In the Cardiovascular Risk in Young Finns Study, longitudinal relations of parental reports of the global physical health of the child (1 = good, 2 = moderately good, 3 = average/not good) and of absent days from daycare due to physical illness during the past year (1 = no absent days, 2 = 1–5 days, 3 = 6–10 days, 4 = 11 days or more) with self‐reported depressive symptoms (a modified version of the Beck Depression Inventory) were studied over 17 years. The sample was population‐based, consisting at the study entry of 3‐ and 6‐year‐olds (n = 567) free of any chronic physical or mental illnesses. The results indicated that parent‐reported global physical health of the child during the childhood period significantly predicted the participant's self‐reported depressive symptom scores at follow‐up 12 and 17 years from the baseline (ps < .03). The risk of having depressive symptom scores at the top quartile of age‐ and gender‐specific distributions at follow‐up 12 and 17 years from the baseline, and both follow‐ups simultaneously was 1.97‐ to 4.49‐fold (95% confidence intervals: 1.15–11.96) for participants with a moderately good to average/not good global physical health at the study entry relative to participants with a good global physical health. Absent days from daycare were not associated with depressive symptoms. Despite its subjectivity, the results support the validity of parental reports and suggest that parent‐reported global physical health rating of the child early in development may indicate a risk for later depressive symptoms.     

A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms

Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression—interpretation bias and attribution style—in adults with varying levels of anxiety and depressive symptoms. Participants (18–26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.     

Depression severity and psychosocial determinants of physical activity behavior in in-patients with major depressive disorders

BackgroundPhysical inactivity is a world-wide health issue. In people with major depressive disorders approximately 68% do not reach the recommended physical activity levels. Psychosocial determinants of and implicit attitudes towards physical activity serve to explain physical activity behavior and may form the basis of interventions to promote physical activity. The aim of this study was to examine, whether psychosocial determinants and implicit attitudes towards physical activity vary according to depression severity.MethodsPhysically inactive, adult in-patients diagnosed with major depressive disorder (according to ICD-10) were recruited from four Swiss psychiatric clinics. Psychosocial determinants of physical activity were assessed with seven questionnaires pertaining to motivational and volitional aspects of physical activity. Implicit attitudes towards physical activity were measured with a computer-based Single Target Implicit Association Test.ResultsIn-patients (N = 215, M_age = 41 ± 13 years, 53% female) with major depressive disorder reporting more severe (n = 52) depression symptomology exhibited less favorable psychosocial determinants for physical activity behavior (self-efficacy, negative outcome expectancies, intention, intrinsic motivation, introjected motivation, external motivation, action planning, perceived barriers, coping planning) compared to those with mild (n = 89) and moderate (n = 74) depression symptomology. Positive outcome expectancies, identified, social support and implicit attitudes towards physical activity did not vary according to depression severity.ConclusionsPsychosocial determinants of physical activity do vary according to depression severity. Attempts to promote physical activity among people with major depressive disorder should take depression severity into account when developing and delivering interventions.Trial registrationISRCTN registry, ISRCTN10469580, registered on 3^rd September 2018, https://www.isrctn.com/ISRCTN10469580.     

The Role of Cardioprotective Avoidance Beliefs in Noncardiac Chest Pain and Associated Emergency Department Utilization

This study examined cardioprotective avoidance beliefs and general panic/agoraphobia variables among 45 Emergency Department patients with a primary complaint of noncardiac chest pain (NCCP) in the absence of coronary artery disease or other medical explanation. Cardioprotective beliefs about the dangerousness of work and physical activity were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Additional measures assessed complaints of cardiac distress and panic, anxiety sensitivity, panic-related beliefs, agoraphobic avoidance, and depressive symptoms. Hierarchical regression analysis indicated that cardiac distress symptoms are a function of panic symptoms and cardioprotective beliefs concerning both physical activity and work, with 62% of the total variance explained. The predictors also explained 57% of the variance in Emergency Department utilization, which was significantly related to cardiac distress symptoms, number of illnesses, and work-avoidance beliefs. Neither outcome was related to demographics, depression symptoms, general anxiety sensitivity, general panic cognitions, or agoraphobic avoidance. Results suggest that current behavioral understandings of NCCP might be advanced by further examination of cardiac-specific avoidance beliefs and behavior and the potential role these factors play in both symptom experience and medical utilization.     

Depressive symptoms are associated with unrealistic negative predictions of future life events

This study examined the relationship between depressive symptoms and bias in the prediction of future life events. Responding to internet announcements, 153 participants varying widely in self-reported depression symptom severity estimated the probability of 40 events occurring over the succeeding 30 days. After the 30-day period, participants reported which events occurred. Optimistic/pessimistic biases were related to level of depressive symptoms. A non-significant optimistic bias characterized participants with low depressive symptoms whereas a significant pessimistic bias characterized participants with high depressive symptoms. Those reporting mild symptoms did not exhibit a systematic pessimistic or optimistic bias. General imprecision in predictions for undesirable events was associated with depressive symptoms. These findings suggest that depression is associated with pessimistic bias rather than accuracy in judgment.     

Newly diagnosed lung cancer patients’ preferences for and beliefs about physical activity prior to chemotherapy

Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients.     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

Efficacy of guided self-help behavioural activation and physical activity for depression: a randomized controlled trial

Behavioural activation and physical activity have received empirical support that highlight their efficacy in reducing depression. Even though both behavioural activation and physical activity share the common goal of reactivating the individual, limited research has directly compared these interventions, and more research is required to evaluate their efficacy when offered in low-intensity formats. The present study involves a randomized controlled clinical trial comparing the efficacy of two guided self-help interventions for the treatment of depression: behavioural activation and physical activity. Fifty-nine participants presenting mild-to-moderate symptoms of depression were randomized either to a behavioural activation intervention (n = 20), a physical activity intervention (n = 19) or a wait-list control group (n = 20). All participants completed symptom measure pre-, mid- and post-intervention, as well as at a two-month follow-up. Mixed-model analyses of variance revealed that both interventions were significantly more efficacious in reducing depressive symptoms in comparison with the control group. Physical activity involved significantly less time-investment compared to the behavioural activation condition (less than half the amount of time). These results indicate that physical activity and behavioural activation both effectively reduce depressive symptoms and are favourably applicable in low-intensity formats. Implications of these results and avenues for future research are discussed.     

Concordance Between Mothers' and Children's Reports of Somatic and Emotional Symptoms in Patients with Recurrent Abdominal Pain or Emotional Disorders

Mother–child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominal pain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominal pain reported more child somatic and depressive symptoms than did their children, and mothers of children with emotional disorders reported more child depressive symptoms than did their children. Higher levels of maternal distress were associated with greater mother-child discordance in the direction of mothers reporting more child symptoms than did their children. No significant child age or sex differences were found in concordance patterns.     

Implicit associations between anxiety-related symptoms and catastrophic consequences in high anxiety sensitive individuals

Anxiety sensitivity refers to the fear of anxiety-related physical sensations arising from beliefs that these sensations have harmful consequences (Reiss & McNally, 1985). The present study examined whether individuals with high (vs. low) anxiety sensitivity show stronger implicit associations in memory between anxiety-related symptoms, as opposed to neutral body parts, and harmful, as compared to harmless, consequences. A total of 22 undergraduate students (14 F, 8 M) completed the Extrinsic Affective Simon Task (EAST; De Houwer, 2003). Results indicated that high anxiety sensitive individuals (n = 10) tended to implicitly associate harmful consequences with anxiety-related symptoms. Their performance was significantly faster on trials where target words related to anxiety symptoms were mapped on to the same response key as harmful consequences. No significant difference in performance was found for low anxiety sensitive individuals (n = 12) or when target words were body parts unlikely related to diseases. Between-group differences persisted after controlling for trait anxiety and history of panic attacks, but not when illness-related beliefs were introduced as a covariate. Identifying this implicit association bias provides additional empirical support for the concept of anxiety sensitivity.     

The Role of Hope in the Psychological Adjustment of Gastropareutic Patients Receiving the Gastric Pacemaker: A Longitudinal Study

Hope, depressive symptoms, anxiety, and physical quality of life (QOL) were assessed in three subgroups of patients receiving the gastric pacemaker. Patients (n = 22) completed questionnaires prior to pacemaker implantation and at 3 and 6 months post-surgery. The idiopathic subgroup reported a significantly greater degree of hope and less anxiety at 6-month follow-up, compared to the diabetes patients. The idiopathic patients also reported significantly less anxiety at 6 months than the postsurgical patients. Across all subgroups, there was an increase in hope and physical QOL, and decrease in depressive symptoms and anxiety, from baseline levels. There was a significant negative relationship between hope and both depressive symptoms and anxiety at baseline and 3- and 6-month follow-up. Presurgical hope level did not significantly predict depressive symptoms or anxiety after implantation. This study provides evidence that the pacemaker improves the physical and psychological health of gastropareutic patients; hope appears to play a role in the psychological adjustment of these patients.     

Effects of Patients' Age,Gender, and Depression on Medical Students' Beliefs,Attitudes, Intentions,and Behavior1

This study examines the effects of patient age, gender, and depression on 88 advanced medical students' beliefs, attitudes, intentions, and behavior. Each subject heard an audiotaped patient portrayal. Patient age (32 or 67 years), gender, and depressive symptoms varied in a 2 × 2 × 2 between-subjects factorial design. All of the patients reported the same symptoms except that half of them also presented symptoms of depression. Questionnaires assessed beliefs about the patient's condition, attitudes toward the patient, treatment intentions, and recall of patient information. Expectations of an age bias were not substantiated. Females were rated less seriously ill, less likely to require laboratory tests, and more likely to receive medication than males. Among depressed patients, counseling and reassurance were more likely for females, and a nonpsychiatric consult was more likely for males. Recall of the symptoms presented was better for depressed patients. The implications for medical practice are discussed.     

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

Differential Determinants of Young Adult Substance Use and High‐Risk Sexual Behavior1

This investigation evaluated how personality traits, self‐efficacy, and outcome expectancies differentially relate to young adult substance use and high‐risk sex. Experiments I (N= 481) and 2 (N= 73) report the development of a new questionnaire to assess self‐efficacy for substance use and sexual behavior. Experiment 3 (N= 375) tested self‐efficacy, outcome expectancies, and trait measures of social conformity and sensation seeking as correlates of substance use and high‐risk sex. Using structural equation modeling, cross‐sectional analyses revealed that positive outcome expectancies had the largest association with substance use, whereas self‐efficacy had the largest association with sexual behavior. Further, personality traits were related to substance use and sexual behavior indirectly through outcome expectancies, with social conformity also having a direct effect on behavior. When examined longitudinally, past alcohol and drug use served as the final pathway by which expectancies and personality impacted substance use, whereas past behavior, self‐efficacy, and social conformity all contributed to high‐risk sex. Results support the utility of different models for explaining, and possibly preventing, young adult substance use and high‐risk sex.