Preventing Depression Among Early Adolescents in the Primary Care Setting: A Randomized Controlled Study of the Penn Resiliency Program

This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions. An erratum to this article is available at .     

A randomized crossover trial to test the effects of positive psychology intervention delivered by text messaging

Positive psychology (PP) interventions delivered through technology have shown encouraging results. In a crossover design, we randomized 60 participants recruited from the community to two weeks of either text messaging-based PP exercises or control exercises, before being crossed over to receive the other condition. Participants were compensated for maintaining high response rates to the texts. Participants reported greater satisfaction and had higher engagement in the program when PP exercises were received first. Overall, PP exercises did not improve moods significantly more than control exercises. However, baseline depressive symptoms significantly moderated the effect of condition on change in depressive symptoms (p < 0.032) and negative affect (p < 0.006), such that regular completion of exercises resulted in better mood outcomes compared to control exercises for those with high depressive symptoms at baseline. Results suggest that completing PP exercises through text messaging can improve moods in those who have elevated depressive symptoms.     

Delivering a Brief Insomnia Intervention to Depressed VA Primary Care Patients

Primary care is often the place where patients with depression and comorbid insomnia seek treatment. The experience of comorbid insomnia with depression can have a significant impact on the efficacy of other depression treatments and exacerbate depressive symptoms. Using the empirically based Cognitive-Behavioral Treatment for Insomnia (CBT-I) to target the comorbid experience of insomnia in patients with depression can help improve sleep and potentially modify some depressive symptoms. Additional rationale for such an approach includes that a positive therapeutic experience may enhance engagement with or adherence to other psychotherapeutic interventions. Although other brief CBT-I interventions have been developed for primary care, none of them were actually delivered to depressed patients or implemented in primary care. Therefore, this paper describes a brief CBT-I intervention that was designed to be delivered in 4 sessions lasting from 15 to 45 minutes each within a primary care setting to depressed veterans. A case study is provided along with sample materials used in this intervention. In addition, we share implementation tips based on our experiences and feedback from eight veterans who have completed the intervention to date. Overall, the intervention was generally well received and suggests that the intervention may be feasibly delivered in a primary care setting.     

A discrete emotions approach to positive emotion disturbance in depression

Converging findings suggest that depressed individuals exhibit disturbances in positive emotion. No study, however, has ascertained which specific positive emotions are implicated in depression. We report two studies that compare how depressive symptoms relate to distinct positive emotions at both trait and state levels of assessment. In Study 1 (N=185), we examined associations between depressive symptoms and three trait positive emotions (pride, happy, amusement). Study 2 compared experiential and autonomic reactivity to pride, happy, and amusement film stimuli between depressive (n=24; DS) and non-depressive (n=31; NDS) symptom groups. Results indicate that symptoms of depression were most strongly associated with decreased trait pride and decreased positive emotion experience to pride-eliciting films. Discussion focuses on the implications these findings have for understanding emotion deficits in depression as well as for the general study of positive emotion.     

A discrete emotions approach to positive emotion disturbance in depression

Converging findings suggest that depressed individuals exhibit disturbances in positive emotion. No study, however, has ascertained which specific positive emotions are implicated in depression. We report two studies that compare how depressive symptoms relate to distinct positive emotions at both trait and state levels of assessment. In Study 1 (N=185), we examined associations between depressive symptoms and three trait positive emotions (pride, happy, amusement). Study 2 compared experiential and autonomic reactivity to pride, happy, and amusement film stimuli between depressive (n=24; DS) and non-depressive (n=31; NDS) symptom groups. Results indicate that symptoms of depression were most strongly associated with decreased trait pride and decreased positive emotion experience to pride-eliciting films. Discussion focuses on the implications these findings have for understanding emotion deficits in depression as well as for the general study of positive emotion.     

Watch,wait, and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy

This research compared two forms of psychodynamic psychotherapeutic interventions for 67 clinically referred infants and their mothers. One was an infant‐led psychotherapy delivered through a program called Watch, Wait, and Wonder (WWW). The other was a mother–infant psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately 5 months. A broad range of measures of attachment, qualities of the mother–infant relationship, maternal perception of parenting stress, parenting competence and satisfaction, depression, and infant cognition and emotion regulation were used. The WWW group showed a greater shift toward a more organized or secure attachment relationship and a greater improvement in cognitive development and emotion regulation than infants in the PPT group. Moreover, mothers in the WWW group reported a larger increase in parenting satisfaction and competence and decrease in depression compared to mothers receiving PPT. Both WWW and PPT were successful in reducing infant ‐presenting problems, decreasing parenting stress, and reducing maternal intrusiveness and mother–infant conflict. Some potential reasons for the differential treatment effects and the theoretical, clinical, and methodological implications from the findings are discussed. ©1999 Michigan Association for Infant Mental Health.     

Gratitude and depressive symptoms: the role of positive reframing and positive emotion

Eight studies (N=2,973) tested the theory that gratitude is related to fewer depressive symptoms through positive reframing and positive emotion. Study 1 found a direct path between gratitude and depressive symptoms. Studies 2-5 demonstrated that positive reframing mediated the relationship between gratitude and depressive symptoms. Studies 6-7 showed that positive emotion mediated the relationship between gratitude and depressive symptoms. Study 8 found that positive reframing and positive emotion simultaneously mediated the relationship between gratitude and depressive symptoms. In sum, these eight studies demonstrate that gratitude is related to fewer depressive symptoms, with positive reframing and positive emotion serving as mechanisms that account for this relationship.     

Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.     

Gratitude and depressive symptoms: The role of positive reframing and positive emotion

Eight studies (N=2,973) tested the theory that gratitude is related to fewer depressive symptoms through positive reframing and positive emotion. Study 1 found a direct path between gratitude and depressive symptoms. Studies 2–5 demonstrated that positive reframing mediated the relationship between gratitude and depressive symptoms. Studies 6–7 showed that positive emotion mediated the relationship between gratitude and depressive symptoms. Study 8 found that positive reframing and positive emotion simultaneously mediated the relationship between gratitude and depressive symptoms. In sum, these eight studies demonstrate that gratitude is related to fewer depressive symptoms, with positive reframing and positive emotion serving as mechanisms that account for this relationship.     

Positive psychotherapy: A strength-based approach

Positive psychotherapy (PPT) is a therapeutic approach broadly based on the principles of positive psychology. Rooted in Chris Peterson’s groundbreaking work on character strengths, PPT integrates symptoms with strengths, resources with risks, weaknesses with values, and hopes with regrets in order to understand the inherent complexities of human experiences in a way that is more balanced than the traditional deficit-oriented approach to psychotherapy. This paper makes the case of an alternative approach to psychotherapy that pays equal attention and effort to negatives and positives. It discusses PPT’s assumptions and describes in detail how PPT exercises work in clinical settings. The paper summarizes results of pilot studies using this approach, discusses caveats in conducting PPT, and suggests potential directions.     

不同抑郁症状青少年日常情绪调节策略使用的差异

为了考察无抑郁、阈下抑郁和抑郁青少年日常情绪调节策略使用的差异,采用流调中心用抑郁量表和青少年日常情绪调节问卷测量了766名青少年的抑郁症状及其情绪调节策略使用。结果发现：青少年抑郁症状越多,使用认知重评越少,使用认知沉浸、表达抑制和表达宣泄越多。当调节积极情绪时,青少年抑郁症状越多,使用认知重评越少,使用认知沉浸和表达抑制越多,但使用表达宣泄无显著差异;当调节消极情绪时,青少年抑郁症状越多,使用认知重评越少,使用认知沉浸、表达抑制和表达宣泄越多。并且,阈下抑郁青少年的情绪调节策略使用均介于无抑郁和抑郁青少年之间。结果表明,青少年抑郁症状越多,使用认知重评等适应性情绪调节策略越少,使用认知沉浸等非适应性情绪调节策略越多,但具体情绪调节策略的使用可能会受所调节情绪效价的影响。同时,相比无抑郁和抑郁青少年,阈下抑郁青少年的情绪调节策略使用更具识别和干预的价值。     

Effectiveness of Cognitive Behavior Therapy for Severe Mood Disorders in an Acute Psychiatric Naturalistic Setting: A Benchmarking Study

The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, “real world” settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.     

不同抑郁症状青少年调节不同强度情绪时策略选择的差异

最新研究发现,情绪强度会影响健康个体的情绪调节策略选择。然而,至今尚未有研究考察情绪强度对不同抑郁症状青少年策略选择的影响。对此,本研究通过流调中心用抑郁量表划分出无抑郁、阈下抑郁和抑郁症青少年,进而考察其在面对高-低强度积极-消极日常情绪事件时选择认知重评和认知沉浸的差异。结果发现：当面对高强度积极情绪、低强度积极情绪和低强度消极情绪时,三组被试的策略选择均无显著差异;当面对高强度消极情绪时,无抑郁青少年比阈下抑郁和抑郁症青少年更多选择认知重评而更少选择认知沉浸,但阈下抑郁和抑郁症青少年之间无显著差异。结果表明：不同抑郁症状青少年在面对不同强度和效价情绪时的情绪调节策略选择存在差异,表现为高强度消极情绪下抑郁症状越多的青少年越少选择认知重评而越多选择认知沉浸。这一发现有助于识别和干预青少年的抑郁症状。     

Development and Preliminary Evaluation of a Positive Emotion Regulation Augmentation Module for Anxiety and Depression

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. Many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to disorder severity and prevent full recovery, and these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of adding a novel brief intervention module for enhancing positive emotion in anxiety and depressive disorders to existing evidence-based treatment. This intervention was evaluated in nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment, utilizing a multiple baseline experimental-across-participants design. Results indicated that the intervention was effective in improving positive emotion regulation skills for five of nine participants. The intervention was also associated with further improvements in anxiety and depressive symptoms, positive and negative emotion, functioning, quality of life, and well-being. Participants reported high acceptability and satisfaction with the study intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.     

Responding to symptoms of depression and anxiety: emotion regulation, neuroticism, and engagement in risky behaviors

The current study examined whether neuroticism, emotional regulation deficits, and/or their interaction predict increased engagement in risky behaviors following increases in symptoms of depression or anxiety over the course of 6 weeks. Results of hierarchical linear modeling analyses indicated that individuals who exhibited high levels of both neuroticism and emotional regulation deficits were more likely than other individuals to report increased engagement in risky behaviors following increases in symptoms of either depression or anxiety. Unexpectedly, individuals who exhibited high levels of neuroticism and adaptive emotion regulation strategies exhibited decreased engagement in risky behaviors following increases in depressive or anxious symptoms.     

Longitudinal Study of Life Events,Well-Being,Emotional Regulation and Depressive Symptomatology

Etiological research regarding adolescent depression is relatively recent and longitudinal studies are needed to explicate the mechanisms by which risk and protective factors impact the development of depression. This investigation evaluated the effects of time 1 predictors (e.g., depressive symptoms, life events, subjective well-being, and emotion regulation strategies) on depressive symptoms assessed at time 2 (1 year later). The sample comprised 182 Portuguese adolescents, aged 12–16. Time 1 depressive symptoms and psychological well-being were significant predictors of time 2 depressive symptoms. Time 1 rumination predicted time 2 depressive symptoms, but time 2 brooding mediated this effect. Time 1 life events did not predict time 2 depressive symptomatology. This study identified several factors that seem to play an important role in the development of depressive symptomatology. Previous depressive symptomatology and well-being had a significant effect in this process and the relationship between rumination in time 1 and depressive symptoms at time 2 (1 year later) was fully mediated by brooding at time 2. Given these results, implications for prevention and treatment of depression include addressing risk factors like early depressive symptoms, rumination and brooding, and increasing the protective effect of psychological well-being.     

Angry rumination moderates the association between perceived ethnic discrimination and risky behaviors

Perceived ethnic discrimination (PED) is associated with increased engagement in risky behaviors in ethnic minority emerging adults. Risky behaviors may reflect efforts to cope with emotional distress like depression or anxiety resulting from PED, particularly for individuals with poor emotion regulation skills. We hypothesized that the association between PED and risky behaviors would be particularly strong for emerging adults with tendencies for angry rumination. We further hypothesized that increased depressive and anxious symptoms would mediate the effect of the PED-rumination interaction on risky behaviors. In this survey study, 155 ethnic minority college students completed measures of PED, depressive and anxiety symptoms, trait angry rumination, and risky behaviors. Analyses revealed that angry rumination moderated the association between PED and greater risky behaviors. Depressive and anxiety symptoms did not mediate this effect. Although cross-sectional, these findings suggest that individuals with poor coping skills may be especially likely to respond to stressors such as PED by engaging in risky behaviors. Implications include using rumination-focused interventions in order to prevent engagement in risky behaviors in ethnic minority emerging adults.     

Emotional responding in depression: Distinctions in the time course of emotion

The current studies were designed to investigate if the emotion context insensitivity hypothesis (ECI; Rottenberg & Gotlib, 2004) is applicable across the time course of emotion. Recent affective science research has pointed to the importance of considering anticipation and maintenance of emotion. In the current studies, we assessed emotion responses among college students with depression symptoms in anticipation of, during, and after an emotional picture using the emotion modulated startle paradigm. People with and without depression symptoms did not differ in blink magnitude in anticipation of emotional pictures suggesting that some anticipatory processes may not be impaired by depression symptoms. In contrast, individuals with depression symptoms did not exhibit blink magnitudes that varied by valence, either during viewing or after the pictures were removed from view. These findings suggest that ECI is relevant not only for those diagnosed with major depressive disorder, but also for people with depression symptoms that may not cross the diagnostic threshold. These data also point to the importance of considering the time course of emotion to better understand emotional deficits in individuals with differing levels of depression symptoms. Identifying where emotion goes awry across the time course of emotion can help inform treatment development.     

Emotional responding in depression: Distinctions in the time course of emotion

The current studies were designed to investigate if the emotion context insensitivity hypothesis (ECI; Rottenberg & Gotlib, 2004) is applicable across the time course of emotion. Recent affective science research has pointed to the importance of considering anticipation and maintenance of emotion. In the current studies, we assessed emotion responses among college students with depression symptoms in anticipation of, during, and after an emotional picture using the emotion modulated startle paradigm. People with and without depression symptoms did not differ in blink magnitude in anticipation of emotional pictures suggesting that some anticipatory processes may not be impaired by depression symptoms. In contrast, individuals with depression symptoms did not exhibit blink magnitudes that varied by valence, either during viewing or after the pictures were removed from view. These findings suggest that ECI is relevant not only for those diagnosed with major depressive disorder, but also for people with depression symptoms that may not cross the diagnostic threshold. These data also point to the importance of considering the time course of emotion to better understand emotional deficits in individuals with differing levels of depression symptoms. Identifying where emotion goes awry across the time course of emotion can help inform treatment development.     

The mediating effect of adaptive and maladaptive emotion regulation strategies on executive functioning impairment and depressive symptoms among adolescents

Past research results suggest that executive functioning (EF) impairment represents an important vulnerability factor in depression. Little research, however, has examined mechanisms underlying this association. The current study investigates the associations between EF impairment, emotion regulation (ER) strategies, and depressive symptoms in a sample of 579 adolescents (320 females, mean age = 12.06 years). Parents reported on adolescents’ EF and general psychopathology, and adolescents self-reported ER strategies and depressive symptoms. The results indicate that greater EF impairment is associated with more depressive symptoms. Youth with greater EF impairment reported more maladaptive ER and less adaptive ER, and maladaptive and adaptive ER strategies jointly mediated the association between EF impairment and depressive symptoms. The results highlight an important role of both maladaptive and adaptive ER in explaining the relationship between EF and depressive symptoms and suggest that clinical interventions targeting ER skills may provide one strategy for the prevention and treatment of depression. Further longitudinal research is needed to replicate these results and evaluate the causality of the relations.