Cognitive style and depressive symptoms in elderly people - Extending the empirical evidence for the cognitive vulnerability-stress hypothesis

Introduction

Depression is common in older people and its identification and treatment has been highlighted as one of the major challenges in an ageing world. Poor physical and cognitive health, bereavement, and prior depression are important risk factors for depression in elderly people. Attributional or cognitive style has been identified as a risk factor for depression in children, adolescents and younger adults but its relevance for depression and mood in elderly people has not been investigated in the context of other risk factors.

Method

Sixty-four older adults from an ‘extra care’ living scheme (aged 59-97) were recruited for a 6-week prospective study to examine the relationships between cognitive style and depressive symptoms.

Results

Regression analyses revealed that, when other risk factors were controlled for, cognitive style and its interaction with stress predicted changes in depressive symptoms, therefore partially replicating prior research.

Conclusion

Cognitive-stress-vulnerability models also apply to elderly populations, but may be rather predictive of changes in depression when facing lower levels of stress.     

Intimate partner violence and depressive symptoms in women: cognitive schemas as moderators and mediators

In this study the role of cognitive schemas as moderators and mediators between intimate partner violence and depressive symptoms was examined. The sample consisted of 312 women who had suffered an abusive relationship. Participants completed measures of physical, psychological and sexual abuse, maladaptive cognitive schemas (disconnection and rejection, autonomy, and other-directedness), and depression. The evidence for a moderation effect was low and mainly restricted to schemas of the impaired autonomy domain. In contrast, the results supported mediational models in which violence was associated to the cognitive schemas, and these in turn were associated to depressive symptoms. Mediation was partial, with the schemas of the disconnection and rejection domain explaining most of the association between violence and depression. Finally, several explanations for these findings are examined, and their implications for the concept and measure of the cognitive schemas are discussed.     

Route-based travel and shared routes in sympatric spider and woolly monkeys: cognitive and evolutionary implications

Many wild primates occupy large home ranges and travel long distances each day. Navigating these ranges to find sufficient food presents a substantial cognitive challenge, but we are still far from understanding either how primates represent spatial information mentally or how they use this information to navigate under natural conditions. In the course of a long-term socioecological study, we investigated and compared the travel paths of sympatric spider monkeys (Ateles belzebuth) and woolly monkeys (Lagothrix poeppigii) in Amazonian Ecuador. During several field seasons spanning an 8-year period, we followed focal individuals or groups of both species continuously for periods of multiple days and mapped their travel paths in detail. We found that both primates typically traveled through their home ranges following repeatedly used paths, or “routes”. Many of these routes were common to both species and were stable across study years. Several important routes appeared to be associated with distinct topographic features (e.g., ridgetops), which may constitute easily recognized landmarks useful for spatial navigation. The majority of all location records for both species fell along or near identified routes, as did most of the trees used for fruit feeding. Our results provide strong support for the idea that both woolly and spider monkey use route-based mental maps similar to those proposed by Poucet (Psychol Rev 100:163–182, 1993). We suggest that rather than remembering the specific locations of thousands of individual feeding trees and their phenological schedules, spider and woolly monkeys could nonetheless forage efficiently by committing to memory a series of route segments that, when followed, bring them into contact with many potential feeding sources for monitoring or visitation. Furthermore, because swallowed and defecated seeds are deposited in greater frequency along routes, the repeated use of particular travel paths over generations could profoundly influence the structure and composition of tropical forests, raising the intriguing possibility that these and other primate frugivores are active participants in constructing their own ecological niches. Building upon the insights of Byrne (Q J Exp Psychol 31:147–154, 1979, Normality and pathology in cognitive functions. Academic, London, pp 239–264, 1982) and Milton (The foraging strategy of howler monkeys: a study in primate economics. Columbia University Press, New York, 1980, On the move: how and why animals travel in groups. University of Chicago Press, Chicago, pp 375–417, 2000), our results highlight the likely general importance of route-based travel in the memory and foraging strategies of nonhuman primates.

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This contribution is part of the Special Issue “A Socioecological Perspective on Primate Cognition” (Cunningham and Janson 2007).     

Interpretation bias and depressive symptoms: The role of self-relevance

Cognitive theories of depression emphasize negatively biased interpretations as an important target of therapy. Much of the research on interpretation bias in depression has focused on selection, or deciding which of several interpretations is likely. However, depressive biases may also exist in the generation of possible interpretations, or the ability to think of positive alternatives. If biases exist for generation as well as selection, therapeutic techniques to encourage the generation of more positive interpretations would be warranted. Asking therapy clients to consider someone else in a similar situation is a commonly used therapy strategy but has not been sufficiently examined empirically. In the current studies, we examine interpretation generation and selection in dysphoric and nondysphoric individuals, and contrast interpretations made for the self to interpretations made for two types of “other.” Our studies reveal depressive biases in both interpretation generation and selection, and indicate that interpretation valence is highly sensitive to the type of other considered. All participants generated and selected significantly more positive interpretations for friends than for themselves, but generated significantly more negative interpretations for hypothetical others than for themselves. Our results suggest that encouraging dysphoric individuals to imagine others can be beneficial, but the type of “other” used is critically important, with instructions to consider a close friend most likely to be effective in decreasing negativity in interpretation.     

When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate

A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year.     

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.     

Negative life events and cognitive vulnerability to depression: Informant effects and sex differences in the prediction of depressive symptoms in middle childhood

While diathesis-stress models of cognitive vulnerability to depression (CVD) in childhood have been tested, few studies have included both parent- and child-reported negative life events, despite the fact that they provide unique information on events that may be relevant to depression risk in boys and girls. It was hypothesized that different types of stress may show moderation of CVD for boys and girls; specifically, we predicted that parent-reported stressors may moderate boys’ CVD, and that self-reported stress may play a more critical moderating role for girls. A community sample of 182 eight-year-olds completed measures of CVD at baseline, and child- and parent-reported measures of stress were collected at follow-up, one year later. Support for diathesis-stress models of CVD varied depending on child sex and the source of information on stress. Results highlight the importance of collecting multiple measures of stress in testing diathesis-stress models of CVD in middle childhood.     

Unpacking the cognitive map: the parallel map theory of hippocampal function

In the parallel map theory, the hippocampus encodes space with 2 mapping systems. The bearing map is constructed primarily in the dentate gyrus from directional cues such as stimulus gradients. The sketch map is constructed within the hippocampus proper from positional cues. The integrated map emerges when data from the bearing and sketch maps are combined. Because the component maps work in parallel, the impairment of one can reveal residual learning by the other. Such parallel function may explain paradoxes of spatial learning, such as learning after partial hippocampal lesions, taxonomic and sex differences in spatial learning, and the function of hippocampal neurogenesis. By integrating evidence from physiology to phylogeny, the parallel map theory offers a unified explanation for hippocampal function.     

An investigation of extreme responding as a mediator of cognitive therapy for depression

Although the efficacy of Cognitive Therapy (CT) for depression is well documented, questions remain about the conditions under which CT is maximally effective, and the mechanisms by which CT is efficacious. This study examined the role of extreme responding (ER) as a mediator and predictor of relapse, as well as a predictor of acute treatment outcome. To test mediation, ER of participants in CT was compared to ER of participants receiving Behavioral Activation (BA). Results indicated that ER was not a mediator of relapse in either condition. Both CT and BA showed reductions in depression severity, however neither group showed significant changes in ER over the course of treatment. Finally, ER did not predict or moderate acute treatment outcome. The implications of these results, strengths and limitations of the current study, and future research directions are discussed.     

Dispositional mindfulness moderates the relation between neuroticism and depressive symptoms

Negative emotional reactivity as measured by neuroticism has been shown to be an important risk factor for the development of depressive symptoms. This study investigated whether the ability to be mindful can protect against the negative effects of this temperamental vulnerability. An English community sample of N = 144 individuals who had completed a neuroticism questionnaire six years previously were assessed for current depressive symptoms and dispositional levels of mindfulness at points of assessment approximately one year apart. Dispositional mindfulness moderated the relation between neuroticism and current depressive symptoms: Neuroticism was significantly related to depression in those with low to medium levels of dispositional mindfulness but not in those with relatively high levels of mindfulness. Further analyzes focusing on particular mindfulness skills indicated that this effect was carried mostly by the ability to describe inner experience. The results suggest that dispositional mindfulness and particularly the ability to describe inner experience are helpful in dealing with negative emotional reactivity in a way that reduces the likelihood of depressive symptoms to develop.     

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.     

Cognitive biases in three prediction tasks: A test of the cognitive model of depression

Cognitive therapy for depression is based on an assumption that depressed individuals have inaccurate, negative biases. Whether this assumption is accurate remains unresolved. Thus, this study sought to examine the relationship between depressive symptoms and bias in three sets of predictions (i.e., predictions of future life events, how one would be rated by a significant other, and performance on a vocabulary test). Following study announcements made to a subset of people pre-screened for depressive symptoms, 85 participants with widely varying depressive symptoms (17 of whom met diagnostic criteria for depression) made predictions on three judgment tasks and the outcomes for these tasks were assessed. Optimistic/pessimistic biases were related to depressive symptoms for each of the three tasks. Participants with high levels of depressive symptoms and depressed participants exhibited substantial pessimistic bias. Those high in depressive symptoms exhibited significant pessimistic bias on all three tasks. Participants meeting diagnostic criteria for depression exhibited pessimistic bias on two of three tasks. There was no evidence that depressive symptoms were associated with greater accuracy in judgments. Results are largely consistent with cognitive models of depression which postulate that depression is associated with pessimistic biases.     

Mood congruent memory in dysphoria: the roles of state affect and cognitive style

Biases in incidental memory for self-referent adjectives and intentional memory were compared across nondysphoric (ND; n=48), experimentally induced dysphoric (EXP; n=49), and naturally dysphoric (NAT; n=48) individuals. Negative biases, "evenhandedness", and positive biases were demonstrated among NAT, EXP and ND participants, respectively, in terms of incidental memory. Correlation analyses suggested that the effects of cognitive style (self-esteem, dysfunctional attitudes, and attributional style) are limited to negative stimuli. Memory for incidental positive stimuli was only predicted by state affect. Groups did not differ in performance on an intentional memory task. Implications for network and schema models of depression are explored.     

An experimental investigation of the cognitive vulnerability to depression

The present study employed an experimental design, to examine the role of metacognitive processing in the prevention of relapse to depression. Eighty remitted depressed participants were randomly allocated to receive training in the metacognitive style of rumination, distraction, acceptance or no training control prior to a negative mood induction. Rumination prolonged the intensity of the negative mood consistent with no training, whereas both distraction and acceptance reduced the intensity of the negative mood. Changes in attitudes were only found in the acceptance condition, as participants in this condition reduced negative attitudes towards negative experiences. These results are consistent with information processing theory, and imply that acceptance-based preventative interventions may operate by both reducing the intensity of sad moods and altering one's attitudes towards temporary moments of sadness.     

The reinterpretation of dreams: an evolutionary hypothesis of the function of dreaming

Several theories claim that dreaming is a random by-product of REM sleep physiology and that it does not serve any natural function. Phenomenal dream content, however, is not as disorganized as such views imply. The form and content of dreams is not random but organized and selective: during dreaming, the brain constructs a complex model of the world in which certain types of elements, when compared to waking life, are underrepresented whereas others are over represented. Furthermore, dream content is consistently and powerfully modulated by certain types of waking experiences. On the basis of this evidence, I put forward the hypothesis that the biological function of dreaming is to simulate threatening events, and to rehearse threat perception and threat avoidance. To evaluate this hypothesis, we need to consider the original evolutionary context of dreaming and the possible traces it has left in the dream content of the present human population. In the ancestral environment human life was short and full of threats. Any behavioral advantage in dealing with highly dangerous events would have increased the probability of reproductive success. A dream-production mechanism that tends to select threatening waking events and simulate them over and over again in various combinations would have been valuable for the development and maintenance of threat-avoidance skills. Empirical evidence from normative dream content, children's dreams, recurrent dreams, nightmares, post traumatic dreams, and the dreams of hunter-gatherers indicates that our dream-production mechanisms are in fact specialized in the simulation of threatening events, and thus provides support to the threat simulation hypothesis of the function of dreaming.     

Attachment and cognitive skills: An investigation of mediating mechanisms

Associations between maternal attachment patterns and cognitive skills at first grade were examined, and mediators of identified associations tested using Phase I and II data from the National Institute of Child Health and Human Development Study of Early Care and Youth Development, a prospective study of 1364 children and families from birth through sixth grade. There were three main findings. First, ambivalent and insecure/other attachment patterns were negative predictors of cognitive skills. Second, the association between ambivalent attachment and cognitive skills was mediated by children's behaviors related to testing. Third, the association between insecure/other attachment and cognitive skills was mediated by children's exploration, maternal instruction, children's social relationships, and children's behaviors related to testing. Implications for attachment theory and education are discussed.     

Explicit and implicit cognition: a preliminary test of a dual-process theory of cognitive vulnerability to depression

Two studies were conducted to test a dual-process theory of cognitive vulnerability to depression. According to this theory, implicit and explicit cognitive processes have differential effects on depressive reactions to stressful life events. Implicit processes are hypothesized to be critical in determining an individual's immediate affective reaction to stress whereas explicit cognitions are thought to be more involved in long-term depressive reactions. Consistent with hypotheses, the results of study 1 (cross-sectional; N=237) showed that implicit, but not explicit, cognitions predicted immediate affective reactions to a lab stressor. Study 2 (longitudinal; N=251) also supported the dual-process model of cognitive vulnerability to depression. Results showed that both the implicit and explicit measures interacted with life stress to predict prospective changes in depressive symptoms, respectively. However, when both implicit and explicit predictors were entered into a regression equation simultaneously, only the explicit measure interacted with stress to remain a unique predictor of depressive symptoms over the five-week prospective interval.     

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.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.