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.     

The effects of modifying interpretation bias on worry in generalized anxiety disorder

This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.     

The effect of attention modification with explicit vs. minimal instructions on worry

In this experiment we investigated the effect of different instructions on the modification of attentional biases, and subsequently on worry persistence. Participants without excessive worry completed a modified dot-probe task, designed to train attention either to threat or neutral words. Half of each group was given explicit instructions regarding the relationship between word valence and target location, and half were given the more usual minimal instructions. Impact on worry persistence was assessed by categorizing the valence of thought intrusions before and after a period of instructed worry. Response latencies to test items on the dot-probe task showed that attention had been successfully manipulated in the expected direction, and explicit instructions led to more effective attention modification. Moreover, participants in the attend-threat group who received explicit instructions reported significantly more negative thought intrusions following instructed worry, as rated by an assessor, whereas participants in the attend-neutral group did not. These findings suggest that an attentional bias towards threatening information plays a role in worry persistence, and that explicit instructions may be helpful in modifying this bias.     

How does mindfulness-based cognitive therapy work?

Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression ( [Kuyken et?al., 2008], [Ma and Teasdale, 2004] and [Teasdale et?al., 2000]). To date, no compelling research addresses MBCT’s mechanisms of change. This study determines whether MBCT’s treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction.MBCT’s effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group.MBCT’s treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.     

Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

Attempted suppression of social threat thoughts: Differential effects for social phobia and healthy controls?

Thought suppression research in the area of social phobia provides conflicting evidence regarding whether individuals demonstrate a general deficit or successful suppression. This paper reports the outcome of two studies using an online thought suppression paradigm measuring activation of target thoughts. Study 1 examined the effects of suppressing social threat stimuli with a healthy control group. Surprisingly, the results showed that participants demonstrated non-suppression of this stimuli class. Study 2 compared individuals with social phobia to a control group using the same stimuli as Study 1. Results revealed that following instructions to suppress social threat stimuli, individuals with social phobia demonstrated successful suppression, whilst the control group, as in Study 1, did not. The lack of suppression of social threat information by the control group may reflect functional impression-management of social threat stimuli. Whereas, successful suppression of these stimuli by individuals with social phobia, may contribute to diminished habituation to such information.     

Did she mean to do it? Acquiring a folk theory of intentionality

The ability to both identify and explain others’ intentional acts is fundamental for successful social interaction. In two cross-sectional studies, we investigated 3- to 9-year-olds’ (n = 148) understanding of the folk concept of intentionality, using three types of intentionality measures. The relationship between this type of reasoning and false belief and interpretive mind understanding was also examined. Judgment of the appropriateness of an explanation was based on adult responses (n = 20). Overall, the results indicated that the ability to both identify and appropriately explain a range of intentional acts does not fully emerge until 7 years of age or later. The pattern of explanations revealed the gradual development of a folk concept of intentionality. Preschool- and early school-age children focused on the protagonists’ desires and actions, whereas 8- and 9-year-olds and adults were more likely to reference the protagonists’ awareness and skills.     

Bayesian parameter estimation in the Expectancy Valence model of the Iowa gambling task

The purpose of the popular Iowa gambling task is to study decision making deficits in clinical populations by mimicking real-life decision making in an experimental context. Busemeyer and Stout [Busemeyer, J. R., & Stout, J. C. (2002). A contribution of cognitive decision models to clinical assessment: Decomposing performance on the Bechara gambling task. Psychological Assessment, 14, 253-262] proposed an “Expectancy Valence” reinforcement learning model that estimates three latent components which are assumed to jointly determine choice behavior in the Iowa gambling task: weighing of wins versus losses, memory for past payoffs, and response consistency. In this article we explore the statistical properties of the Expectancy Valence model. We first demonstrate the difficulty of applying the model on the level of a single participant, we then propose and implement a Bayesian hierarchical estimation procedure to coherently combine information from different participants, and we finally apply the Bayesian estimation procedure to data from an experiment designed to provide a test of specific influence.     

Religion is natural, atheism is not: On why everybody is both right and wrong

After discussing evidence of irreligion and the rise of the so called “New Atheism”, the authors refute the claim that this poses a problem for the cognitive science of religion and its hypothesis that religion is natural. The “naturalness hypothesis” is not deterministic but probabilistic and thus leaves room for atheism. This, the authors maintain, is true of both the by-product and adaptationist stances within the cognitive science of religion. In this context the authors also discuss the memetic or “unnaturalness” hypothesis, i.e. that religion is a “virus of the mind”. The authors criticize accounts of atheism offered by cognitive scientists of religion as being based on unfounded assumptions about the psychology of atheists, and object to the notion that the natural aspects of religion by corollary make atheism unnatural. By considering human cognition in a semiotic framework and emphasizing its natural ability to take part in semiotic systems of signs, atheism emerges as a natural, cognitive strategy. The authors argue that to reach a fuller account of religion, the cognitive (naturalness) and memetic (unnaturalness) hypotheses of religion must be merged. Finally, a preliminary analysis of the “New Atheism” is offered in terms of semiotic and cognitive dynamics.     

The dual pathway to creativity model: Creative ideation as a function of flexibility and persistence

The dual pathway to creativity model argues that creativity—the generation of original and appropriate ideas—is a function of cognitive flexibility and cognitive persistence, and that dispositional or situational variables may influence creativity either through their effects on flexibility, on persistence, or both. This model is tested in a number of studies in which participants performed creative ideation tasks. We review work showing that cognitive flexibility, operationalised as the number of content categories surveyed, directly relates to idea originality, but that originality can also be achieved by exploring a few content categories in great depth (i.e., persistence). We also show that a global processing mode is associated with cognitive flexibility, but only leads to high originality in tasks that capitalise on cognitive flexibility. We finally show that activating positive mood states enhance creativity because they stimulate flexibility, while activating negative mood states can enhance creativity because they stimulate persistence. Implications for theory and practice are discussed.