Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study

Although intrusive images are a hallmark of post-traumatic stress disorder (PTSD) and also occur in depression, little is known about the differences and similarities of such images in these conditions. Our study focuses on the qualities and triggers of intrusive images and responses to them in three groups--patients with PTSD, and depressed patients with and without trauma (n=65)-to highlight the diagnostic specificity of intrusive images for PTSD and depression. We distinguished intrusive images from verbal intrusive cognitions such as rumination and intrusive (brief) lexical thoughts. Consistent with the literature, the intrusive images of PTSD patients had a more "here-and-now quality" and were perceived more visually compared to those of both depressed groups. The groups showed a good deal of similarity concerning other image qualities. Most importantly, the intrusive images in PTSD and depressed patients with and without trauma were perceived as similarly distressing. Rumination and intrusive (brief) lexical thoughts were two of the five most named triggers of intrusive images. Limitations, such as the lack of a control group, and the clinical implications of these results are discussed, demonstrating the need to help non-PTSD patients with and without trauma to deal with intrusive images.     

Subtyping adolescents with bulimia nervosa

Cluster analyses of eating disorder patients have yielded a "dietary-depressive" subtype, typified by greater negative affect, and a "dietary" subtype, typified by dietary restraint. This study aimed to replicate these findings in an adolescent sample with bulimia nervosa (BN) from a randomized controlled trial and to examine the validity and reliability of this methodology. In the sample of BN adolescents (N=80), cluster analysis revealed a "dietary-depressive" subtype (37.5%) and a "dietary" subtype (62.5%) using the Beck Depression Inventory, Rosenberg Self-Esteem Scale and Eating Disorder Examination Restraint subscale. The "dietary-depressive" subtype compared to the "dietary" subtype was significantly more likely to: (1) report co-occurring disorders, (2) greater eating and weight concerns, and (3) less vomiting abstinence at post-treatment (all p's<.05). The cluster analysis based on "dietary" and "dietary-depressive" subtypes appeared to have concurrent validity, yielding more distinct groups than subtyping by vomiting frequency. In order to assess the reliability of the subtyping scheme, a larger sample of adolescents with mixed eating and weight disorders in an outpatient eating disorder clinic (N=149) was subtyped, yielding similar subtypes. These results support the validity and reliability of the subtyping strategy in two adolescent samples.     

Rumination and attention in major depression

Up until recently, it had been assumed that attentional biases for negative information do not exist in depression. However studies using post-conscious exposure durations have produced contradictory results. The limitations of common attentional tasks, suitability of stimulus materials and differences in stimulus duration times may have contributed to these inconsistencies. We aimed to address many of these issues and examine attentional responses in major depression at two post-conscious exposure times. We also investigated possible roles for rumination and distraction in increasing and lessening attentional biases for negative information. We used a fully controlled experimental design to test the effects of both induced and trait rumination and distraction on attention in patients with major depression and healthy controls. Attention was assessed using the dot-probe task. The findings revealed an attentional bias for negative information in depressed patients only at the longer post-conscious exposure duration. Furthermore although this bias was not influenced by either induced or trait distraction, it was related to trait rumination. Overall, the results showed that depression is associated with a strategic attentional bias towards negative information and that this bias is stronger in individuals who habitually ruminate.     

Maternal Characteristics Associated with Television Viewing Habits of Low-Income Preschool Children

Few studies have examined maternal characteristics associated with heavy or inappropriate television viewing on the part of their children. We investigated the relationship between children’s television viewing habits and maternal depressive symptoms and parenting beliefs. The participants were 175 low income children (mean age = 62.1 months) and their mothers who participated in a larger national study of Early Head Start eligible children. Our sample included families from two predominantly rural sites. Mothers completed a survey about the amount of time their children spend watching television during the week and on the weekend, and the types of programs they watch, as well as questionnaires related to maternal depression and parenting attitudes. According to mothers’ report, most of the young children in our sample exceeded the total viewing time recommended by the American Academy of Pediatrics (maximum 2 h per day), and the majority watched at least some programming designed for adult audiences. Maternal depressive symptoms and beliefs about parenting were associated with heavier viewing on the part of the child, as well as with viewing of age-inappropriate content.     

The Influence of Cancer-related Distress and Sense of Coherence on Anxiety and Depression in Patients with Hereditary Cancer

This study examines the association between Sense of Coherence and anxiety and depression amongst patients at risk of hereditary cancer receiving genetic counseling. When writing this article, 144 patients referred for genetic counseling due to a suspicion of hereditary cancer in the family were recruited for this multicentered longitudinal study on the psychosocial aspects of genetic counseling in Norway. A total of 96 (66%) patients responded to the follow-up survey distributed 6 months after genetic counseling. This survey included the Sense of Coherence-29 Scale, Impact of Event Scale, and Hospital Anxiety and Depression Scale. Multiple regression analyses were applied. Our results show association between cancer-related distress and symptoms of anxiety and depression. Sense of Coherence is significantly associated with both anxiety and depression. The hypothesis of Sense of Coherence buffering cancer-related distress and the possible impact of these findings for genetic counseling are discussed.     

A Cognitive Psychophysiological Model to Predict Functional Decline in Chronically Stressed Older Adults

The current study evaluated whether psychological distress (composite of depression, anxiety, vital exhaustion), inflammation (C-reactive protein, CRP) and cognitive function (Digit Symbol Test, DST) and their changes mediated the relationship between caregiver status and functional decline. Caregivers for spouses with Alzheimer’s disease were compared to demographically-similar non-caregiver spouses at study entry (T1), T2 (1 year later), and T3 (2 years after T1). Caregivers had greater functional impairment, higher distress scores, and poorer DST scores at all points of measurement and also showed functional decline. Non-caregivers did not demonstrate functional decline. Caregivers declined 85% faster than did non-caregivers. Regressions showed that after controlling for functional impairment at T1, illness, medication, and health behavior covariates, psychological distress at T1 and increases in CRP from T1 to T3 mediated the difference in functional decline. Moreover, after DST decline from T1 to T2 was entered in the model, caregiver status, psychological distress and increases in inflammation all showed reductions in their predictive importance. These findings suggest psychological distress and increases in inflammation may help explain why caregivers show greater functional decline than non-caregivers. However, the influences of these psychophysiological variables may be driven in part by cognitive decline prior to functional decline. This article is based upon an invited address, “Potential Hazards of Caring for a Loved One with Alzheimer’s Disease” given by the first author in recognition of the author’s receipt of the Association of Psychologists in Academic Health Centers 2005 Award for Distinguished Achievement in Research. The address was presented at the Annual meeting of the American Psychological Association, New Orleans, LA., August, 2006.     

Psychometric Properties of the Beck Depression Inventory-II in a Clinically-Identified Sample of Mexican American Adolescents

We examined the internal consistency reliability, convergent and divergent validity, and factor structure of the Beck Depression Inventory-II (BDI-II) in a sample of 131 Mexican American youth. The BDI-II demonstrated excellent internal consistency reliability (α=.90) and solid convergent and divergent validity with various clinical scales of the Adolescent Psychopathology Scale. Two factors, Cognitive-Somatic and Affective, emerged from an exploratory factor analysis and suggested that depressive symptomology may manifest somewhat differently in Mexican American youth. In sum, results provide tentative support for the use of the BDI-II as a measure of depression for this sample.     

Improving access to psychological therapy: Initial evaluation of two UK demonstration sites

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed ‘demonstration sites’) during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.     

Specificity of cognitive and behavioral variables to Positive and Negative Affect

The Tripartite Model proposes that a combination of greater Negative Affect (NA) and reduced Positive Affect (PA) contributes to depressive symptoms. The purpose of this study was to test a model of affective experience in which cognitive variables (i.e., negative cognitions and appraisals) are uniquely related to NA but not PA, and in which behavioral variables (i.e., activity participation) are uniquely associated with PA but not NA. Participants included 88 spousal Alzheimer caregivers (mean age = 74 years). Multiple regression models, in which negative cognitions (i.e., helplessness, blames self, and negative appraisals) and activity participation (i.e., frequency of engaging in social and recreational activities) were used to predict depressive symptoms, PA and NA. Results indicated that while helplessness, blaming oneself, negative appraisals, and activity participation all significantly predicted depressive symptoms, only negative cognitive variables significantly predicted NA, and only activity participation significantly predicted PA. These data confirm that depressive experience consists of two relatively independent components - increased Negative Affect and reduced Positive Affect - which have unique correlates in negative cognitions and activity participation. If confirmed, the findings suggest the utility of focusing interventions on each of these components in the management of depressive symptoms.     

The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder

Background

Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high.

Aim

To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for BPD.

Method

EA and depression were assessed in 81 clients at baseline and 4-month intervals during 1 year of therapy. Simple correlations, hierarchical linear modeling, and latent difference score models were used to investigate the association between self-reports of EA and both self-reports and observer-based ratings of depression.

Results

EA was positively associated with greater severity of depression at all points of assessment, and changes in EA were positively associated with changes in depression. Moreover, EA significantly predicted less subsequent reduction in depression whereas no such effect was found for depression on subsequent EA.

Conclusion

The findings are consistent with the hypothesis that EA impedes the reduction of depression in the treatment of BPD and should thus be considered an important treatment target.