Emotional Reactivity and Internalizing Symptoms: Moderating Role of Emotion Regulation

Emotion dysregulation has been associated with increases in many forms of psychopathology in adolescents and adults. The development of effective emotion regulation skills is important during adolescence, especially as stressful life events increase during this time. The current study examined two emotion regulation strategies, cognitive reappraisal and affective suppression, in interaction with self-report and biological measures of emotional reactivity as predictors of internalizing symptoms. A community sample of adolescents (n = 127), at an age of risk for depression and anxiety, completed self-report measures of emotional reactivity and internalizing symptoms. In addition, they completed a modified social stress task and were assessed on biological measures of reactivity and regulation. Findings suggested that the trait tendency to reappraise was associated with a reduced impact of emotional reactivity on depressive, but not anxiety symptoms. Implications for shared and specific aspects of emotional reactivity and regulation are discussed.     

Understanding the Constellation of Adolescent Emotional Clarity and Cognitive Response Styles when Predicting Depression: A Latent Class Analysis

Adolescence is a period of human development associated with increased emotional intensity and heightened vulnerability to developing psychopathology. This study used Latent Class Analysis to identify subgroups of youth based on emotional clarity and cognitive response styles. Participants were 436 adolescents (51.8% female; 48.2% African-American/Black, 47.4% Caucasian/White) who completed measures of emotional clarity, cognitive response styles, and depression at baseline (M?=?13.02 years, SD?=?.83), and at a 1-year and 4-year follow-up. Four classes were identified and used to predict depression outcomes. Overall, youth with above average emotional clarity who reported using a variety of adaptive cognitive response styles also had the lowest level of depressive symptoms at baseline. Class membership did not predict depressive symptoms at any follow-up. The results suggest that the unique profiles based on youth reported levels of emotional clarity and use of problem solving, distraction, and rumination, may not be more predictive of depression outcomes, beyond earlier assessments of depression or by examining these facets in isolation.     

Childhood Maltreatment and Psychopathology: Prospective Tests of Attachment,Cognitive Vulnerability,and Stress as Mediating Processes

A childhood history of maltreatment is a distal risk factor for depression, although less research has examined the proximal mechanisms for this relation. To address this question, three theoretically derived mechanisms were tested as mediators: an insecure attachment style, a negative cognitive style, and negative life events. These mediating processes were examined in two prospective studies. In the first, young adults (n = 652) completed a detailed self-report measure assessing a childhood history (before age 14) of physical, sexual, and emotional abuse. In the second, an independent sample of young adults (n = 75) were interviewed with a well-validated, objective, contextual threat interview that assesses a childhood history (before age 14) of physical, sexual, and psychological abuse as well as the surrounding familial context of emotional neglect, antipathy, discipline, and discord. In both studies, participants completed measures of the proposed mediators as well as anxiety and depressive symptoms at 2 time points (10-week interval in Study 1 and 2-year interval in Study 2). Across both studies, a childhood history of emotional maltreatment and adversity specifically predicted prospective elevations of depressive symptoms, whereas no specific form of childhood maltreatment predicted anxiety symptoms after controlling for initial symptoms and overlap among forms of maltreatment. Further, support was found for the proposed mediating processes. An insecure attachment style, a negative cognitive style, and negative events helped to account for the link between childhood maltreatment and later depressive symptoms in young adulthood.     

Depression and HIV disease.

Depressive disorders are common among 20% to 32% of people with HIV disease but are frequently unrecognized. Major depression is a recurring and disabling illness that typically responds to medications, cognitive psychotherapy, education, and social support. A large percentage of the emotional distress and major depression associated with HIV disease results from immunosuppression, treatment, and neuropsychiatric aspects of the disease. People with a history of intravenous drug use also have increased rates of depressive disorders. Untreated depression along with other comorbid conditions may increase costly clinic visits, hospitalizations, substance abuse, and risky behaviors and may reduce adherence to treatment and quality of life. HIV clinicians need not have psychiatric expertise to play a major role in depression. Screening tools improve case finding and encourage early treatment. Effective treatments can reduce major depression in 80% to 90% of patients. Clinicians who mistake depressive signs and symptoms for those of HIV disease make a common error that increases morbidity and mortality.     

Emotion Regulation in Depression: Reflection Predicts Recovery from a Major Depressive Episode

Little is known about the relation between individual differences in emotion regulation (ER) and the maintenance of clinical depression. This study examined whether frequency of use of four ER strategies (i.e., cognitive reappraisal, expressive suppression, reflection, and brooding) predicts recovery from a major depressive episode. At an initial appointment (Time 1), participants diagnosed with current major depressive disorder completed measures assessing symptom severity and use of ER strategies. Six months later (Time 2), participants were reassessed to determine diagnostic status (i.e., recovered or non-recovered). Results demonstrated that, after controlling for symptom severity, use of ER strategies predicted recovery status at Time 2. Specifically, use of reflection at Time 1 was a unique and significant predictor of greater chance for recovery. Results indicate that ER strategies may be utilized to predict long-term symptom maintenance and provide support for the proposition that reflection may be used adaptively among individuals diagnosed with depression.     

Gender Differences in the Cognitive Vulnerability-Stress Model of Depression in the Transition to Adolescence

This study examined whether the cognitive vulnerability-stress model of depression may contribute to our understanding of the gender difference in depression in adolescence. Specifically, we examined emergent gender differences in depressive symptoms, cognitive style, and stress in the context of exposure, cognitive scar, and stress generation models. We also examined whether gender moderated the cognitive vulnerability-stress effects on depression. Participants were 366 youth from a community sample who completed measures of depressive symptoms, stress, and negative cognitive style at ages 11, 13, and 15. Data were analyzed longitudinally using multi-level modeling and structural equation modeling. Results indicated that gender differences in depressive symptoms emerged prior to gender differences in cognitive vulnerability and stressful life events; depressive symptoms significantly mediated the emergent gender difference in cognitive style and dependent interpersonal stress. Gender also moderated several components of the cognitive vulnerability-stress model. Girls showed stronger associations between stress and depression over time, and the cognitive vulnerability-stress interaction was significant in predicting girls’ but not boys’ depression trajectories.     

Effects of Two Forms of Internet-Delivered Cognitive Behaviour Therapy for Depression on Future Thinking

The aim of this study was to investigate if future thinking would change following two forms of Internet-delivered cognitive behavior therapy (ICBT) for major depression. A second aim was to study the association between pre-post changes in future thinking and pre-post changes in depressive symptoms. Effects of psychological treatments are most often tested with self-report inventories and seldom with tests of cognitive function. We included data from 47 persons diagnosed with major depression who received either e-mail therapy or guided self-help during 8 weeks. Participants completed a future thinking task (FTT), in which they were asked to generate positive and negative events that they thought were going to happen in the future and rated the events in terms of emotion and likelihood. The FTT was completed before and after treatment. Data on depressive symptoms were also collected. FTT index scores for negative events were reduced after treatment. There was no increase for the positive events. Change scores for the FTT negative events and depression symptoms were significantly correlated. We conclude that ICBT may lead to decreased negative future thinking and that changes in depression symptoms correlate to some extent with reductions in negative future thinking.     

Experiential Avoidance and Negative Emotional Experiences: The Moderating Role of Expectancies About Emotion Regulation Strategies

In the present set of studies we examined whether expectancies about emotion regulation strategies moderate the relationship between experiential avoidance (EA) and negative emotional experiences. In Study 1, college students (N = 334) completed self-report measures assessing EA, expectancies about emotion regulation strategies, and psychological symptoms (depression, anxiety, and stress). In Study 2, college students (N = 97) completed (a) self-report measures assessing pre-task state negative affect, EA, and expectancies about emotion regulation strategies; (b) either an emotionally neutral or emotionally negative task; and (c) a self-report measure of post-task state negative affect. Consistent with predictions, pessimistic expectancies about emotion regulation strategies (reflecting perceptions about having a lack of emotion regulation abilities) potentiated the relationship between EA and negative emotional reactions in both studies. In Study 2, this potentiating effect was observed in response to the emotionally negative, but not emotionally neutral, task. Conceptual and therapeutic implications are discussed.     

Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed

This study examined the association between history of depression and day-to-day coping with rheumatoid arthritis (RA) pain. The sample was 188 RA-diagnosed participants, 73 of whom were identified by a structured clinical interview as having a history of major depression. None had current major depression. All participated in a 30-day prospective study in which they made end-of-day ratings of their arthritis pain, the strategies for how they coped with their pain, their appraisals of daily pain, and daily mood. Hierarchical linear models evaluated whether individuals with and without depression history differed in their average pain and the other daily measures; and separately, whether they differed in their within-person associations between pain and the daily measures (e.g., the day-to-day contingency between pain and mood). All analyses controlled for current mild depressive symptoms, neuroticism, and age. Previously depressed individuals were indistinguishable from their never depressed peers in their average pain and the other daily measures; however, the previously depressed exhibited significantly stronger associations between pain and several aspects of their daily emotional experience, suggesting more pain-contingent well-being. For individuals with a history of depression, increases in daily pain corresponded with more frequent efforts to cope with their pain by venting their emotions, significantly stronger impairments in mood, and, if they were also presently distressed, reduced perceptions of control over their pain, compared to the never depressed. Patterns suggest that formerly depressed individuals exhibit a hidden vulnerability in how they manage chronic pain. This vulnerability is best revealed by a daily process approach.     

The impact of cognitive challenges in major depression: the role of the primary care physician

Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the ‘serotonin conundrum’: SSRI’s frequently do not treat to full remission, and can cause cognitive blunting—actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.     

Excessive Reassurance Seeking as a Mediator of Sociotropy and Negative Interpersonal Life Events

The Interpersonal Theory of Depression suggests that depressed individuals have behavioral patterns that alienate people in their environment, thereby reducing social support and maintaining their depression. Excessive reassurance seeking has been implicated as such a behavior. A model was tested in which excessive reassurance seeking mediates the relationships between sociotropy and increases in negative interpersonal life events as well as sociotropy and depressive symptoms. Participants consisted of 110 undergraduate students. Measures were given at two time points 6 weeks apart assessing sociotropy, excessive reassurance seeking, negative interpersonal life events, and depressive symptoms. Results suggested that excessive reassurance seeking mediated the predicted relationship between sociotropy and negative interpersonal life events, but did not mediate the relationship between sociotropy and depressive symptoms. The implications for these findings in the interactional nature of depression are discussed.     

Assessment and correlates of self-esteem following stroke using a pictorial measure

OBJECTIVE: To describe the characteristics of a non-verbal measure of self-esteem in a sample of individuals in the acute phase following stroke. DESIGN: Acute-phase stroke survivors (n=156) were administered measures of self-esteem, depression, anxiety, general emotional distress and cognitive functioning during admission to an inpatient stroke rehabilitation unit. MAIN MEASURES: Visual Analogue Self-Esteem Scale (VASES), Geriatric Depression Scale, Adult Manifest Anxiety Scale, Visual Analog Mood Scales, measures of neuropsychological functioning. RESULTS: VASES performance was not related to demographic variables, cognitive functioning, visual acuity, prior stroke or severe visuoperceptual impairment/left visual neglect. The VASES was most related to emotional functioning, with lower self-esteem ratings associated with higher levels of depressive symptoms and general emotional distress. Individuals with right hemisphere stroke tended to endorse lower self-esteem ratings, while aphasic individuals may have misunderstood the intent of the task. CONCLUSIONS: The non-verbal VASES appears to be minimally impacted by potentially invalidating patient factors (e.g. visual acuity, left visual neglect), although its use with patients with severe communication deficits is cautioned. The VASES may prove useful in identifying acute stroke survivors most at risk for emotional dysfunction, and may be useful as a research tool in this population.     

Brooding Perfectionism: Refining the Roles of Rumination and Perfectionism in the Etiology of Depression

The current study examines the hypothesized interaction between certain dimensions of both perfectionism and rumination as diatheses for depressive symptoms. Three hundred and five participants completed measures of perfectionism, rumination, and depressive symptoms at Time 1, and then returned 4 weeks later at Time 2 to complete measures of stress and depressive symptoms. In line with our hypotheses, results indicated that individuals with high levels of certain dimensions of perfectionism (i.e., self-oriented and socially prescribed, but not other-oriented), high levels of brooding rumination (but not the reflection dimension of rumination), and high stress experienced the greatest increases in depressive symptoms over time. Moreover, results revealed that the role of self-oriented and socially prescribed perfectionism as diatheses for depression is dependent upon brooding rumination. This work has potential benefits for understanding the cognitive mechanisms that lead to depression.

Cognitive Vulnerability to Hopelessness Depression: A Chain Is Only as Strong as Its Weakest Link

The hopelessness theory proposes that depressogenic inferential styles about the self, consequences, and causes serve as vulnerability factors to hopelessness depression. Previous research on the diathesis–stress component of the theory has examined each inferential style separately. Doing so, however, is likely to provide an inaccurate test of the theory because individuals who possess only one depressogenic inferential style but who show increases in symptoms following negative events will appear to support the theory in some analyses but to contradict the theory in others. The weakest link hypothesis posits that an individual is as vulnerable to hopelessness depression as her most depressogenic inferential style makes her. Therefore, according to this hypothesis, when testing the theory, researchers should determine each participant's degree of vulnerability using her most depressogenic inferential style. The goal of the current study was to test the diathesis–stress and symptom components of the hopelessness theory in seventh grade children using both the traditional and weakest link approaches. Seventy-nine children completed measures of depressogenic inferential styles and depressive symptoms (Time 1). Ten weeks later (Time 2), they completed measures of depressive symptoms and negative events. Neither depressogenic inferential styles about the self, consequences, nor causes interacted with negative events to predict increases in symptoms of hopelessness depression. In line with hypotheses, however, children's weakest links interacted with negative events to predict increases in hopelessness depression symptoms. In addition, in line with the symptom component of the theory, this interaction did not predict increases in nonhopelessness depression symptoms.     

Parent perceptions of adolescent pain expression: the adolescent pain behavior questionnaire

Pain behaviors provide meaningful information about adolescents in chronic pain, enhancing their verbal report of pain intensity with information about the global pain experience. Caregivers likely consider these expressions when making judgments about their adolescents’ medical or emotional needs. Current validated measures of pain behavior target acute or procedural pain and young or non-verbal children, while observation systems may be too cumbersome for clinical practice. The objective of this research was to design and evaluate the Adolescent Pain Behavior Questionnaire (APBQ), a parent-report measure of adolescent (11-19 years) pain expressions. This paper provides preliminary results on reliability and validity of the APBQ. Parent-adolescent dyads (N = 138) seen in a multidisciplinary pain management clinic completed the APBQ and questionnaires assessing pain characteristics, quality of life, functional disability, depressive symptoms, and pain catastrophizing. Principal components analysis of the APBQ supported a single component structure. The final APBQ scale contained 23 items with high internal consistency (α = 0.93). No relationship was found between parent-reported pain behaviors and adolescent-reported pain intensity. However, significant correlations were found between parent-reported pain behaviors and parent- and adolescent-reported functional disability, pain catastrophizing, depressive symptoms, and poorer quality of life. The assessment of pain behaviors provides qualitatively different information than solely recording pain intensity and disability. It has clinical utility for use in behavioral treatments seeking to reduce disability, poor coping, and distress.     

Negative Cognitive Style and Past History of Major Depressive Episodes in University Students

The current study examined whether questionnaire- and interview-based assessments of negative cognitive style (Abramson et al. in Psychol Rev 96:358–372, 1989) were each associated with a past history of major depressive episodes (MDE) in currently non-disordered university students. In addition, we examined whether negative cognitive style as assessed by either questionnaire or interview was associated with a past history of MDE above and beyond the association between negative core beliefs (Beck in Depression: clinical, experimental, and theoretical aspects. Harper & Row, New York, 1967; Treatment of depression: old controversies and new approaches. Raven Press, New York, 1983; Young in Cognitive therapy for personality disorders: A schema-focused approach, 3rd edn. Professional Resource Exchange, Sarasota, 1990; Young et al. in Schema therapy: a practitioner’s guide. Guilford Press, New York, 2003) and such a history. Sixty university students completed self-report measures assessing current depressive symptoms and negative cognitive style as well as semi-structured clinical interviews assessing current and past history of MDEs, negative cognitive style, and negative core beliefs. In line with hypotheses, negative cognitive style as assessed by both questionnaire and interview were each significantly associated with a past history of MDE after controlling for current depressive symptoms. At the same time, of the two approaches to assessing negative cognitive style, only the interview-based approach exhibited a unique effect. Negative cognitive style as assessed by interview, but not by questionnaire, remained significantly associated with past depression after controlling for the association between negative core beliefs and such a history.     

The relationship between executive function, AD/HD, overeating, and obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ(2) = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.     

Negative Cognitive Styles and Stress-Reactive Rumination Interact to Predict Depression: A Prospective Study

Research on cognitive theories of depression has identified negative cognitive styles and rumination in response to depressed mood as risk factors for depressive episodes. In addition, a general self-focusing style has been suggested to increase vulnerability to depression. The present study used a behavioral high-risk paradigm to test whether the interaction of negative cognitive styles and rumination predicted the prospective onset, number, and duration of depressive episodes in a sample of 148 initially nondepressed undergraduates over a 2.5-year follow-up. In addition, rumination was assessed specifically as the tendency to focus on maladaptive self-referential thoughts following stressful events (stress-reactive rumination; SRR). The principal hypotheses tested were (1) the interaction of negative cognitive styles and SRR increases risk for developing depressive episodes as well as longer duration depressive episodes; and (2) this interaction would not be obtained when a trait measure of general self-focus or a measure of rumination in response to depressed mood is used instead of the measure of SRR. After controlling for subsyndromal depressive symptoms and the main effects of negative cognitive styles and SRR, the interaction of negative cognitive styles and SRR was found to predict the prospective onset, number, and duration of major depressive and hopelessness depressive episodes. These interactions were not obtained when other measures of trait self-focus and depressive rumination were used instead of SRR.     

Testing the psychometric properties of the Cognitions Checklist,a measure to differentiate anxiety and depression among older adults

Considerable debate has been waged in the field about whether anxiety and depressive cognitions can be discriminated, and whether they can discriminate anxiety and depression symptoms. The current study examined a standard measure of cognitions, the Cognitions Checklist (CCL) that has yielded mixed results when tested in older age samples. A community sample of older adults (N = 169; mean age = 75.70; SD = 8.55) completed a series of self-report questionnaires, including the CCL as well as measures of anxiety and depression symptoms. The CCL, which yielded a three-factor structure rather than the typical two-factor structure, did not cognitively discriminate anxiety from depression. The results have implications for understanding cognitive factors that differentiate between anxiety and depression symptoms in older adults and suggest the importance of assessing cognitions that are tailored to the concerns of this population.