Association between decentering and reductions in relapse/recurrence in mindfulness-based cognitive therapy for depression in adults: A randomized controlled trial.

OBJECTIVE: "Decentering" is defined as the ability to observe one's thoughts and feelings as temporary, objective events in the mind (Safran & Segal, 1990), and is increasingly regarded as a candidate mechanism in mindfulness-based interventions. The present study sought to examine the role of decentering, and other related variables, in the efficacy of Mindfulness-based cognitive therapy (MBCT) as compared to two active comparison conditions. METHOD: Formerly depressed individuals (N = 227), randomly assigned to MBCT (n = 74), relaxation group therapy (RGT; n = 77) or Treatment as usual (TAU; n = 76), completed self-report measures of decentering and symptoms of depression at pre-, mid-, and posttreatment, and relapse was assessed at 3, 6, 9, and 12 months, posttreatment. RESULTS: With regard to the acute treatment phase, results indicated that, whereas levels of depression increased in both RGT and TAU, MBCT patients remained free from symptom gains. Moreover, gains in decentering from mid- to posttreatment predicted reductions in depression from pre- to posttreatment for MBCT and TAU, but not for RGT. Participants who experienced increases in decentering, measured from mid- to posttreatment, generally evidenced the lowest levels of relapse/recurrence (during the four follow-up assessments), largely irrespective of treatment group. However, results related to change in decentering should be considered exploratory due to small cell sizes among participants who did not experience gains in decentering. CONCLUSIONS: Taken together, these results suggest that decentering is a potent mechanism for reduction of relapse in major depression, albeit one that is nonspecific to MBCT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Structural Validity of the Social Problem-Solving Inventory-Revised Short Form: Application to Brooding and Reflection.

Research on social problem-solving ability or the cognitive-behavioral processes used to find successful solutions to everyday problems has been advanced by the availability of easy-to-administer self-report measures. The goal of the current study is twofold: (a) validate the factor structure of the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R:S) and (b) examine the relationship between depressive rumination subtypes and dimensions of social problem solving. An initial confirmatory factor analyses (CFA) in Sample 1 revealed poor model fit. An exploratory factor analysis revealed that several items cross-loaded on more than one factor. These items were removed and a subsequent CFA demonstrated adequate model. The revised model was validated in a second sample and convergent and divergent validity were examined. Brooding was related to more maladaptive problem-solving ability while reflection was generally associated with a more adaptive problem-solving style. No gender differences were found.

Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions.

Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.

Staff Views of an Emergency Department Intervention Using Safety Planning and Structured Follow-Up with Suicidal Veterans.

The objective of this study is to summarize staff perceptions of the acceptability and utility of the safety planning and structured post-discharge follow-up contact intervention (SPI-SFU), a suicide prevention intervention that was implemented and tested in five Veterans Affairs Medical Center emergency departments (EDs). A purposive sampling approach was used to identify 50 staff member key informants. Interviews were transcribed and coded using thematic analysis. Almost all staff perceived the intervention as helpful in connecting SPI-SFU participants to follow-up services. A slight majority of staff believed SPI-SFU increased Veteran safety. Staff members also benefited from the implementation of SPI-SFU. Their comfort discharging Veterans at some suicide risk increased. SPI-SFU provides an appealing option for improving suicide prevention services in acute care settings.

Advances in cognitive theory and therapy: the generic cognitive model.

For over 50 years, Beck's cognitive model has provided an evidence-based way to conceptualize and treat psychological disorders. The generic cognitive model represents a set of common principles that can be applied across the spectrum of psychological disorders. The updated theoretical model provides a framework for addressing significant questions regarding the phenomenology of disorders not explained in previous iterations of the original model. New additions to the theory include continuity of adaptive and maladaptive function, dual information processing, energizing of schemas, and attentional focus. The model includes a theory of modes, an organization of schemas relevant to expectancies, self-evaluations, rules, and memories. A description of the new theoretical model is followed by a presentation of the corresponding applied model, which provides a template for conceptualizing a specific disorder and formulating a case. The focus on beliefs differentiates disorders and provides a target for treatment. A variety of interventions are described.

Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples.

The fourth edition of the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV) is a self-report measure that is commonly used to screen for the presence of generalized anxiety disorder (GAD). The current investigation attempted to identify an optimal cut score using samples obtained from an outpatient psychiatric (n=163) and primary care clinic (n=99). Results indicated that a cut score of 7.67 provided an optimal balance of sensitivity (.85) and specificity (.74) comparable to a previously identified cut score (5.7) across both samples (sensitivity=.90, specificity=.66). However, both cut scores were consistently outperformed by a score representing the criteria for GAD described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (sensitivity=.89, specificity=.82).

Neural mechanisms of the cognitive model of depression.

In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model--biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas--have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck's cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck's cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.

Examination of the factor structure and concurrent validity of the Langer Mindfulness/Mindlessness Scale.

Langer's theory of mindfulness proposes that a mindful person seeks out and produces novelty, is attentive to context, and is flexible in thought and behavior. In three independent studies, the factor structure of the Langer Mindfulness/Mindlessness Scale was examined. Confirmatory factor analysis failed to replicate the four-factor model and a subsequent exploratory factor analysis revealed the presence of a two-factor (mindfulness and mindlessness) solution. Study 2 demonstrated that the two factors assessed discrete constructs and were not merely products of acquiescence. Support was also found for a nine-item, one-factor model comprised solely of mindfulness items. On comparing models, Study 3 suggested the superiority of the one-factor mindfulness model. Finally, a preliminary investigation of the concurrent validity of the revised nine-item Langer Mindfulness/Mindlessness Scale is presented. The current article offers researchers a revised version of a mindfulness measure derived from a cognitive perspective.

Beyond Depression: Towards a Process-Based Approach to Research, Diagnosis, and Treatment.

Despite decades of research on the etiology and treatment of depression, a significant proportion of the population is affected by the disorder, fails to respond to treatment and is plagued by relapse. Six prominent scientists, Aaron Beck, Richard Davidson, Fritz Henn, Steven Maier, Helen Mayberg, and Martin Seligman, gathered to discuss the current state of scientific knowledge on depression, and in particular on the basic neurobiological and psychopathological processes at play in the disorder. These general themes were addressed: 1) the relevance of learned helplessness as a basic process involved in the development of depression; 2) the limitations of our current taxonomy of psychological disorders; 3) the need to work towards a psychobiological process-based taxonomy; and 4) the clinical implications of implementing such a process-based taxonomy.

Interpersonal vulnerability to depression in high-risk children: the role of insecure attachment and reassurance seeking.

This study examined the relation between insecure attachment and depression in a sample of 140 children (69 boys and 71 girls; ages 6 to 14) whose parents have a history of major depressive episodes. In addition, we examined whether this relation was moderated by excessive reassurance seeking. Children completed measures assessing insecure attachment to parents, excessive reassurance seeking, and current depressive symptoms. In addition, children and their parents participated in a semistructured clinical interview assessing children's current and past history of depressive symptoms and episodes. In line with hypotheses, children who exhibited high levels of both insecure attachment and excessive reassurance seeking experienced higher levels of current depressive symptoms than children who possessed only one or neither of these interpersonal risk factors. Furthermore, the interaction of insecure attachment with excessive reassurance was associated with a past history and greater severity of depressive episodes even after controlling for current depressive symptoms.