Dismantling cognitive-behavioural therapy components for attention-deficit hyperactivity disorder in adolescents and adults: protocol for a network meta-analysis.

INTRODUCTION: Cognitive-behavioural therapy (CBT) consists of multiple treatment techniques for each treatment model and is tailored to the patient's characteristics. Randomised controlled trials (RCTs) have reported that CBT is effective for attention-deficit/hyperactivity disorder (ADHD); however, which CBT components are effective is unknown. In order to provide the best treatment technique, it is important to know which therapeutic component or combination thereof is more effective and what the specific effect size is. METHODS AND ANALYSIS: We will perform component network meta-analysis (cNMA). The search will include studies published from database inception up to 31 March 2022, in English. The electronic databases of MEDLINE (via PubMed), EMBASE, PsycINFO, ClinicalTrials.gov and Cochrane Library will be searched. We will systematically identify all RCTs in the treatment of ADHD between the ages of 10 and 60 years, comparing interventions composed of various CBT components with controlled interventions. We will perform pairwise and network meta-analysis with random effects to estimate summary ORs and standardised mean differences. We will assess the risk of bias in selected studies using the Cochrane risk of bias tool. ETHICS AND DISSEMINATION: Since we will review published papers, ethical approval is not required. The results from this cNMA will provide a panorama of the CBT-based ADHD studies. The results of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022323898.

In COVID-19 Health Messaging, Loss Framing Increases Anxiety with Little-to-No Concomitant Benefits: Experimental Evidence from 84 Countries.

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., "If you do not practice these steps, you can endanger yourself and others") or potential gains (e.g., "If you practice these steps, you can protect yourself and others")? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions.

Preliminary validation of the self-report measure assessing experiences of negative independent and dependent event frequency in Japanese university students.

Background: In the past, different stress generation studies have used self-report measures comprising different items to assess each category of negative events. Moreover, the validity of these scales has not been adequately investigated. Therefore, we developed a self-report measure dedicated to assessing experiences of negative interpersonal dependent events, negative non-interpersonal dependent events, and negative independent events in university students, which was named the Negative Independent/Dependent Events Scale. Methods: Japanese undergraduate students (N = 247; mean age = 19.18 years, SD = 3.08) responded to the Negative Independent/Dependent Events Scale, which had items selected for adequate content validity. They also responded to self-report measures of depressive symptoms, reassurance-seeking behaviors, inattention, and lack of perseverance. Results: All the negative events subscales had moderate positive correlations with depressive symptoms. In addition, the negative interpersonal dependent events subscale showed a moderate positive correlation with reassurance-seeking behaviors, and the negative non-interpersonal dependent events subscale showed a strong positive correlation with inattention. Furthermore, the negative non-interpersonal dependent events subscale was more strongly correlated with inattention than the other two negative events subscales. In contrast, the negative interpersonal dependent events subscale was more strongly correlated with reassurance-seeking behaviors than with the negative independent events subscale but not more strongly than with the negative non-interpersonal dependent events subscale. Conclusions: These findings indicated the acceptable construct validity of the Negative Independent/Dependent Events Scale. However, further research is necessary to establish the discriminant validity of the negative interpersonal dependent events subscale and the negative non-interpersonal dependent events subscale.

Metacognitive Ability and the Precision of Confidence.

In prior research, signal detection theory (SDT) has been widely utilized to assess metacognitive ability. However, the SDT metacognitive model requires the use of a two-alternative forced-choice task, while confidence must also be measured discretely. In our model, participants' cognitive ability and their confidence in the cognitive task were used to estimate their metacognitive abilities. Therefore, in this study, a metacognitive model that can be applied to various cognitive tasks was developed. This model implements the item response theory (IRT) and Q-learning models to estimate cognitive ability; participants' metacognitive ability is defined as the discrepancy between their confidence in their cognitive ability and their actual cognitive ability. The entire procedure was divided into two experiments. In experiment 1, two different cognitive tasks were used to estimate metacognitive ability and to examine overall discriminative and convergent validity. Notably, the parameters representing metacognitive ability did not correlate with cognitive ability but were positively correlated between the two tasks. In experiment 2, we performed a similar analysis using a different task to test the replicability of experiment 1. The results for experiment 2 were replicated for discriminative and convergent validity, albeit with weak results. Our metacognitive model exhibited high interpretability and versatility.

Causes and consequences of stress generation: Longitudinal associations of negative events, aggressive behaviors, rumination, and depressive symptoms.

The present study examined the causes and consequences of stress generation in university students in Japan. A two-wave longitudinal study with an 8- or 9-week interval was conducted in the fall of 2020. Undergraduate and graduate students at four universities in Japan (N = 201) completed self-report measures assessing experiences of negative interpersonal dependent events, negative non-interpersonal events, and negative independent events at two times. At the same time, they also responded to measures of aggressive behaviors, trait rumination, and depressive symptoms. Path analyses revealed that baseline aggressive behaviors were positively associated with an increase in subsequent negative interpersonal dependent events, even after controlling for the influences of negative interpersonal dependent events, rumination, and depressive symptoms at baseline. However, aggressive behaviors were not significantly associated with subsequent negative non-interpersonal dependent events or negative independent events. These findings suggest that aggressive behaviors may have been a factor leading to interpersonal stress generation. Furthermore, all categories of negative event experiences predicted an increase in subsequent depressive symptoms, but not subsequent rumination, and rumination was not significantly associated with subsequent depressive symptoms. This research extends previous studies on the causes and consequences of stress generation conducted in the US by using specific measures of aggressive behaviors and including a non-restricted sample of university students in Japan. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02859-9.

Classifying patients with depressive and anxiety disorders according to symptom network structures: A Gaussian graphical mixture model-based clustering.

Patients with mental disorders often suffer from comorbidity. Transdiagnostic understandings of mental disorders are expected to provide more accurate and detailed descriptions of psychopathology and be helpful in developing efficient treatments. Although conventional clustering techniques, such as latent profile analysis, are useful for the taxonomy of psychopathology, they provide little implications for targeting specific symptoms in each cluster. To overcome these limitations, we introduced Gaussian graphical mixture model (GGMM)-based clustering, a method developed in mathematical statistics to integrate clustering and network statistical approaches. To illustrate the technical details and clinical utility of the analysis, we applied GGMM-based clustering to a Japanese sample of 1,521 patients (Mage = 42.42 years), who had diagnostic labels of major depressive disorder (MDD; n = 406), panic disorder (PD; n = 198), social anxiety disorder (SAD; n = 116), obsessive-compulsive disorder (OCD; n = 66), comorbid MDD and any anxiety disorder (n = 636), or comorbid anxiety disorders (n = 99). As a result, we identified the following four transdiagnostic clusters characterized by i) strong OCD and PD symptoms, and moderate MDD and SAD symptoms; ii) moderate MDD, PD, and SAD symptoms, and weak OCD symptoms; iii) weak symptoms of all four disorders; and iv) strong symptoms of all four disorders. Simultaneously, a covariance symptom network within each cluster was visualized. The discussion highlighted that the GGMM-based clusters help us generate clinical hypotheses for transdiagnostic clusters by enabling further investigations of each symptom network, such as the calculation of centrality indexes.

Depression, Rumination, and Impulsive Action: A Latent Variable Approach to Behavioral Impulsivity.

Previous research on the relationship between rumination and behavioral impulsivity has been limited because impulsivity was assessed by using individual tasks. This study examined the concurrent associations of a latent variable named impulsive action with rumination and depression to alleviate the task-impurity problem and the low reliability of laboratory tasks assessing impulsivity. This study also examined whether stressors mediated the association between impulsive action and rumination. University students in Japan (N = 176) conducted three laboratory tasks assessing impulsive action: the Go/No-Go Task, the Stop Signal Task, and the Conners Continuous Performance Test 3rd Edition. They also completed self-report measures of rumination, stressors, and depression. Results indicated that the latent variable named impulsive action constructed from the performance in these three tasks was positively associated with rumination. Moreover, stressors mediated this association. Also, impulsive action was positively associated with depression via the increase in stressors and rumination. These findings and those of previous studies examining associations between rumination and self-reported impulsivity suggest that impulsivity might be a determinant of rumination.

Computational Psychiatry Research Map (CPSYMAP): A New Database for Visualizing Research Papers.

The field of computational psychiatry is growing in prominence along with recent advances in computational neuroscience, machine learning, and the cumulative scientific understanding of psychiatric disorders. Computational approaches based on cutting-edge technologies and high-dimensional data are expected to provide an understanding of psychiatric disorders with integrating the notions of psychology and neuroscience, and to contribute to clinical practices. However, the multidisciplinary nature of this field seems to limit the development of computational psychiatry studies. Computational psychiatry combines knowledge from neuroscience, psychiatry, and computation; thus, there is an emerging need for a platform to integrate and coordinate these perspectives. In this study, we developed a new database for visualizing research papers as a two-dimensional "map" called the Computational Psychiatry Research Map (CPSYMAP). This map shows the distribution of papers along neuroscientific, psychiatric, and computational dimensions to enable anyone to find niche research and deepen their understanding ofthe field.

Linear Ballistic Accumulator Modeling of Attentional Bias Modification Revealed Disturbed Evidence Accumulation of Negative Information by Explicit Instruction.

In recent years, several attentional bias modification (ABM) studies have been conducted. Previous studies have suggested that explicit instruction (i.e., informing participants of the contingency of stimuli) enhances the effect of ABM. However, the specific working mechanism has not been identified. This is partly because reaction time (RT) data are typically reduced to an attention bias score, which is a mere difference of RT between experimental and control conditions. This data reduction causes a loss of information, as RT reflects various cognitive processes at play while making a response or decision. To overcome this issue, the present study applied linear ballistic accumulator (LBA) modeling to the outcomes (RT measures) of explicitly guided (compared to standard) ABM. This computational modeling approach allowed us to dissociate RTs into distinct components that can be relevant for attentional bias, such as efficiency of information processing or prior knowledge of the task; this provides an understanding of the mechanism of action underlying explicitly guided ABM. The analyzed data were RT-observed in the dot-probe task, which was administered before and after 3-days of ABM training. Our main focus was on the changes in LBA components that would be induced by the training. Additionally, we analyzed in-session performances over the 3 days of training. The LBA analysis revealed a significant reduction in processing efficiency (i.e., drift rate) in the congruent condition, where the target probe is presented in the same location as a negative stimulus. This explains the reduction in the overall attentional bias score, suggesting that explicit ABM suppresses processing of negative stimuli. Moreover, the results suggest that explicitly guided ABM may influence prior knowledge of the target location in the training task and make participants prepared to respond to the task. These findings highlight the usefulness of LBA-based analysis to explore the underlying cognitive mechanisms in ABM, and indeed our analyses revealed the differences between the explicit and the standard ABM that could not be identified by traditional RT analysis or attentional bias scores.

Gambling symptoms, behaviors, and cognitive distortions in Japanese university students.

BACKGROUND: This study was conducted to investigate the relationship between symptoms of gambling problems, gambling behaviours, and cognitive distortions among a university student population in Japan ages 20 to 29 years. We aimed to address the gap in knowledge of gambling disorders and treatment for this population. METHODS: Data were obtained from 1471 Japanese undergraduate students from 19 universities in Japan. Descriptive statistics and hierarchical multivariate regression analysis were used to investigate whether the factors of gambling cognitive distortions would have predictive effects on gambling disorder symptoms. RESULTS: Results indicated that 5.1% of the participants are classifiable as probable disordered gamblers. The bias of the gambling type to pachinko and pachislot was unique to gamblers in Japan. Of the students sampled, 342 self-reported gambling symptoms via the South Oaks Gambling Screen. Hierarchical multivariate regression analysis indicated that one domain of gambling cognitive distortions was associated significantly with gambling symptoms among the 342 symptomatic participants: gambling expectancy (ß = 0.19, p < .05). The multivariate model explained 47% of the variance in the gambling symptoms. CONCLUSION: This study successfully contributed to the sparse research on university student gambling in Japan. Specifically, our results indicated a statistically significant relationship between gambling cognitive distortions and gambling disorder symptoms. These results can inform the development of preventive education and treatment for university students with gambling disorder in Japan. The report also describes needs for future research of university students with gambling disorder.

[Simulation of Schizophrenia].

There have been so many and various researches of schizophrenia since the early days of modern psychiatry, but the pathology remains unexplained, and the treatmens not established. One of the reasons is the complexity of a brain which makes it difficult to form a bridge between biological findings and symptoms. Computational psychiatry has been recently expected to overcome this difficulty. In the field, a brain is seen as an information-processing system, and the dynamics of a brain are expressed using mathematical models. In addition, mental disorders are expressed as changes including parameters in the models. Here, we introduce some studies conducted in Japan.

Enduring effects of a 5-week behavioral activation program for subthreshold depression among late adolescents: an exploratory randomized controlled trial.

BACKGROUND: No significant effect of psychological treatment has been reported from meta-analysis of subthreshold depression patients and control subjects at 1-year follow-up. However, behavioral activation is a simpler and more cost-effective treatment than cognitive behavioral therapy. The primary purpose of this study was to assess by comparison to an assessment-only control group whether the effects of behavioral activation program for depressive symptoms can persist up to 1-year follow-up without the use of antidepressants or other psychotherapy. PATIENTS AND METHODS: Late adolescent students were the population targeted in this study. Participants were allocated randomly to an intervention group (n=62) or a control group (n=56). Treatment consisted of five-weekly 60-minute sessions. Participants underwent a structured interview and completed self-report scales at 1 year post-assessment. RESULTS: Late adolescent students receiving treatment had significantly lower mean Beck Depression Inventory, second edition scores at 1-year follow-up than control group students. The effect size (Hedges' g) for between-group differences at 1-year follow-up was -0.41. CONCLUSION: Our behavioral activation program is simple and short. Nevertheless, the results obtained at 1-year follow-up of the control group and late adolescent students receiving treatment indicated a significant difference in their Beck Depression Inventory, second edition scores. Our 5-week behavioral activation program based on behavioral characteristics for subthreshold depression might be promising for subthreshold depression. The sample examined for this study imposed some study limitations.

How do Rumination and Social Problem Solving Intensify Depression? A Longitudinal Study.

In order to examine how rumination and social problem solving intensify depression, the present study investigated longitudinal associations among each dimension of rumination and social problem solving and evaluated aspects of these constructs that predicted subsequent depression. A three-wave longitudinal study, with an interval of 4 weeks between waves, was conducted. Japanese university students completed the Beck Depression Inventory-Second Edition, Ruminative Responses Scale, Social Problem-Solving Inventory-Revised Short Version, and Interpersonal Stress Event Scale on three occasions 4 weeks apart (n = 284 at Time 1, 198 at Time 2, 165 at Time 3). Linear mixed models were analyzed to test whether each variable predicted subsequent depression, rumination, and each dimension of social problem solving. Rumination and negative problem orientation demonstrated a mutually enhancing relationship. Because these two variables were not associated with interpersonal conflict during the subsequent 4 weeks, rumination and negative problem orientation appear to strengthen each other without environmental change. Rumination and impulsivity/carelessness style were associated with subsequent depressive symptoms, after controlling for the effect of initial depression. Because rumination and impulsivity/carelessness style were not concurrently and longitudinally associated with each other, rumination and impulsive/careless problem solving style appear to be independent processes that serve to intensify depression.

Validation of brain-derived signals in near-infrared spectroscopy through multivoxel analysis of concurrent functional magnetic resonance imaging.

Near-infrared spectroscopy (NIRS) is a convenient and safe brain-mapping tool. However, its inevitable confounding with hemodynamic responses outside the brain, especially in the frontotemporal head, has questioned its validity. Some researchers attempted to validate NIRS signals through concurrent measurements with functional magnetic resonance imaging (fMRI), but, counterintuitively, NIRS signals rarely correlate with local fMRI signals in NIRS channels, although both mapping techniques should measure the same hemoglobin concentration. Here, we tested a novel hypothesis that different voxels within the scalp and the brain tissues might have substantially different hemoglobin absorption rates of near-infrared light, which might differentially contribute to NIRS signals across channels. Therefore, we newly applied a multivariate approach, a partial least squares regression, to explain NIRS signals with multivoxel information from fMRI within the brain and soft tissues in the head. We concurrently obtained fMRI and NIRS signals in 9 healthy human subjects engaging in an n-back task. The multivariate fMRI model was quite successfully able to predict the NIRS signals by cross-validation (interclass correlation coefficient = ∼0.85). This result confirmed that fMRI and NIRS surely measure the same hemoglobin concentration. Additional application of Monte-Carlo permutation tests confirmed that the model surely reflects temporal and spatial hemodynamic information, not random noise. After this thorough validation, we calculated the ratios of the contributions of the brain and soft-tissue hemodynamics to the NIRS signals, and found that the contribution ratios were quite different across different NIRS channels in reality, presumably because of the structural complexity of the frontotemporal regions. Hum Brain Mapp 38:5274-5291, 2017. © 2017 Wiley Periodicals, Inc.

Cognitive behavioral therapy changes functional connectivity between medial prefrontal and anterior cingulate cortices.

BACKGROUND: Depression is characterized by negative self-cognition. Our previous study (Yoshimura et al. 2014) revealed changes in brain activity after cognitive behavioral therapy (CBT) for depression, but changes in functional connectivity were not assessed. METHOD: This study included 29 depressive patients and 15 healthy control participants. Functional Magnetic Resonance Imaging was used to investigate possible CBT-related functional connectivity changes associated with negative emotional self-referential processing. Depressed and healthy participants (overlapping with our previous study, Yoshimura et al. 2014) were included. We defined a seed region (medial prefrontal cortex) and coupled region (ACC) based on our previous study, and we examined changes in MPFC-ACC functional connectivity from pretreatment to posttreatment. RESULTS: CBT was associated with reduced functional connectivity between the MPFC and ACC. Symptom change with CBT was positively correlated with change in MPFC-ACC functional connectivity. LIMITATIONS: Patients received pharmacotherapy including antidepressant. The present sample size was quite small and more study is needed. Statistical threshold in fMRI analysis was relatively liberal. CONCLUSIONS: CBT for depression may disrupt MPFC-ACC connectivity, with associated improvements in depressive symptoms and dysfunctional cognition.

Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial.

The main behavioral characteristic of subthreshold depression that is observed in adolescents is the low frequency of exposure to environmental rewards. Therefore, it was considered that a simple intervention conducted in short sessions, focusing on increasing access to positively reinforcing activities, would be efficacious in increasing the availability of rewards. We conduct a randomized controlled trial to examine the efficacy of such a behavioral activation program that was conducted weekly for 5 weeks in 60-min sessions. Late adolescent university students aged 18-19 years with subthreshold depression were randomly allocated to a treatment (n = 62) or a control group (n = 56). The primary outcome of the study was the Beck Depression Inventory-II score. Results indicated that late adolescent students in the treatment group showed significant improvements in their depressive symptoms (effect size -0.90, 95 % CI -1.28 to -0.51) compared to the control group. Students in the treatment group also showed significant improvements in self-reported rating of quality of life and in behavioral characteristics. It is concluded that this intervention had a large and significant effect despite being short and simple and that this low-intensity cognitive behavioral therapy program could be conducted in many different types of institutions. It is suggested that the long-term effects of the treatment program should be targeted for investigation in future studies.

Is Trait Rumination Associated with the Ability to Generate Effective Problem Solving Strategies? Utilizing Two Versions of the Means-Ends Problem-Solving Test.

This study examined the relationship between trait rumination and the effectiveness of problem solving strategies as assessed by the Means-Ends Problem-Solving Test (MEPS) in a nonclinical population. The present study extended previous studies in terms of using two instructions in the MEPS: the second-person, actual strategy instructions, which has been utilized in previous studies on rumination, and the third-person, ideal-strategy instructions, which is considered more suitable for assessing the effectiveness of problem solving strategies. We also replicated the association between rumination and each dimension of the Social Problem-Solving Inventory-Revised Short Version (SPSI-R:S). Japanese undergraduate students (N = 223) completed the Beck Depression Inventory-Second Edition, Ruminative Responses Scale (RRS), MEPS, and SPSI-R:S. One half of the sample completed the MEPS with the second-person, actual strategy instructions. The other participants completed the MEPS with the third-person, ideal-strategy instructions. The results showed that neither total RRS score, nor its subscale scores were significantly correlated with MEPS scores under either of the two instructions. These findings taken together with previous findings indicate that in nonclinical populations, trait rumination is not related to the effectiveness of problem solving strategies, but that state rumination while responding to the MEPS deteriorates the quality of strategies. The correlations between RRS and SPSI-R:S scores indicated that trait rumination in general, and its brooding subcomponent in particular are parts of cognitive and behavioral responses that attempt to avoid negative environmental and negative private events. Results also showed that reflection is a part of active problem solving.

Do Individuals with Alcohol Dependence Show Higher Unfairness Sensitivity? The Relationship Between Impulsivity and Unfairness Sensitivity in Alcohol-Dependent Adults.

BACKGROUND: Alcohol-dependent patients are known to be generally more unfairness sensitive. The ultimatum game (UG) is an experimental task designed to provoke feelings of perceived unfairness. A previous study using the UG has reported more unfairness sensitivity in patients with alcohol dependence than in a nondependent control group; it has been speculated that this increased sensitivity might be due to a difficulty in impulse control. However, the mechanism of this relationship has not been clarified. Therefore, the relationship between unfairness sensitivity in interpersonal relationships and impulsivity was investigated using UG and delay discounting (DD) paradigms. METHODS: Subjects were 32 individuals with alcohol dependency and 36 healthy control individuals; both groups performed UG and DD tasks. RESULTS: Participants with alcohol dependence rejected monetary offers deemed unfair at a significantly higher rate than did control participants. Moreover, the proportion of accepting unfairness was negatively correlated with impulsivity in patients with alcohol dependence. CONCLUSIONS: Perceived unfairness is related to impulsivity in patients with alcohol dependence. These results provide insights concerning the psychopathology of alcohol dependence.

fMRI Study of Social Anxiety during Social Ostracism with and without Emotional Support.

Social anxiety is characterized by an excessive fear of being embarrassed in social interactions or social performance situations. Emotional support can help to decrease or diminish social distress. Such support may play an important role at different points of social interaction. However, it is unclear how the beneficial effects of social support are represented in the brains of socially anxious individuals. To explore this, we used the same paradigm previously used to examine the effects of emotional support on social pain caused by exclusion. Undergraduates (n = 46) showing a wide range of social anxiety scores underwent functional magnetic resonance imaging (fMRI) while participating in a Cyberball game. Participants were initially included and later excluded from the game. In the latter half of the session in which participants were excluded, they were provided with supportive messages. In line with our previous work, we found that social exclusion led to increased anterior cingulate cortex (ACC) activity, whereas emotional support led to increased left dorsolateral prefrontal cortex (DLPFC) activity. Despite validation of the paradigm, social anxiety was not associated with increased ACC activity during social exclusion, or during perceived emotional support. Instead, fear of negative evaluation as assessed by the Brief Fear of Negative Evaluation (BFNE) scale showed positive associations with left DLPFC activation while receiving emotional support, compared to while being socially excluded. The more socially anxious an individual was, the greater was the left DLPFC activity increased during receipt of messages. This suggests that highly socially anxious people still have the ability to perceive social support, but that they are nevertheless susceptible to negative evaluation by others.