The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic.

OBJECTIVES: The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic. METHODS: Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021. RESULTS: Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association. CONCLUSIONS: These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

Negative affective priming: Reliability and associations with depression symptoms in three samples.

The negative affective priming (NAP) task is a behavioral measure of inhibition of emotional stimuli. Previous studies using the NAP task have found that individuals with depression show reduced inhibition of negative stimuli, suggesting that inhibition biases may play a role in the etiology and maintenance of depression. However, the psychometric properties of the NAP task have not been evaluated or reported. In the present study, we report data on the association between NAP task performance and depression symptoms in three independent samples, and we evaluate the internal consistency and test-retest reliability of the NAP effect indices. The NAP effect for both negative and positive target words had poor internal consistency in all three samples, as well as poor 2-week (Study 2) and 6-month (Study 3) test-retest reliability. The internal consistency and test-retest reliability of response times (RT) for the individual trial types were moderate to high, as were the intercorrelations between trial types. This pattern of results indicates that overall RT is reliable but variance in RTs for the different trial types in the NAP task is indistinguishable from variance in overall RT. Depression symptom severity was not associated with the NAP effect for negative or positive target words in any of the samples, which could be due to the poor reliability of the NAP effect. Based on these findings, we do not recommend that researchers use the NAP task as a measure of individual differences in the inhibition of emotional stimuli.

Gambling Disorder and Stigma: Opportunities for Treatment and Prevention.

Purpose of Review: Gambling disorder is among the most stigmatized mental health problems. More research is needed to understand the mechanisms that underlie this stigma and the effects of stigma-reduction interventions. This paper reviews extant literature on the stigma of gambling disorder and highlights evidence from this research and the broader mental illness stigma literature to help advance research on the prevention and reduction of gambling-related stigma. Recent Finding: The public stigma of gambling disorder includes stereotypes of affected individuals as "greedy" and "irresponsible," beliefs that affected individuals are to blame for their problems, and desire to avoid social contact with affected individuals. Stigmatizing attitudes held by the public are often internalized by individuals with gambling disorder, which leads to problem concealment, reduced treatment-seeking, and decreased self-esteem. Women with gambling disorder, as well as those with more severe gambling problems and who perceive greater stigma by the public, are most vulnerable to self-stigma. There is evidence that certain beliefs may underlie the stigmatization of gambling disorder, including beliefs about its causes. Contact- and education-based interventions show efficacy for the reduction of mental illness-related stigma more broadly; additional research is needed to determine the efficacy of various stigma reduction strategies for gambling disorder specifically. Summary: Gambling disorder is highly stigmatized relative to other mental health problems, in part because it is viewed as more likely to be caused by controllable factors. Interventions that emphasize the biopsychosocial etiology of gambling disorder may help to prevent and reduce the blame and stigmatization of affected individuals. Structural stigma within domains such as legislation, healthcare, and the gambling industry, interventions to reduce self-stigma, stigma among mental health professionals, and the influence of culture on stigma and its reduction are critical issues for future research.

Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder.

Intolerance of uncertainty (IU) is a key construct in generalized anxiety disorder (GAD), but little is known about the concurrent and temporal patterns of associations between IU and GAD symptom severity during treatment. In addition, most of the extant literature focuses on IU as a unidimensional construct, whereas some researchers conceptualize IU as being comprised of two dimensions, inhibitory and prospective IU. Ninety individuals with GAD completed measures of IU and worry severity at pre-treatment, session 4, session 8, and end of treatment (session 12), during group-based cognitive behavior therapy (CBT) for GAD. Longitudinal multilevel modeling showed that IU predicted worry severity concurrently, but not prospectively over time; this pattern of associations was found with the total IUS score and the inhibitory (but not prospective) subscale score. Further, the relationship between IU total scores and worry severity became stronger over time. The relationship between inhibitory (but not prospective) IU and worry also became stronger over time. When the order of the variables in the model was reversed, worry severity also predicted concurrent but not future IU. Therefore, change in IU is associated with change in worry throughout the course of CBT, particularly as treatment progresses, though its directional association as a cause and/or effect remains unclear.

Coherence of attention and memory biases in currently and previously depressed women.

Previous research has found that depression is characterised by biased processing of emotional information. Although most studies have examined cognitive biases in isolation, simultaneous examination of multiple biases is required to understand how they may interact and influence one another to produce depression vulnerability. In this study, the attention and memory biases of currently depressed, previously depressed, and never depressed women were examined using the same stimuli and a unified methodology. Participants viewed negative, positive, and neutral words while their eye gaze was tracked and recorded. After a distraction task, participants completed an incidental recognition test that included words from the eye-tracking task and new words. The results supported the hypothesised mediation model for positive words: currently depressed women had a reduced attention bias for positive words and, in turn, had poorer memory for positive words relative to never depressed women. Previously depressed women, however, showed a lack of coherence between attention and memory biases for positive words. The groups did not differ in their attention or memory biases for negative words. The findings provide novel evidence in support of a causal link between the absence of protective attention and memory biases for positive information in clinical depression.

Avoidance of mild threat observed in generalized anxiety disorder (GAD) using eye tracking.

Attentional biases towards threat are assumed to be a causal factor in the development of anxiety disorders, including generalized anxiety disorder (GAD). However, findings have been inconsistent, and studies often examine single time-point bias during threat exposure, instead of across time. Attention to threat may shift throughout exposure (e.g., from initial engagement to avoidance), and research suggests that threat intensity and state anxiety influence attentional biases. No studies to our knowledge have examined biases across time and with varying threat intensity and state anxiety. Participants with GAD (n=38) and non-anxious controls (n=25) viewed emotional (high threat, mild threat, and positive) and neutral image pairs under calm and anxious mood states while their eye movements were tracked. Participants showed an initial orientation to emotional images, and, under the anxious mood induction, demonstrated a bias towards threatening images at first fixation and over time. Results suggest it may be normative to attend to threat cues over other stimuli while in an anxious state. Individuals with GAD uniquely showed a bias away from mild (but not high) threat images over time relative to controls. Implications for theories of attentional biases to threat and clinical implications for GAD and anxiety disorders broadly are discussed.

Mindfulness and Depersonalization: a Nuanced Relationship.

Objectives: Although depersonalization has been described as the antithesis of mindfulness, few studies have empirically examined this relationship, and none have considered how it may differ across various facets of mindfulness, either alone or in interaction. The present study examined the relationship between symptoms of depersonalization and facets of dispositional mindfulness in a general population sample. Methods: A total of 296 adult participants (139 male, 155 female, 2 other) were recruited online via Qualtrics and completed the Cambridge Depersonalisation Scale; Depression, Anxiety, and Stress Scale; and Five Facet Mindfulness Questionnaire. Results: Controlling for general distress, depersonalization symptoms were positively associated with Observe, Describe, and Nonreactivity facets and negatively associated with Acting with Awareness and Nonjudgment facets. After controlling for intercorrelations among the facets, depersonalization symptoms remained significantly associated with higher Nonreactivity and lower Acting with Awareness. The overall positive relationship between depersonalization symptoms and the Observe facet was moderated by both Nonjudgment and Nonreactivity. Specifically, higher Observing was related to increased depersonalization symptoms at low levels of Nonjudgment and to decreased symptoms at low levels of Nonreactivity. Conclusions: The current study provides novel insight into the relationship between depersonalization symptoms and various aspects of mindfulness. Experiences of depersonalization demonstrated divergent relationships with mindfulness facets, alone and in interaction. The results may inform theoretical models of depersonalization and mindfulness-based interventions for depersonalization. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01890-y.

Depression and the willingness to expend cognitive and physical effort for rewards: A systematic review.

Depression is associated with reduced motivation to engage in previously enjoyed activities. In particular, anhedonia has been linked to reduced motivation, though other depressive symptoms may also play a role. The purposes of this systematic review were to 1) examine the relationship between depression and motivation, as operationalized by a willingness to expend effort for rewards, 2) examine the relationship between anhedonia and motivation, and 3) examine potential methodological moderators of these relationships. Forty-three articles met our inclusion criteria for the review. Our review found that individuals with depression and anhedonia demonstrate reduced willingness to expend cognitive and physical effort for rewards, though the effect has been more robustly demonstrated for physical effort expenditure. Task design impacted the strength of these relationships, with stronger effects for tasks that used indices of decision-making and accuracy rather than response time. These findings have clinical implications for behavioral activation, which seeks to improve depressive symptoms by encouraging individuals to increase their activity level. Future research should examine the determinants of motivation in individuals with depression and anhedonia, to ultimately help these individuals become more active and hopefully improve their quality of life as a result.

Does self-focus orientation influence recall of autobiographical memories and subsequent mood in dysphoria?

Past research suggests that depressed individuals are less likely than non-depressed individuals to engage in mood-incongruent recall in response to negative mood and do not experience associated mood reparative effects. The present study examined the effects of adopting a reflective versus ruminative self-focus orientation towards one's mood on the valence of autobiographical memories recalled following a negative mood induction and the extent of mood repair following memory recall among individuals with varying depressive symptomatology. Participants underwent a negative mood induction and either a ruminative (n = 69) or reflective (n = 49) self-focus manipulation, and then recalled five specific autobiographical memories. Depression symptoms were associated with recall of less positive memories and reduced mood repair. The valence of recalled memories was associated with the extent of mood improvement, and depressive symptoms did not moderate this association. Contrary to our hypothesis, a reflective self-focus was not associated with recall of more positive memories or greater mood improvement than a ruminative self-focus. The results suggest that more depressed individuals are less likely to spontaneously engage in mood-incongruent recall in a negative mood state; however, recall of positive memories is associated with similar mood reparative effects regardless of depressive symptomatology.

QTc Prolongation in Pediatric Patients with Diabetic Ketoacidosis.

OBJECTIVE: To investigate the association between diabetic ketoacidosis (DKA) and prolonged QTc interval and to assess for correlation between DKA severity and QTc prolongation. STUDY DESIGN: Retrospective observational study in a pediatric hospital. Patients admitted with DKA diagnosed by laboratory criteria and an electrocardiogram (ECG) performed during a period of acidosis were identified using Looking Glass Clinical Analytics. Data including age, sex, pH, electrolytes, anion gap, and ECG variables were collected. Patients were excluded if they had a prior diagnosis of prolonged QTc or were taking QTc prolonging medications. Severity of DKA was classified as mild (pH 7.24-7.3), moderate (pH 7-7.24), or severe (pH <7). ECGs were read by a pediatric electrophysiologist and QTc interval was manually calculated utilizing the Bazett formula. RESULTS: Ninety-six patients were included (mean age 15.2 ± 4.2 years, pH 7.12 ± 0.12, bicarbonate 8.6 ± 3.7 mmol/L, potassium 5.3 ± 1.1 mEq/L). Mean QTc interval for all patients in DKA was 454 ± 32 msec. Mean QTc in the mild group was 441 ± 22 msec, moderate group 460 ± 36 msec, and severe group 461 ± 34 msec. There was a significant difference in QTc interval across DKA severity groups (P = .05). There was a significant association between higher anion gaps and greater QTc intervals (r = 0.21, P = .04). CONCLUSIONS: Thirty-one percent of pediatric patients with DKA demonstrated QTc prolongation on ECG. Severity of DKA and worsening acidosis were associated with increased prolongation of the QTc. Further study is required to evaluate the clinical impact of these findings.

Cognitive control over emotional information in current and remitted depression.

Cognitive theories of depression propose that difficulty exerting cognitive control over emotional information may be involved in the development, maintenance, and/or recurrence of depression. This study evaluated depression-related biases in three cognitive control functions, namely inhibition, working memory updating, and set shifting. Currently depressed (n = 53), remitted depressed (n = 55), and non-clinical control (n = 51) participants completed computer-based paradigms designed to measure inhibition, working memory updating, and set shifting, respectively, involving emotional stimuli. As hypothesized, currently depressed participants exhibited biases in cognitive control over emotional information but did not exhibit broad impairments on a non-emotional measure of cognitive control. Specifically, currently depressed participants showed a reduced ability to inhibit the processing of negative distracting stimuli and to update working memory with emotional information, relative to control participants. Currently depressed participants also had greater difficulty shifting away from an emotion-relevant task set than from an emotion-irrelevant task set, whereas control participants did not show this bias. Remitted depressed participants did not demonstrate similar biases to currently depressed participants.

What's in a Name? Evaluating the Public Stigma of Gambling Disorder.

Public stigma of gambling disorder has negative effects on the mental health and functioning of affected individuals and impedes treatment-seeking. One factor thought to be implicated in stigma is the label used to describe the condition. The aims of this research were to: (1) evaluate whether different labels for problematic gambling behavior influence public stigma; and (2) compare public stigma of gambling disorder to other health conditions. Separate samples of university student (Study 1) and general population (Study 2) participants were randomly assigned to label conditions and completed questionnaires assessing stigma and attitudes towards the assigned label. In Study 1, the eight conditions included four gambling labels (problem gambling, pathological gambling, gambling disorder, and gambling addiction) and four psychiatric or health comparison labels (depression, obsessive-compulsive disorder, alcohol use disorder, and asthma). In Study 2, compulsive buying disorder was added as a fifth psychiatric comparison for a total of nine conditions. The results indicated that the four gambling label conditions elicited similar attitudes and stigma. Those conditions were also more stigmatized than the depression, obsessive-compulsive disorder, and asthma conditions. The gambling conditions elicited similar stigmatizing attitudes as alcohol use disorder but were slightly more stigmatized than compulsive buying disorder, with these conditions showing both similarities and differences across the stigma-related outcomes. The results were largely consistent across both samples and contribute to knowledge of the nature and origins of gambling-related stigma.

The reliability of attentional biases for emotional images measured using a free-viewing eye-tracking paradigm.

Cognitive theories of anxiety disorders and depression posit that attentional biases play a role in the development, maintenance, and recurrence of these disorders. Several paradigms have been used to examine attentional biases in anxiety and depression, but information on the reliability of different attentional bias indices is limited. In this study we examined the internal consistency and 6-month test-retest reliability of attentional bias indices derived from a free-viewing eye-tracking paradigm. Participants completed two versions of an eye-tracking task-one that used naturalistic images as stimuli, and one that used face images. In both tasks, participants viewed displays of four images, each display consisting of one threat image, one sad image, one positive/happy image, and one neutral image. The internal consistency of the fixation indices (dwell time and number of fixations) for threat, sad, and positive images over the full 8-s display was moderate to excellent. When the 8-s display was divided into 2-s intervals, the dwell times for the 0- to 2-s and 2- to 4-s intervals showed lower reliability, particularly for the face images. The attentional bias indices for the naturalistic images showed adequate to good stability over the test-retest period, whereas the test-retest reliability estimates for the face images were in the low to moderate range. The implications of these results for attentional bias research are discussed.

Cognitive change in cognitive-behavioural therapy v. pharmacotherapy for adult depression: a longitudinal mediation analysis.

BACKGROUND: Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS: The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS: Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS: The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.

Psychometric Properties of the Inventory of Attitudes Toward Seeking Mental Health Services (Chinese Version).

ABSTRACTResearch on underutilization patterns of mental health services among older Chinese immigrants is limited, partly due to the absence of translated, psychometrically sound measures for assessing attitudes towards seeking help. In this study we interviewed 200 older Chinese Canadian immigrants using a translated version of the Inventory of Attitudes Toward Seeking Mental Health Services scale (IASMHS), and assessed mental health care utilization over the past 12 months and intentions to seek help. Confirmatory factor analysis failed to replicate the original three-factor structure; thus, we used exploratory factor analysis to create a 20-item Chinese version, the C-IASMHS. It had acceptable internal consistency and was positively correlated with intentions to seek help. The Help-Seeking Propensity subscale had the strongest psychometric properties whereas the Psychological Openness subscale performed poorly based on factor analysis results and unacceptable internal consistency. Future research should focus on the conceptual equivalence of psychological openness among Chinese older adults.

Avoidance and depression vulnerability: An examination of avoidance in remitted and currently depressed individuals.

Behavioral theories posit that depression is characterized by heightened levels of avoidance, and recent research has supported this notion. Whether avoidance persists after remission from depression is unknown, however. In this study, we investigated levels of cognitive and behavioral avoidance in remitted, currently, and never depressed individuals. We also examined relationships among avoidance and purported adaptive and maladaptive emotion regulation strategies. Remitted depressed individuals exhibited levels of cognitive and behavioral avoidance, in social and nonsocial domains, that were greater than nonclinical control individuals but lower than currently depressed individuals. Avoidance was significantly associated with use of maladaptive emotion regulation strategies, although the pattern of relationships differed across remitted and currently depressed individuals. In contrast, avoidance was largely unrelated to use of adaptive emotion regulation strategies, among remitted and currently depressed individuals.

Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals.

Depression is associated with attentional biases for emotional information that are proposed to reflect stable vulnerability factors for the development and recurrence of depression. A key question for researchers is whether those who have recovered from depression also exhibit attentional biases, and if so, how similar these biases are to those who are currently depressed. To address this question, the present study examined attention to emotional faces in remitted depressed (N=26), currently depressed (N=16), and never depressed (N=33) individuals. Participants viewed sets of four face images (happy, sad, threatening, and neutral) while their eye movements were tracked throughout an 8-s presentation. Like currently depressed participants, remitted depressed participants attended to sad faces significantly more than never depressed participants and attended to happy faces significantly less. Analyzing temporal changes in attention revealed that currently and remitted depressed participants did not reduce their attention to sad faces over the 8-s presentation, unlike never depressed participants. In contrast, remitted depressed participants attended to happy faces similarly to never depressed participants, increasing their attention to happy faces over the 8-s presentation. The implications for cognitive theories of depression and depression vulnerability are discussed.

The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis.

Motivational interviewing is a client-centered therapeutic intervention that aims to resolve ambivalence toward change. We conducted a systematic review and meta-analysis on the efficacy of motivational interviewing, compared to non-motivational interviewing controls, in the treatment of disordered gambling. Electronic databases were searched for randomized controlled trials that evaluated change in gambling behavior using motivational interviewing in adult disordered gamblers. The primary outcomes were the weighted mean difference (WMD) for change in average days gambled per month and average dollars lost per month. The search strategy yielded 447 articles, of which 20 met criteria for full text review. Overall, 8 studies (N=730) fulfilled the inclusion criteria for systematic review and 5 (N=477) were included in the meta-analysis. Motivational interviewing was associated with significant reduction in gambling frequency up to a year after treatment delivery. For gambling expenditure, motivational interviewing yielded significant reductions in dollars spent gambling compared to non-motivational controls at post-treatment only (1-3 months). Overall, the results of this review suggest that motivational interviewing is an efficacious style of therapy for disordered gambling in the short term. Whether treatment effects are maintained over time remains unclear.

Comorbid Problem Gambling and Major Depression in a Community Sample.

Major depression is among the most common comorbid conditions in problem gambling. However, little is known about the effects of comorbid depression on problem gambling. The present study examined the prevalence of current major depression among problem gamblers (N = 105) identified from a community sample of men and women in Alberta, and examined group differences in gambling severity, escape motivation for gambling, family functioning, childhood trauma, and personality traits across problem gamblers with and without comorbid depression. The prevalence of major depression among the sample of problem gamblers was 32.4%. Compared to problem gamblers without depression (n = 71), problem gamblers with comorbid depression (n = 34) reported more severe gambling problems, greater history of childhood abuse and neglect, poorer family functioning, higher levels of neuroticism, and lower levels of extraversion, agreeableness, and conscientiousness. Furthermore, the problem gamblers with comorbid depression had greater levels of childhood abuse and neglect, worse family functioning, higher neuroticism, and lower agreeableness and conscientiousness than a comparison sample of recreational gamblers with depression (n = 160). These findings underscore the need to address comorbid depression in assessment and treatment of problem gambling and for continued research on how problem gambling is related to frequently co-occurring disorders such as depression.

Distinguishing the roles of trait and state anxiety on the nature of anxiety-related attentional biases to threat using a free viewing eye movement paradigm.

Although attentional biases to threatening information are thought to contribute to the development and persistence of anxiety disorders, it is not clear whether an attentional bias to threat (ABT) is driven by trait anxiety, state anxiety or an interaction between the two. ABT may also be influenced by "top down" processes of motivation to attend or avoid threat. In the current study, participants high, mid and low in trait anxiety viewed high threat-neutral, mild threat-neutral and positive-neutral image pairs for 5 seconds in both calm and anxious mood states while their eye movements were recorded. State anxiety alone, but not trait anxiety, predicted greater maintenance of attention to high threat images (relative to neutral) following the first fixation (i.e., delayed disengagement) and over the time course. Motivation was associated with the time course of attention as would be expected, such that those motivated to look towards negative images showed the greatest ABT over time, and those highly motivated to look away from negative images showed the greatest avoidance. Interestingly, those ambivalent about where to direct their attention when viewing negative images showed the greatest ABT in the first 500 ms of viewing. Implications for theory and treatment of anxiety disorders, as well as areas for further study, are discussed.