Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy for Depression: A Systematic Review of Cognitive Outcomes.

Objectives: Summarize existing literature on cognitive outcomes of MBSR and MBCT for individuals with depression. Methods: Following PRISMA (2021) guidance, we conducted a systematic review. We searched databases for studies published from 2000 to 2020 which examined cognitive outcomes of MBSR and MBCT in individuals with at least mild depressive symptoms. The search result in 10 studies (11 articles) meeting inclusion criteria. Results: We identified five single armed trials and five randomized controlled trials. Results indicated that three studies did not show any improvements on cognitive outcomes, and seven studies showed at least one improvement in cognitive outcomes. Conclusions: Overall, the review highlighted several inconsistencies in the literature including inconsistent use of terminology, disparate samples, and inconsistent use of methodology. These inconsistencies may help to explain the mixed results of MBSR and MBCT on cognitive outcomes. Recommendations include a more streamlined approach to studying cognitive outcomes in depressed individuals in the context of MBSR and MBCT.

Trait mindfulness and attention to emotional information: An eye tracking study.

Biased attention for emotional information is associated with the emotional disorders. Trait mindfulness is associated with lower depression and anxiety and with improved attentional control. Mindfulness is also related to lower levels of brooding rumination. The current study examined the association between trait mindfulness, brooding rumination, depressed and anxious state moods, and attention to emotional visual stimuli utilizing eye tracking methodology. Participants were 158 undergraduates. Trait mindfulness was negatively associated with attention to sad and threatening stimuli, but was not associated with attention to positive or neutral stimuli. There was an indirect effect of mindfulness on attention to sad stimuli through brooding rumination. Data are cross sectional but provide initial evidence that mindfulness may partially exert its effects on depression and anxiety by lessening attention to negatively-valenced stimuli.

Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia.

Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.

An adapted Delphi approach: The use of an expert panel to operationally define non-judgment of internal experiences as it relates to mindfulness.

OBJECTIVES: There are several definitions of mindfulness throughout the literature, many of which suggest an attitude of non-judgmental awareness. However, the concept of "non-judgment" itself has not previously been systematically operationally defined. Our purpose was to use an expert panel to generate an operational definition of non-judgment of internal experiences, as it relates to mindfulness, to be used to inform the development of an implicit measure of the construct. DESIGN: We utilized an adapted Delphi survey method consisting of three survey rounds. SETTING: We employed in-person and online survey methods. RESULTS: We used three survey rounds with an adapted Delphi approach. Expert review panelists consisted of 18 mindfulness researchers or clinicians. Each round of survey results was assessed and discussed among the core team. A consensus was reached among the core team for an operational definition of non-judgment of internal experiences: "acknowledging our thoughts, feelings, and sensations, as they are, without applying valence (e.g., good, bad, right, wrong) to them." CONCLUSIONS: An expert panel review process informed the generation of an operational definition of non-judgment of internal experiences. Our operational definition provides a foundation for the future development of an implicit task of non-judgment of internal experiences, with the aim of using this task to assess change in response to mindfulness-based treatments. To our knowledge, this is the first systematic definition of non-judgment of internal experiences within the mindfulness literature.

Implicit bias for suicide persists after ideation resolves.

Individuals with suicidal ideation (SI), demonstrate an association between suicide-related information and the self that is automatic and outside conscious control (i.e., implicit). However, it is unclear whether this implicit bias is a state-like processes that will resolve with the reduction of SI or whether it is more trait-like and enduring. Given that implicit bias has been proposed as an indirect measurement of SI, understanding its dynamic nature is important. To investigate this, we recruited 79 (22 with a history of, but no current, SI; 57 with no lifetime history of SI) young adults who completed a structured interview assessing current and past SI. Participants also completed the Suicide Affect Misattribution Procedure assessing implicit association with suicide-relevant, negative but not suicide relevant, positive, and neutral stimuli. Participants with a history of SI demonstrated greater implicit bias for suicide compared to participants with no lifetime history, but did not significantly differ in their responses to negative, positive, or neutral stimuli. This indicates that suicide-relevant implicit bias may be a trait-like process that endures after resolution of SI. This has important implications for the conceptualization of cognitive bias in suicide and the use of these biases as implicit markers of SI.

Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are comorbid conditions, and SAD confers risk for MDD. Biased attention and interpersonal rejection are important for the development of SAD and MDD, but little research has examined how these processes may lead to MDD. We hypothesized that interpersonal rejection would result in SAD symptoms being associated with more "depression-like" attention biases. Participants (n = 164) completed a measure of SAD symptoms and an eye tracking task before and after a task in which they were randomized to be socially included or rejected. SAD symptoms, inclusion or rejection condition, and the interaction term were entered into separate hierarchical linear regressions predicting change in attention for five emotional faces. Rejection condition significantly moderated the effects of SAD on change in attention to sad, happy, and neutral faces. SAD predicted increased attention to sad faces and decreased attention to happy faces in the rejection condition, but not in the inclusion condition. SAD predicted increased attention to neutral faces in the inclusion condition, but not in the rejection condition. There were no significant effects for angry or disgust. Results suggest that SAD symptoms are associated with more depression-like attention biases in the context of interpersonal rejection.

The role of excessive reassurance seeking: An eye tracking study of the indirect effect of social anxiety symptoms on attention bias.

High social anxiety is associated with increased attentional bias, and difficulties disengaging from relevant threat information, though social anxiety may also be associated with avoidance of threat. Few mechanisms of this relationship have been empirically evaluated, whereas theories and treatment manuals implicate avoidance and/or safety behaviors as significant agents of negative reinforcement for anxiety symptoms and search for threat. The current study sought to investigate one safety behavior, excessive reassurance seeking, as a mediator of the relationship between social anxiety and attention bias to disgust facial stimuli. Support was found for our hypotheses, such that social anxiety symptoms had an indirect effect on attention bias to disgust faces through increased reassurance seeking. These results suggest that reassurance seeking may result in disengagement of attention to threat stimuli. Specifically, social anxiety may result in a decreased threshold for negative social cues and therefore seek out reassurance feedback and avoid threatening stimuli. Future studies should test these directly and utilize a prospective design. The current study suggests that reassurance seeking may be involved in the attention bias process, providing additional data for current cognitive theories of social anxiety and additional support for reinforcement patterns of anxiety symptoms.

Rejection sensitivity, interpersonal rejection, and attention for emotional facial expressions.

BACKGROUND AND OBJECTIVES: Rejection sensitivity (RS), attention for depression-relevant stimuli, and interpersonal rejection are established risk factors for depression. RS has previously been associated with increased attention for socially threatening faces, but has not been examined in the context of specifically depression-relevant stimuli. The current study examined whether RS influences attention for emotional facial expressions in the context of social rejection or inclusion. METHODS: Participants (n = 180) completed a self-report measure of RS and a free viewing eye tracking task before and after an experimental task (Cyberball) in which participants were randomized to be included or rejected. RESULTS: Hierarchical linear regressions predicting change in attention to emotional faces revealed significant effects only for sad faces. Higher RS was associated with increased attention for sad faces from pre- to post-Cyberball. Cyberball condition moderated the effect with participants in the rejection condition demonstrating increased attention for sad faces, but with no significant relationship in the inclusion condition. LIMITATIONS: Our sample had relatively low levels of RS and depression. CONCLUSIONS: Consistent with interpersonal and cognitive models of depression, we found that RS was associated with increased attention for sad faces when participants were interpersonally rejected. Results provide preliminary evidence that rejection sensitivity may contribute to depression vulnerability via increased attention to depression-relevant information in the context of interpersonal rejection. Further research including clinically depressed participants and using longitudinal approaches are necessary to confirm this potential relationship.

Rejection Sensitivity and Depression: Indirect Effects Through Problem Solving.

OBJECTIVE: Rejection sensitivity (RS) and deficits in social problem solving are risk factors for depression. Despite their relationship to depression and the potential connection between them, no studies have examined RS and social problem solving together in the context of depression. As such, we examined RS, five facets of social problem solving, and symptoms of depression in a young adult sample. METHOD: A total of 180 participants completed measures of RS, social problem solving, and depressive symptoms. We used bootstrapping to examine the indirect effect of RS on depressive symptoms through problem solving. RESULTS: RS was positively associated with depressive symptoms. A negative problem orientation, impulsive/careless style, and avoidance style of social problem solving were positively associated with depressive symptoms, and a positive problem orientation was negatively associated with depressive symptoms. RS demonstrated an indirect effect on depressive symptoms through two social problem-solving facets: the tendency to view problems as threats to one's well-being and an avoidance problem-solving style characterized by procrastination, passivity, or overdependence on others. CONCLUSIONS: These results are consistent with prior research that found a positive association between RS and depression symptoms, but this is the first study to implicate specific problem-solving deficits in the relationship between RS and depression. Our results suggest that depressive symptoms in high RS individuals may result from viewing problems as threats and taking an avoidant, rather than proactive, approach to dealing with problems. These findings may have implications for problem-solving interventions for rejection sensitive individuals.

Rumination's effect on suicide ideation through grit and gratitude: A path analysis study.

The current study documents the relationship between suicide ideation, grit and gratitude, and rumination subtypes of brooding and reflection. The relationship between rumination and suicide ideation has been well documented and previous research has demonstrated that grit and gratitude are protective factors against suicide. We hypothesized that both subtypes of rumination would have an indirect effect on suicide ideation through levels of grit and gratitude. Results of a conditional indirect effects path analysis indicated that brooding was indirectly related to suicide ideation through gratitude. Brooding interacted with grit such that it only predicted suicide ideation at low levels of grit. Reflection interacted with gratitude to predict levels of grit. Results suggest that brooding may impact suicide risk and resilience through its effect on gratitude, indicating important cognitive-behavioral targets for suicide prevention strategies. These results extend the literature about the relationship between well known risk factors for suicide and protective factors.

Sex differences in attention to disgust facial expressions.

Research demonstrates that women experience disgust more readily and with more intensity than men. The experience of disgust is associated with increased attention to disgust-related stimuli, but no prior study has examined sex differences in attention to disgust facial expressions. We hypothesised that women, compared to men, would demonstrate increased attention to disgust facial expressions. Participants (n = 172) completed an eye tracking task to measure visual attention to emotional facial expressions. Results indicated that women spent more time attending to disgust facial expressions compared to men. Unexpectedly, we found that men spent significantly more time attending to neutral faces compared to women. The findings indicate that women's increased experience of emotional disgust also extends to attention to disgust facial stimuli. These findings may help to explain sex differences in the experience of disgust and in diagnoses of anxiety disorders in which disgust plays an important role.

Elucidating the relation between childhood emotional abuse and depressive symptoms in adulthood: The mediating role of maladaptive interpersonal processes.

OBJECTIVE: The purpose of this study is to assess the potential unique and relative mediating effects of three interpersonal risk factors (i.e., excessive reassurance-seeking [ERS], negative feedback seeking [NFS], and rejection sensitivity [RS]) in the relationship between childhood emotional abuse (CEA) and depressive symptoms. METHOD: One hundred eighty-five undergraduates were followed over a four-month interval. Participants completed assessments of childhood abuse history, ERS, NFS, and RS, and depressive symptoms at baseline, as well as depressive symptoms at four-month followup. RESULTS: Findings from single-mediator analyses indicated that RS and NFS, but not ERS, mediated the relationship between CEA and prospective depressive symptoms, after accounting for childhood sexual and physical abuse, as well as baseline depressive symptoms. In our multi-mediator model, only RS remained a significant mediator of the relationship between CEA and prospective depressive symptoms. CONCLUSIONS: The current study provides preliminary evidence that negative behavioral styles may function as a mechanism linking prior experiences of CEA to subsequent depressive symptoms. Clinical implications of these findings suggest that targeting maladaptive behavioral tendencies, particularly RS, may be an effective adjunct in behavioral modification treatments of CEA victims at risk for depression.

Self-reported benefits and risks of yoga in individuals with bipolar disorder.

BACKGROUND: Although hatha yoga has frequently been recommended for patients with bipolar disorder (BD) and there is preliminary evidence that it alleviates depression, there are no published data on the benefits-and potential risks-of yoga for patients with BD. Thus, the goal of this study was to assess the risks and benefits of yoga in individuals with BD. METHODS: We recruited self-identified yoga practitioners with BD (N=109) to complete an Internet survey that included measures of demographic and clinical information and open-ended questions about yoga practice and the impact of yoga. RESULTS: 86 respondents provided sufficient information for analysis, 70 of whom met positive screening criteria for a lifetime history of mania or hypomania. The most common styles of yoga preferred were hatha and vinyasa. When asked what impact yoga had on their life, participants responded most commonly with positive emotional effects, particularly reduced anxiety, positive cognitive effects (e.g., acceptance, focus, or "a break from my thoughts"), or positive physical effects (e.g., weight loss, increased energy). Some respondents considered yoga to be significantly life changing. The most common negative effect of yoga was physical injury or pain. Five respondents gave examples of specific instances or a yoga practice that they believed increased agitation or manic symptoms; five respondents gave examples of times that yoga increased depression or lethargy. CONCLUSIONS: Many individuals who self-identify as having BD believe that yoga has benefits for mental health. However, yoga is not without potential risks. It is possible that yoga could serve as a useful adjunctive treatment for BD.

Rejection sensitivity and depression: mediation by stress generation.

Rejection sensitivity has been found to confer risk for depression. The process through which this occurs remains unclear. This risk factor also has been associated with negative behavioral tendencies and interpersonal difficulties. Drawing on these different lines of research, the current investigation aimed to evaluate stress generation, the tendency for depression-prone individuals to experience higher rates of life stressors that are at least in part influenced by their own behavior, as a potential mechanism mediating the link between rejection sensitivity and subsequent depressive symptoms. Sixty-six adults with a history of depression were followed over a 4-month interval and completed assessments of rejection sensitivity and depressive symptoms at baseline, and depressive symptoms, a diagnostic interview for depression, and a contextual threat life stress interview at 4-month follow-up. Consistent with the stress generation hypothesis, rejection sensitivity predicted higher rates of dependent stressors, but not independent ones, over the 4-month prospective follow-up period. Furthermore, prospectively occurring dependent stressors mediated the relationship between baseline rejection sensitivity and depressive symptoms at follow-up. The finding that stress generation may operate as a mediating mechanism underlying the pathway between rejection sensitivity and depression lends preliminary support for the importance of targeting maladaptive behavioral tendencies in rejection-sensitive individuals in clinical settings.

Sociodemographic predictors of suicide means in a population-based surveillance system: findings from the National Violent Death Reporting system.

BACKGROUND: Multivariate studies of specific suicide means are relatively rare, given the logistical challenges associated with the low base rate of suicide in the general population. Thus, information on individual characteristics associated with specific suicide means remains relatively wanting. The current study provided the largest examination to date of sociodemographic characteristics associated with different means of lethality among suicide decedents, using data from a multi-state population-based surveillance system. METHODS: Multivariate logistic regression was used with data for 20,577 suicide decedents in the National Violent Death Reporting System from 2003 to 2005. RESULTS: Firearm decedents were more likely male, elderly, non-Hispanic white, married, veterans, and born in the U.S. Hanging and suffocation decedents were more likely male, young, racial/ethnic minorities, never married, non-veterans, and foreign-born. Decedents that jumped from heights were more likely female, older, non-Hispanic black, never married, non-veterans, and foreign-born. Decedents who used sharp instruments were more likely older, never married, and foreign-born. Self-poisoned decedents were more likely female, middle-age, non-Hispanic white, and not married. Regarding specific poisons, alcohol was more likely to be used by middle-age decedents; gas by males, elderly, and married individuals; over-the-counter drugs by females, adolescents, and foreign-born decedents; prescription drugs by females, middle-aged, and U.S. born individuals; and street drugs by males and racial/ethnic minorities. LIMITATIONS: The data were drawn from 18 states and so cannot be regarded as nationally representative. CONCLUSIONS: Substantial sociodemographic variability exists across different suicide means. Recognition of this variability may help to tailor prevention efforts involving means restriction.