The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study.

BACKGROUND: Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform. METHODS: A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care. RESULTS: At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04). CONCLUSIONS: This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

Development and validation of the Child Weight Risk Questionnaire.

PURPOSE: The study objective was to develop and validate a measure of parent perception of child weight-related risk, the Child Weight Risk Questionnaire (CWRQ), among a sample of US parents. METHODS: A cross-sectional survey was conducted in a sample of 216 parents of 6- to 12-year-old children who were overweight. The CWRQ was used to assess parent beliefs about their child's susceptibility to physical, social-emotional, and behavioral health problems due to weight. RESULTS: Confirmatory factor analysis supported the three-factor structure of the CWRQ and acceptable fit was achieved. The internal consistency of the measure was excellent. Convergent, discriminant, and incremental validity analyses provided initial evidence for CWRQ validity. CONCLUSION: The CWRQ is a reliable and valid instrument for assessing parent perception of child weight-related risk. This measure could be utilized in research and applied settings to capture the multifaceted nature of parent risk perception and support efforts to tailor family weight interventions in ways that align with parent beliefs. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

Mindfulness-Informed Guided Imagery to Target Physical Activity: A Mixed Method Feasibility and Acceptability Pilot Study.

Physical activity offers substantial mind-body health benefits and reduced mortality, yet many individuals are chronically underactive. Physical activity interventions may benefit from integrative approaches that join components of mindfulness and neurobiological models of behavior. Mindfulness increases one's awareness of cognitions and physical sensations to potentially facilitate self-regulation, while neurobiological models such as the dual system model of health behavior offer guidance on improving physical activity intervention targets. This 2-phase study includes an initial development process to create brief (∼4 min) mindfulness informed guided imagery audio files that target distinct cognitive and affective processes to promote physical activity. In the second phase, participants completed a 2-week pilot intervention study to gather qualitative and quantitative data on intervention feasibility and acceptability. Participants endorsed the mindfulness informed guided imagery as easy to use, enjoyable and helpful. Over a 2-week intervention period participants reported positive shifts in behavior change, physical activity enjoyment, increased mindfulness during physical activity, and increased physical exercise self-efficacy and satisfaction. Interview data revealed that participants increased their frequency of physical activity and tended to experience positive affect during physical activity, engaged in future oriented thinking and were able to view physical activity in a more positive light. Findings support the feasibility and acceptability of an integrative online mindfulness informed guided imagery intervention to promote physical activity enjoyment and engagement. This study extends health behavior change intervention research and provides supporting evidence for a flexible and tailorable online mindfulness-based intervention.

The relation between emotion regulation choice and posttraumatic growth.

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.

The Effects of Positive Affect and Episodic Future Thinking on Temporal Discounting and Healthy Food Demand and Choice Among Overweight and Obese Individuals: Protocol for a Pilot 2×2 Factorial Randomized Controlled Study.

BACKGROUND: Unhealthy behaviors (eg, poor food choices) contribute to obesity and numerous negative health outcomes, including multiple types of cancer and cardiovascular and metabolic diseases. To promote healthy food choice, diet interventions should build on the dual-system model to target the regulation and reward mechanisms that guide eating behavior. Episodic future thinking (EFT) has been shown to strengthen regulation mechanisms by reducing unhealthy food choice and temporal discounting (TD), a process of placing greater value on smaller immediate rewards over larger future rewards. However, these interventions do not target the reward mechanisms that could support healthy eating and strengthen the impact of EFT-anchored programs. Increasing positive affect (PosA) related to healthy food choices may target reward mechanisms by enhancing the rewarding effects of healthy eating. An intervention that increases self-regulation regarding unhealthy foods and the reward value of healthy foods will likely have a greater impact on eating behavior compared with interventions focused on either process alone. OBJECTIVE: This study aimed to introduce a protocol that tests the independent and interactive effects of EFT and PosA on TD, food choice, and food demand in overweight and obese adults. METHODS: This protocol describes a factorial, randomized, controlled pilot study that employs a 2 (affective imagery: positive, neutral) by 2 (EFT: yes, no) design in which participants are randomized to 1 of 4 guided imagery intervention arms. In total, 156 eligible participants will complete 2 lab visits separated by 5 days. At visit 1, participants complete surveys; listen to the audio guided imagery intervention; and complete TD, food demand, and food choice tasks. At visit 2, participants complete TD, food demand, and food choice tasks and surveys. Participants complete a daily food frequency questionnaire between visits 1 and 2. Analyses will compare primary outcome measures at baseline, postintervention, and at follow-up across treatment arms. RESULTS: Funding notification was received on April 27, 2017, and the protocol was approved by the institutional review board on October 6, 2017. Feasibility testing of the protocol was conducted from February 21, 2018, to April 18, 2018, among the first 32 participants. As no major protocol changes were required at the end of the feasibility phase, these 32 participants were included in the target sample of 156 participants. Recruitment, therefore, continued immediately after the feasibility phase. When this manuscript was submitted, 84 participants had completed the protocol. CONCLUSIONS: Our research goal is to develop novel, theory-based interventions to promote and improve healthy decision-making and behaviors. The findings will advance decision-making research and have the potential to generate new neuroscience and psychological research to further understand these mechanisms and their interactions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11704675; http://www.isrctn.com/ISRCTN11704675 (Archived by WebCite at http://www.webcitation.org/760ouOoKG). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12265.

Examining the psychological and emotional mechanisms of mindfulness that reduce stress to enhance healthy behaviours.

Engagement in modifiable health behaviours plays a critical role in the development of chronic illnesses. Research suggests that mindfulness facilitates health-enhancing behaviour, yet the influence of mindfulness on different health behaviours and the mechanisms underlying this association are unclear. This study investigated a mediation model that explores psychological and emotional coping processes (reappraisal, suppression, and psychological flexibility) as mechanisms connecting mindfulness to reduced stress perceptions and reactions, which then predict physical activity, fruit and vegetable consumption, and sleep quality. Adults (n = 233) completed self-report measures via Amazon's Mechanical Turk and path modelling was used to test the model for direct, indirect, and total effects. Results revealed that greater mindfulness was indirectly associated with greater engagement in all 3 health behaviours through the proposed mediators, although the association with fruit and vegetable consumption was only trending in significance. Among the coping processes, psychological flexibility emerged as the strongest mechanism in the prediction of stress. Findings suggest that being more mindful may have downstream stress-reductive effects that enhance engagement in healthy behaviour, supporting mindfulness as a potential addition to behavioural health interventions.

Stressful life events, relationship stressors, and cortisol reactivity: The moderating role of suppression.

Stressful life events (SLEs) are exceedingly common and have been associated with a range of psychological disorders, perhaps through dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis. The use of certain emotion regulation strategies in response to stress, such as expressive suppression and cognitive reappraisal, has additionally been linked to heightened HPA axis reactivity to acute stress. However, it is unclear how emotion regulation may interact with SLEs to affect HPA axis reactivity, particularly concerning relationship stressors (RSs). Using cross-sectional data from 117 men and 85 women aged 18-55 years old (M = 39.9 ±â€¯10.7), we investigated whether trait use of suppression or reappraisal interacted with recent negatively perceived SLEs and relationship stressors to impact HPA axis response to an acute stressor. Separate area under the curve and linear mixed models revealed that trait suppression interacted with SLEs and RSs to predict cortisol response to stress, while reappraisal did not. Findings indicate higher trait expressive suppression may influence the cortisol response to acute stress after exposure to more recent stressful events, particularly when those stressful events include relationship stress.

The two sides of adversity: the effect of distant versus recent adversity on updating emotional content in working memory.

Previous research suggests that adversity can have both adaptive and maladaptive effects, yet the emotional and working memory processes that contribute to more or less adaptive outcomes are unclear. The present study sought to investigate how updating emotional content differs in adolescents who have experienced past, recent, or no adversity. Participants who had experienced distant adversity (N = 53), no adversity (N = 58), or recent adversity only (N = 20) performed an emotion n-back task with emotional facial expressions. Results revealed that the distant adversity group exhibited significantly faster reaction times (RTs) than the no adversity and recent adversity only groups. In contrast, the recent adversity only group exhibited significantly slower RTs and more errors than the distant adversity and no adversity groups. These results suggest an emotion and executive control pathway by which both the benefits and negative effects of adversity may be conferred. Results also highlight the importance of time in assessing the impact of adversity.

Cognitive reappraisal ability buffers against the indirect effects of perceived stress reactivity on Type 2 diabetes.

OBJECTIVE: Stress contributes to poor health outcomes; importantly, a stress reaction begins with the negative appraisal of a situation. The ability to use cognitive reappraisal, an emotion regulation strategy that involves reinterpreting an initial appraisal to change its emotional impact, could be a protective factor against the health consequences of stress reactivity. The present study investigated (a) if cognitive reappraisal ability (CRA) acts as a stress buffer against a body mass index (BMI) indicative of being overweight (≥25 kg/m2) or obese (≥30 kg/m2), and (b) if this buffering effect persists against the indirect influences of perceived stress reactivity (PSR) on Type 2 diabetes. METHOD: One hundred fifty participants (54% female; mean age = 40.4 years ± 12.4 years) completed an online CRA task, self-report measures of PSR, height, weight, and Type 2 diabetes diagnosis on Amazon's Mechanical Turk. RESULTS: Results revealed that CRA significantly interacted with PSR to predict BMI, which indirectly predicted Type 2 diabetes. Individuals with higher PSR and higher CRA exhibited BMIs within a normal weight range and lower incidence of Type 2 diabetes. In contrast, individuals with higher PSR and lower CRA were overweight or obese, with a higher incidence of Type 2 diabetes. Interestingly, higher CRA was not protective in those who had lower levels of PSR. CONCLUSIONS: Findings from this study suggest that emotion regulation interventions can be developed to indirectly target Type 2 diabetes and similar obesity-related illnesses, and that emotion regulation interventions should be tailored to the individual. (PsycINFO Database Record

Updating emotional content in recovered depressed individuals: Evaluating deficits in emotion processing following a depressive episode.

BACKGROUND AND OBJECTIVES: Previous research has demonstrated that depressed individuals have difficulty both disengaging from negative information and maintaining positive information in working memory (WM). The present study was conducted to examine whether the tendency for depressed individuals to maintain negative content in WM and to experience difficulties maintaining positive content in WM is due to negative mood (in)congruency effects during a depressive episode, or whether these tendencies are evident outside of a depressive episode. METHODS: Individuals who had recovered from a depressive episode and never disordered controls performed emotion 0-back and 2-back tasks designed to assess biases in updating emotional content in working memory. RESULTS: Similar to currently depressed individuals in previous studies, recovered depressed participants disengaged from happy stimuli more quickly and from sad stimuli more slowly than did their never-depressed counterparts. LIMITATIONS: Despite the extension of a depression-specific finding to recovered depressed individuals, the present study does not test whether the identified emotion updating biases predict long-term relapse or recovery. CONCLUSION: The obtained results suggest that a decreased ability to disengage from negative content and to maintain positive content in WM represents a trait-like cognitive style that impairs adaptive emotion regulation and may contribute to the recurrent nature of depression.

What might have been? The role of the ventromedial prefrontal cortex and lateral orbitofrontal cortex in counterfactual emotions and choice.

Counterfactual feelings of regret occur when people make comparisons between an actual outcome and a better outcome that would have occurred under a different choice. We investigated the choices of individuals with damage to the ventral medial prefrontal cortex (VMPFC) and the lateral orbital frontal cortex (LOFC) to see whether their emotional responses were sensitive to regret. Participants made choices between gambles, each with monetary outcomes. After every choice, subjects learned the consequences of both gambles and rated their emotional response to the outcome. Normal subjects and lesion control subjects tended to make better choices and reported post-decision emotions that were sensitive to regret comparisons. VMPFC patients tended to make worse choices, and, contrary to our predictions, they reported emotions that were sensitive to regret comparisons. In contrast, LOFC patients made better choices, but reported emotional reactions that were insensitive to regret comparisons. We suggest the VMPFC is involved in the association between choices and anticipated emotions that guide future choices, while the LOFC is involved in experienced emotions that follow choices, emotions that may signal the need for behavioral change.

Frontostriatal white matter integrity mediates adult age differences in probabilistic reward learning.

Frontostriatal circuits have been implicated in reward learning, and emerging findings suggest that frontal white matter structural integrity and probabilistic reward learning are reduced in older age. This cross-sectional study examined whether age differences in frontostriatal white matter integrity could account for age differences in reward learning in a community life span sample of human adults. By combining diffusion tensor imaging with a probabilistic reward learning task, we found that older age was associated with decreased reward learning and decreased white matter integrity in specific pathways running from the thalamus to the medial prefrontal cortex and from the medial prefrontal cortex to the ventral striatum. Further, white matter integrity in these thalamocorticostriatal paths could statistically account for age differences in learning. These findings suggest that the integrity of frontostriatal white matter pathways critically supports reward learning. The findings also raise the possibility that interventions that bolster frontostriatal integrity might improve reward learning and decision making.

The effects of optimism and pessimism on updating emotional information in working memory.

In the present study we elucidate the emotional and executive control interactions that might underlie optimism and pessimism. Participants completed a self-report measure of optimism/pessimism and performed an emotion faces categorisation task and an emotion n-back task in which they indicated whether each of a series of faces had the same or a different emotional expression (happy, sad, neutral) as the face presented two trials before. Trials were structured to measure latency to update emotional content in working memory (WM). More pessimistic individuals formed connections among positive stimuli, and broke connections among positive and sad stimuli, in WM more slowly than did less pessimistic individuals; levels of optimism/pessimism did not affect the rate with which individuals formed and broke connections among neutral representations in WM. It appears, therefore, that levels of pessimism are related to specific affective cognitive mechanisms in WM that may be involved in emotion regulation.

Role of the left amygdala and right orbital frontal cortex in emotional interference resolution facilitation in working memory.

Previous research has shown that emotional information aids conflict resolution in working memory (Levens & Phelps, 2008). Using a Recency-probes working memory (WM) paradigm, Levens and Phelps found that positive and negative emotional stimuli reduced the amount of interference created when information that was once relevant conflicted with currently relevant information, suggesting that emotional information facilitates interference resolution in WM. To determine what regions of the prefrontal cortex (PFC) and temporal lobes are critical to the influence of emotional stimuli on interference resolution, we conducted a Recency-probes emotion paradigm with right and left unilateral frontal and temporal lobe lesion patients. The frontal lobe lesion patient group comprised individuals with unilateral ventral and dorsal PFC lesions. The temporal lobe lesion patient group comprised individuals with lesions of the amygdala and surrounding structures. Results indicate that when the left amygdala is damaged, emotional facilitation of interference resolution is absent (equal emotional and neutral interference levels), when the right orbital frontal cortex (OFC) is damaged, in contrast, emotional interference resolution is impaired (emotional interference levels are higher than neutral levels are). Based on these unique patterns we propose specific contributions for these regions in the emotional facilitation of interference resolution in WM.

Sticky thoughts: depression and rumination are associated with difficulties manipulating emotional material in working memory.

Cognitive inflexibility may play an important role in rumination, a risk factor for the onset and maintenance of depressive episodes. In the study reported here, we assessed participants' ability to either reverse or maintain in working memory the order of three emotion or three neutral words. Differences (or sorting costs) between response latencies in backward trials, on which participants were asked to reverse the order of the words, and forward trials, on which participants were asked to remember the words in the order in which they were presented, were calculated. Compared with control participants, depressed participants had higher sorting costs, particularly when presented with negative words. It is important to note that rumination predicted sorting costs for negative words but not for positive or neutral words in the depressed group. These findings indicate that depression and rumination are associated with deficits in cognitive control.

Updating positive and negative stimuli in working memory in depression.

Difficulties in the ability to update stimuli in working memory (WM) may underlie the problems with regulating emotions that lead to the development and perpetuation of mood disorders such as depression. To examine the ability to update affective material in WM, the authors had diagnosed depressed and never-disordered control participants perform an emotion 2-back task in which participants were presented with a series of happy, sad, and neutral faces and were asked to indicate whether the current face had the same (match-set) or different (break-set or no-set) emotional expression as that presented 2 faces earlier. Participants also performed a 0-back task with the same emotional stimuli to serve as a control for perceptual processing. After transforming reaction times to control for baseline group differences, depressed and nondepressed participants exhibited biases in updating emotional content that reflects the tendency to keep negative information and positive information, respectively, active in WM. Compared with controls, depressed participants were both slower to disengage from sad stimuli and faster to disengage from happy facial expressions. In contrast, nondepressed controls took longer to disengage from happy stimuli than from neutral or sad stimuli. These group differences in reaction times may reflect both protective and maladaptive biases in WM that underlie the ability to effectively regulate negative affect.

Insula and orbital frontal cortex activity underlying emotion interference resolution in working memory.

Previous research has shown that emotional information aids conflict resolution in working memory [WM; Levens, S. M., & Phelps, E. A. Emotion processing effects on interference resolution in working memory. Journal of Emotion, 8, 267-280, 2008]. Using a recency-probes WM paradigm, it was found that positive and negative emotional stimuli reduced the amount of interference created when information that was once relevant conflicted with currently relevant information. To explore the neural mechanisms behind these facilitation effects, an event-related fMRI version of the recency-probes task was conducted using neutral and arousing positive and negative words as stimuli. Results replicate previous findings showing that the left and right inferior frontal gyrus (IFG) is involved in the interference resolution of neutral information and reveal that the IFG is involved in the interference resolution of emotional information as well. In addition, ROIs in the right and left anterior insula and in the right orbital frontal cortex (OFC) were identified that appear to underlie emotional interference resolution in WM. We conclude that the IFG underlies neutral and emotional interference resolution, and that additional regions of the anterior insula and OFC may contribute to the facilitation of interference resolution for emotional information. These findings clarify the role of the insula and OFC in affective and executive processing, specifically in WM conflict resolution.

Rumination and impaired resource allocation in depression.

Depression is characterized by a range of cognitive deficits that theorists posit are due to the resource capturing properties of rumination. The present study was designed to examine the relation between rumination and resource allocation in depression. Twenty-five depressed and 25 nondepressed participants completed a modified dual-task version of the recency-probes task, which assesses the controlled allocation of cognitive resources by comparing performance across low- and high-interference conditions. In low-interference conditions, participants performed either the recency-probes task or a tracking task, which required participants to track specific stimuli across trials (i.e., no dual-task interference). In the high-interference condition, participants performed both the recency-probes task and the tracking task, which required the controlled allocation of resources to resolve dual-task interference. Depressed participants performed significantly worse than did their nondepressed counterparts in only the high-interference condition; performance of the 2 groups was comparable in the low-interference conditions. Furthermore, the degree to which depressed participants were impaired in the high-interference condition was correlated .74 with rumination. These findings suggest that an association between rumination and impairments in resource allocation underlies the cognitive difficulties experienced by depressed individuals.

Impaired selection of relevant positive information in depression.

BACKGROUND: A hallmark characteristic of depression is the inability to regulate the effect of emotional material on cognition. Previous research has demonstrated that depressed individuals are less able than are nondepressed persons to expel irrelevant negative information from working memory (WM), thereby exacerbating the effects of negative content on cognition. The primary goal of this study was to examine whether depressed individuals are also impaired at selecting relevant positive content in the context of representations competing for resources in WM; such an impairment would limit depressed persons' ability to use positive material to ameliorate the cognitive effects of negative information. METHODS: We administered a Recency-probes task with neutral, positive, and negative words to 20 currently depressed and 22 never-depressed participants. This task assesses the selection of relevant content in WM by inducing interference between current and prior representations of a stimulus in WM. Reaction times to interference and noninterference trials were compared across valence and group to assess how effectively depressed individuals select task-relevant emotional content to resolve interference. RESULTS: Compared to never-depressed controls, depressed individuals were impaired in selecting task-relevant positive stimuli; the performance of the two groups was comparable for selecting task-relevant neutral and negative stimuli. CONCLUSIONS: Findings indicate that a valence-specific deficit in WM may contribute to the inability of depressed individuals to regulate emotion, and provide empirical support for formulations that implicate positive insensitivity in the maintenance of depression.

Emotion processing effects on interference resolution in working memory.

The interaction between emotion and working memory maintenance, load, and performance has been investigated with mixed results. The effect of emotion on specific executive processes such as interference resolution, however, remains relatively unexplored. In this series of studies, we examine how emotion affects interference resolution processes within working memory by modifying the Recency-probes paradigm (Monsel, 1978) to include emotional and neutral stimuli. Reaction time differences were compared between interference and non-interference trials for neutral and emotional words (Studies 1 & 3) and pictures (Study 2). Our results indicate that trials using emotional stimuli show a relative decrease in interference compared with trials using neutral stimuli, suggesting facilitation of interference resolution in the former. Furthermore, both valence and arousal seem to interact to produce this facilitation effect. These findings suggest that emotion facilitates response selection amid interference in working memory.