Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study.

Background: Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. Methods: 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Results: Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Discussion: Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.

Originalbeiträge (Originals). Psychotherapeutic inpatient depression treatment in open versus closed group format.

OBJECTIVE: Controversy exists about the comparative efficacy of different group formats, e. g., open versus closed. Most of the findings come from outpatient, closed group research. In practice, the open format is more widely used. This monocentric study aims to compare the efficacy as well as group cohesion during inpatient group psychotherapy for depression delivered in an open versus closed format. METHODS: 291 depressed inpatients (ageM= 55.7, SD = 11) of a psychosomatic-rehabilitation clinic were consecutively assigned to either open (n = 117) or closed (n = 174) cognitive-behavioral groups, further subdivided into groups based on length of the stay. Using multilevel models, we examined depression and group cohesion concerning changes in patients' random effects over time. RESULTS: Both group formats showed a reduction in symptomatology (d = 1.8). A significant group format x time interaction in favor of the closed format was found regarding group cohesion. CONCLUSION: While group cohesion improved in the closed format only, we did not find any significant difference between group formats regarding their efficacy. Further research should focus on randomized controlled trials comparing both formats directly.

Cognitive Motivation as a Resource for Affective Adjustment and Mental Health.

Background: Depressive symptoms compromise cognitive and self-regulating capacities. Overcoming associated deficits (e.g., attentional bias) demands cognitive effort and motivation. Previous studies on healthy individuals have found cognitive motivation to positively relate to self-regulation and negatively to depressive symptoms. A test of these associations in a clinical sample is lacking. Methods: We assessed cognitive motivation, self-regulation and depressive symptoms by means of well-validated questionnaires in N = 1,060 psychosomatic rehabilitation in-patients before and after treatment. Data were split and analyzed in two steps: We tested previously reported cross-sectional and longitudinal associations of all variables as well as their longitudinal changes in a first sample. Afterward, findings and derived hypotheses were replicated and tested in a second sample. Results: Analyses of both samples confirmed earlier reports on positive associations between cognitive motivation and self-regulation, and negative associations of both with depressive symptoms. While the change in all variables was predicted by their baseline scores, higher baseline cognitive motivation was found to predict stronger improvements in self-regulation, and lower baseline depression scores to predict smaller changes in cognitive motivation and self-regulation. In addition, the change in cognitive motivation partially mediated the association between the changes in depressive symptoms and self-regulation. Conclusion: Based on a large longitudinal data set, the present study expands previous findings and suggests a resource allocation model in which decreasing depressive symptoms lead to a release of capacities benefitting self-regulation directly, and indirectly via cognitive motivation.

Cold pressor test improves fear extinction in healthy men.

Fear extinction is an important paradigm to study the neural basis of anxiety and trauma- and stressor-related disorders and for modeling features of extinction learning and exposure-based psychotherapy. To date the effects of acute stress on extinction learning in humans are not well understood. Models of stress effects on emotional memory suggest that learning during the so-called first wave of the stress response will be enhanced. The first wave includes (among others) increases of noradrenaline in the brain and increased sympathetic tone, adrenaline and noradrenaline in the periphery while the second wave includes genomic glucocorticoid-actions. The cold pressor test (CPT) is a valid way to induce the first wave of the stress response. We thus hypothesized that the CPT will facilitate extinction. In a 2-day fear-conditioning procedure with 40 healthy men, using differential skin conductance responses as a measure of conditioned fear, we placed the CPT versus a control procedure prior to extinction training on Day 1. We tested for extinction learning on Day 1 and extinction retrieval on Day 2. During extinction training (Day 1) only the CPT-group showed a significant reduction in differential responding. This was still evident on Day 2, where the CPT group had less differential responding during early trials (retrieval) and a higher extinction retention index. This is the first human study to show that a simple procedure, triggering the first-wave stress response--the CPT--can effectively enhance fear extinction in humans.

Electrophysiological evidence of the effect of natural polyphenols upon the human higher brain functions.

OBJECTIVE: Several natural polyphenols exert effects upon the cardiovascular as well as nervous system. In vitro and animal studies suggest that polyphenols may potentially affect the human cognitive function. The aim was to study the effect of Provinols™, the polyphenolic compounds isolated from red wine, upon the human higher brain functions. MATERIAL AND METHODS: The accuracy of space memory was assessed by means of visually-guided and memory-guided saccadic eye movements. The EEG and blood pressure were registered also. The healthy undergraduates served as subjects. They were divided into the control, placebo and Provinols™ groups. The amplitudes of saccades, EEG spectral density, evoked potentials time-locked to saccadic onset and blood pressure were analyzed in control condition and 2 hours later, after administration of placebo, Provinols™ (4 mg/kg of body weight) or nothing. RESULTS: After the Provinols™ administration the memory-guided saccades were significantly more accurate and the significant decrease in the slow EEG bands, alpha power mainly, was registered over the broad regions of temporo-parietal cortex. No changes in saccadic eye movement related potentials as well as in blood pressure were found after the single dose Provinols™ administration. CONCLUSIONS: Even a single dose of the Provinols™ was able to affect positively the space memory for limited time duration. The improvement in space memory function and/or the positive role of attentional mechanisms may be taken into account mainly. More sensitive analysis of the particular participation of attentional and memory components demands the further study.