The Mediating Role of Non-reactivity to Mindfulness Training and Cognitive Flexibility: A Randomized Controlled Trial.

Mindfulness training has been shown to have a beneficial effect on cognitive flexibility. However, little is known about the mediators that produce this effect. Cross-sectional studies show that there might be a link between Non-judgment, Non-reactivity and cognitive flexibility. Longitudinal studies examining whether Non-judgment or Non-reactivity mediate the effectiveness of mindfulness training on improving cognitive flexibility are lacking. The present study aims to test the effect of mindfulness training on increasing cognitive flexibility and to test whether this effect is mediated by Non-judgment or Non-reactivity. We conducted a single-blind randomized controlled trial in 54 nonclinical high-stress participants between October 2018 and January 2019. Participants were randomly assigned to a Mindfulness Based Stress Reduction (MBSR) group or a waitlist control group. The experimenters were blind to the group assignment of participants. The MBSR group received 8-weekly sessions (2.5-h per week) and a one-day retreat (6-h), and was required to accomplish a 45-min daily formal practice during the intervention. The waitlist control group did not receive any intervention during the waiting period and received a 2-day (6-h per day) mindfulness training after the post-intervention. The primary outcome was self-report cognitive flexibility and perceived stress administered before and after MBSR. The secondary outcome was self-report mindfulness skills (including Non-reactivity and Non-judgment) measured at pre-treatment, Week 3, Week 6, and post-intervention. For cognitive flexibility, mixed-model repeated-measure ANOVA results showed that there were significant main effects of Time, Group and a significant interaction of Time by Group. Follow-up ANOVA indicated that the MBSR group was associated with greater improvements in cognitive flexibility than the waitlist. Path analysis results showed that the effect of the treatment on cognitive flexibility at post-treatment was fully mediated by Non-reactivity at Week 6. The mediation effects of Non-reactivity at Week 3, and Non-judgment at Week 3 and Week 6 were not significant. Our findings support the efficacy of MBSR on improving cognitive flexibility. Non-reactivity is an important element of the effectiveness of MBSR training on cognitive flexibility.

Validation of the Chinese version of the Multidimensional Schizotypy Scale (MSS): Convergent evidence from exploratory and confirmatory factor analyses.

BACKGROUND: Schizotypy has been shown to be a time-stable construct that exists across the schizophrenia spectrum. The Multidimensional Schizotypy Scale (MSS) was developed to capture the three factors underlying schizotypy: positive, disorganized and negative schizotypy. However, a recent validation study reported a four-factor construct with an additional negative social anhedonia factor. The factor structure of the Chinese version of the MSS remains unknown. This study aimed to identify and validate the factor structure of the Chinese version of the MSS. METHODS: We recruited 641 Chinese speakers via on-line advertisement. We administered the Chinese version of the MSS, which was a self-report instrument. The scale consists of 77 items with true or false response options. We identified and removed 43 outliers. Finally, a total of 294 participants were randomly selected as the derivative sample for exploratory factor analysis (EFA). The remaining 304 participants were retained as the validation sample for confirmatory factor analysis (CFA). RESULTS: EFA identified four factors: the positive factor, the disorganization factor, the negative affective and motivational anhedonia factor, and the negative social anhedonia factor. The EFA-identified four-factor model was compared with the unidimensional, three-factor bifactorial and theoretical three-factor models using CFAs. The three-factor bifactorial model fitted the data better than the EFA-identified four-factor model. CONCLUSION: Our finding suggests that the Chinese version of the MSS is a valid tool for assessing schizotypy in the Chinese setting.

Effort-cost computation in a transdiagnostic psychiatric sample: Differences among patients with schizophrenia, bipolar disorder, and major depressive disorder.

Amotivational symptoms are observed in schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD). Effort-cost computation may be a potential contributor to amotivation transdiagnostically. This study examined effort-cost computation in these three diagnostic groups. This study recruited 141 outpatients (49 SCZ, 52 non-psychotic BD, and 40 non-psychotic MDD) and 57 healthy controls (HCs). We administered the Effort-Expenditure for Reward Task (EEfRT), which manipulated different levels of reward magnitude and probability relating to a high and low physical effort task. There were significant interactions between group and reward magnitude, group and reward probability, and group and expected value on the percentage of high-effort choices. SCZ, BD, and MDD patients made comparably fewer high-effort choices than HCs in the high-reward magnitude, high-reward probability, and high-expected-value conditions. Self-reported amotivation did not correlate with decision-making on the EEfRT. Our findings suggest that reduced effort expenditure for reward is a transdiagnostic phenotype in SCZ, BD, and MDD.

Prospection deficits in schizophrenia: Evidence from clinical and subclinical samples.

Previous research has revealed anticipatory pleasure deficits in people with schizophrenia and people with social anhedonia but who do not have schizophrenia. Prospection is an important component of anticipatory pleasure, but little is known about the role of prospection in social anhedonia. In 2 studies, we investigated prospection and anticipatory pleasure in people with schizophrenia and people with social anhedonia using an affective prospection task and a self-report measure, the Temporal Experience of Pleasure Scale (TEPS). In Study 1, we found that people with schizophrenia (n = 31) reported less TEPS anticipatory pleasure, generated less rich and vivid prospections, and reported less preexperiencing of future events than people without schizophrenia (n = 29). In Study 2, we found that people with social anhedonia (n = 34) reported less TEPS anticipatory pleasure, generated less rich prospections, and reported less pleasure and preexperiencing for future events than people without social anhedonia (n = 33). Taken together, prospection impairments and decreased anticipatory pleasure were observed in schizophrenia and social anhedonia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms.

OBJECTIVE: The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS). METHOD: A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups. RESULTS: Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%. CONCLUSION: We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.

Low-pleasure beliefs in patients with schizophrenia and individuals with social anhedonia.

Anhedonia in schizophrenia has been suggested to comprise a set of low-pleasure beliefs, defined as beliefs that certain things/activities were not pleasurable or that one does not feel pleasant generally. However, no instrument has been intentionally developed to specifically measure low-pleasure beliefs, and there is a paucity of empirical evidence for low-pleasure beliefs and their relationship with anhedonia in both patients with schizophrenia and individuals with high social anhedonia. We developed and validated the Beliefs About Pleasure Scale (BAPS) using non-clinical (Studies 1, 2 & 3), chronic schizophrenia (Study 2), and first episode schizophrenia (Study 3) samples. Across these studies, we examined psychometric properties of the BAPS, including temporal stability, internal consistency, factor structure, and convergent validity. The 22 BAPS items loaded onto 4 factors, namely the "Devaluation of Pleasure", the "Pleasurable Activity Expectancies", the "Negative Outcomes Expectancies", and the "Attention to Pleasure". The measure demonstrated good internal consistency and convergent validity in each sample. Moreover, both individual with schizophrenia and non-clinical participants with high social anhedonia scored higher on the BAPS than controls (Study 3), supporting construct validity. These findings provide preliminary evidence for the presence of low-pleasure beliefs in both clinical and subclinical groups and suggest that the BAPS has promising initial psychometric properties. The BAPS will be useful for exploring the cognitive component of anhedonia and provides a novel assessment for mechanism of change in psychosocial treatment studies.

Profiling of experiential pleasure, emotional regulation and emotion expression in patients with schizophrenia.

BACKGROUND: Emotion deficits may be the basis of negative symptoms in schizophrenia patients and they are prevalent in these patients. However, inconsistent findings about emotion deficits in schizophrenia suggest that there may be subtypes. AIM: The present study aimed to examine and profile experiential pleasure, emotional regulation and expression in patients with schizophrenia. METHODS: A set of checklists specifically capturing experiential pleasure, emotional regulation, emotion expression, depressive symptoms and anhedonia were administered to 146 in-patients with schizophrenia and 73 demographically-matched healthy controls. Psychiatric symptoms and negative symptoms were also evaluated by a trained psychiatrist for patients with schizophrenia. RESULTS: Two-stage cluster analysis and discriminant function analysis were used to analyze the profile of these measures in patients with schizophrenia. We found a three-cluster solution. Cluster 1 (n=41) was characterized by a deficit in experiential pleasure and emotional regulation, Cluster 2 (n=47) was characterized by a general deficit in experiential pleasure, emotional regulation and emotion expression, and Cluster 3 (n=57) was characterized by a deficit in emotion expression. Results of a discriminant function analysis indicated that the three groups were reasonably discrete. CONCLUSION: The present findings suggest that schizophrenia patients can be classified into three subtypes based on experiential pleasure, emotional regulation and emotion expression, which are characterized by distinct clinical representations.

Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder.

BACKGROUND: Although Theory of Mind (ToM) impairment has been observed in patients with a wide range of mental disorders, the similarity and uniqueness of these deficits across diagnostic groups has not been thoroughly investigated. METHODS: We recruited 35 participants with schizophrenia (SCZ), 35 with bipolar disorder (BD), 35 with major depressive disorder (MDD), and 35 healthy controls in this study. All participants were matched in age, gender proportion and IQ estimates. The Yoni task, capturing both the cognitive and affective components of ToM at the first- and second-order level was administered. Repeated-measure ANOVA and MANOVA were conducted to compare the group differences in ToM performance. A network was then constructed with ToM performances, psychotic and depressive symptoms, and executive function as nodes exploring the clinical correlates of ToM. RESULTS: Overall, ToM impairments were observed in all patient groups compared with healthy controls, with patients with SCZ performing worse than those with BD. In second-order conditions, patients with SCZ and MDD showed deficits in both cognitive and affective conditions, while patients with BD performed significantly poorer in cognitive conditions. Network analysis showed that second-order affective ToM performance was associated with psychotic and depressive symptoms as well as executive dysfunction, while second-order affective ToM performance and negative symptoms showed relatively high centrality in the network. CONCLUSIONS: Patients with SCZ, MDD and BD exhibited different types and severity of impairments in ToM sub-components. Impairment in higher-order affective ToM appears to be closely related to clinical symptoms in both psychotic and affective disorders.

A suicidal mind tends to maintain less negative information in visual working memory.

The motivation to avoid psychological pain may characterize a suicidal mindset. This study examines how this motivational manifestation of suicidal ideation modulates the maintenance of affective information in visual working memory (WM). Forty-five outpatients with major depressive disorder (MDD) and twenty-five healthy participants performed visual WM change localization tasks with emotional (e.g., positive or negative schematic facial expressions) and non-emotional (e.g., colors) stimuli. The number of items that participants retained in WM (i.e., capacity) for each of those stimuli was measured. Based on the Beck Scale for Suicide Ideation, MDD patients were categorized into high and low suicidal ideation groups. These two groups had comparable depression levels. In addition to showing a smaller overall WM capacity for emotionally neutral information (colors), MDD patients with high suicidal ideation retained fewer negative schematic facial stimuli in WM. This disproportional reduction in the amount of negative information held in visual WM was correlated with levels of suicidal ideation and psychological pain across participants. Together, these results reveal the impact of pain avoidance motivation on information processing in WM and provide a novel perspective to understand aberrant cognitive patterns that are potentially driven by maladaptive affective processing in individuals with higher suicide risk.

Dissociation between affective experience and motivated behaviour in schizophrenia patients and their unaffected first-degree relatives and schizotypal individuals.

BACKGROUND: The neuropsychological origins of negative syndrome of schizophrenia remain elusive. Evidence from behavioural studies, which utilised emotion-inducing pictures to elicit motivated behaviour generally reported that that schizophrenia patients experienced similar affective experience as healthy individuals but failed to translate emotional salience to motivated behaviour, a phenomenon called emotion-behaviour decoupling. However, a few studies have examined emotion-behaviour decoupling in non-psychotic high-risk populations, who are relatively unaffected by medication effects. METHODS: In this study, we examined the nature and extent of emotion-behaviour decoupling in in three independent samples (65 schizophrenia patients v. 63 controls; 40 unaffected relatives v. 45 controls; and 32 individuals with social anhedonia v. 32 controls). We administered an experimental task to examine their affective experience and its coupling with behaviour, using emotion-inducing slides, and allowed participants to alter stimulus exposure using button-pressing to seek pleasure or avoid aversion. RESULTS: Schizophrenia patients reported similar affective experiences as their controls, while their unaffected relatives and individuals with high levels of social anhedonia exhibited attenuated affective experiences, in particular in the arousal aspect. Compared with their respective control groups, all of the three groups showed emotion-behaviour decoupling. CONCLUSIONS: Our findings support that both genetically and behaviourally high-risk groups exhibit emotion-behaviour decoupling. The familial association apparently supports its role as a putative trait marker for schizophrenia.

Predictive Roles of Three-Dimensional Psychological Pain, Psychache, and Depression in Suicidal Ideation among Chinese College Students.

How to develop an effective screening instrument for predicting suicide risk is an important issue in suicidal research. The aim of the present research was to explore the predictive roles of three screening measures in the evaluation of preexisting suicide risk factors in a sample of undergraduate students. We assessed 1,061 students using the Beck depression and suicidal ideation scales (BDI-I) (BSI), the Psychache Scale (PAS), and the three-dimensional Psychological Pain Scale (TDPPS). Simultaneous multivariate regression analysis showed that the predictive values of pain avoidance scores and BDI scores for suicidal ideation were more significant than that of the PAS scores. Subsequently, 42 patients with major depressive disorder (MDD), 39 students with subthreshold depression (SD), and 18 healthy controls were voluntarily recruited. Students with SD were divided into high suicidal ideation (HSI-SD) and low suicidal ideation (LSI-SD) groups. Pain avoidance scores and BDI scores differed significantly among the MDD, HSI-SD, LSI-SD, and healthy control groups. Pain avoidance and BSI scores were significantly higher in the MDD and HSI-SD groups than those in the LSI-SD and healthy control groups. However, no significant difference was observed in BDI scores between the HSI-SD and LSI-SD groups. Pain avoidance and depression, rather than psychache, may be promising predictors of suicidal ideation in a Chinese young adult population.

Efficacy of psychological pain theory-based cognitive therapy in suicidal patients with major depressive disorder: A pilot study.

The present study aimed to explore the effects of psychological pain theory-based cognitive therapy (PPTBCT) on suicide among depressed patients, compared with a control group who received usual psychological care (UPC). The sample consisted of 32 depressed patients and 32 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory, Three-Dimensional Psychological Pain Scale (TDPPS), and Problem Solving Inventory(PSI), and Automatic Thoughts Questionnaire (ATQ). All measures differed significantly between depressed patients and healthy controls. Then clinical participants were assigned randomly to the PPTBCT (n=19) and control (n=13) groups. During the 8-week intervention, scores related to depression, suicidal ideation, psychological pain, and automatic thoughts were decreased in both groups at the post-intervention and 4-week follow-up time points, compared with pre-intervention scores. BSI scores remained low at follow up and did not differ significantly from post-intervention scores in the PPTBCT group, but were significantly higher at follow up than at post-intervention in the control group. PPTBCT may effectively reduce suicide risk in patients with major depressive disorder, although the effects of its application need to be confirmed.

Affective bias in visual working memory is associated with capacity.

How does the affective nature of task stimuli modulate working memory (WM)? This study investigates whether WM maintains emotional information in a biased manner to meet the motivational principle of approaching positivity and avoiding negativity by retaining more approach-related positive content over avoidance-related negative content. This bias may exist regardless of individual differences in WM functionality, as indexed by WM capacity (overall bias hypothesis). Alternatively, this bias may be contingent on WM capacity (capacity-based hypothesis), in which a better WM system may be more likely to reveal an adaptive bias. In two experiments, participants performed change localisation tasks with emotional and non-emotional stimuli to estimate the number of items that they could retain for each of those stimuli. Although participants did not seem to remember one type of emotional content (e.g. happy faces) better than the other type of emotional content (e.g. sad faces), there was a significant correlation between WM capacity and affective bias. Specifically, participants with higher WM capacity for non-emotional stimuli (colours or line-drawing symbols) tended to maintain more happy faces over sad faces. These findings demonstrated the presence of a "built-in" affective bias in WM as a function of its systematic limitations, favouring the capacity-based hypothesis.

Role of Stressful Life Events, Avoidant Coping Styles, and Neuroticism in Online Game Addiction among College Students: A Moderated Mediation Model.

Online game addiction (OGA) is becoming a significant problem worldwide. The aim of this study was to explore the incidence of OGA and the roles of stressful life events, avoidant coping styles (ACSs), and neuroticism in OGA. A total of 651 Chinese college students were selected by random cluster sampling. Subjects completed the Chinese version of Young's eight-item Internet Addiction Scale (CIAS), Online Game Cognition Addiction Scale (OGCAS), Revised Eysenck Personality Questionnaire Short Scale in Chinese (EPQ-RSC), Chinese College-student Stress Questionnaire, and Coping Style Questionnaire. Structural equation modeling (SEM) was used to explore the interactive effects of stressful life events, ACSs, and neuroticism on OGA. Of the 651 participants in the sample, 31 (4.8%) were identified as addicts. The incidence of OGA was two times higher for males than females. The addicts had markedly higher scores on the neuroticism subscale of the EPQ-RSC than non-addicts. Compared to non-addicts, addicts were more apt to use ACSs. Having an avoidant coping strategy mediated the effect of stressful life events on OGA. Furthermore, neuroticism moderated the indirect effect of stressful life events on OGA via ACSs. Applications of these findings to etiological research and clinical treatment programs are discussed.

Anhedonia and pain avoidance in the suicidal mind: behavioral evidence for motivational manifestations of suicidal ideation in patients with major depressive disorder.

OBJECTIVES: Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. METHOD: The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. RESULTS: In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. CONCLUSIONS: The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.