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Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS. Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6 months of index ACS (baseline), then 2 months and 6 months later. 169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6 months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6 months. Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease. [ABSTRACT FROM AUTHOR]

Inhibitory processes have been implicated in depressive rumination. Inhibitory deficits may cause difficulties in disengaging from ruminative content (e.g., Joormann, 2005), or rumination may constitute a working memory load, causing deficits in inhibitory control (e.g., Hertel, 2004). These hypotheses have different implications for the treatment of depression. We conducted a systematic review of existing evidence, and conclude that most studies do not unambiguously measure inhibition. The majority of published evidence is correlational, and thus supports neither causal direction. No published experimental studies have investigated the inhibitory deficit → rumination causal direction, and only six have investigated the rumination → inhibitory deficit hypothesis. In two of these studies the dependent variable has low construct validity. One study reported no effect of rumination on interference, and three did not control for mood effects. There is need for carefully designed experimental research that has the potential to investigate these proposed causal mechanisms. [ABSTRACT FROM AUTHOR]

Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p =.79) and 0.67 (95% CI [0.48, 0.93], p =.02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of −0.27 (95% CI [ −0.37, −0.17], p <.001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of −0.21 (95% CI [-0.31, −0.10], p <.001). Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity. • This review evaluates self-guided internet and mobile based interventions designed to prevent anxiety and depression. • Data from 32 studies involving 20,249 participants were examined to assess effects on symptom severity and incidence. • Self-guided interventions appear to have a small, meaningful impact on symptoms indicative of anxiety and depression. • They may also lead to a reduced risk of receiving a diagnosis of depression within certain populations. • The literature shows a lack of studies using standard tools to establish whether participants meet diagnostic criteria. [ABSTRACT FROM AUTHOR]

Objective: Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions.Method: Four electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized.Results: Thirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r=0.23 to r=0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes.Conclusion: Strongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes. [ABSTRACT FROM AUTHOR]

This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background: Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap is limited understanding of how complex psychological interventions for depression work. Recent reviews have argued that the active ingredients of therapy need to be identified so that therapy can be made briefer, more potent, and to improve scalability. This in turn requires the use of rigorous study designs that test the presence or absence of individual therapeutic elements, rather than standard comparative randomised controlled trials. One such approach is the Multiphase Optimization Strategy, which uses efficient experimentation such as factorial designs to identify active factors in complex interventions. This approach has been successfully applied to behavioural health but not yet to mental health interventions. Methods/Design: A Phase III randomised, single-blind balanced fractional factorial trial, based in England and conducted on the internet, randomized at the level of the patient, will investigate the active ingredients of internet cognitive-behavioural therapy (CBT) for depression. Adults with depression (operationalized as PHQ-9 score ≥ 10), recruited directly from the internet and from an UK National Health Service Improving Access to Psychological Therapies service, will be randomized across seven experimental factors, each reflecting the presence versus absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, self-compassion training) using a 32-condition balanced fractional factorial design (2IV7-2). The primary outcome is symptoms of depression (PHQ-9) at 12 weeks. Secondary outcomes include symptoms of anxiety and process measures related to hypothesized mechanisms. Discussion: Better understanding of the active ingredients of efficacious therapies, such as CBT, is necessary in order to improve and further disseminate these interventions. This study is the first application of a component selection experiment to psychological interventions in depression and will enable us to determine the main effect of each treatment component and its relative efficacy, and cast light on underlying mechanisms, so that we can systematically enhance internet CBT. [ABSTRACT FROM AUTHOR]

Background: Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control.Methods/design: A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Framework will extend a Dutch trial to the United Kingdom, with the addition of diagnostic interviews, primarily to test whether guided internet-RFCBT reduces the onset of depression relative to a no-intervention control. High-risk young adults (aged 18 to 24 years), selected with elevated worry/rumination and recruited through university and internet advertisement, will be randomised to receive either guided internet-RFCBT, supported by clinical psychologists or mental health paraprofessionals, or a no-intervention control. As an adjunct arm, participants are also randomised to unguided internet-RFCBT self-help to provide an initial test of the feasibility and effect size of this intervention. While participants are also randomised to unguided internet-RFCBT, the trial was designed and powered as a phase III trial comparing guided internet-RFCBT versus a no-intervention control. In the comparison between these two arms, the primary outcomes are as follows: a) onset of major depressive episode over a 12-month period, assessed with a Structured Clinical Interview for Diagnosis at 3 months (post-intervention), 6 months and 15 months after randomisation. The following secondary outcomes will be recorded: the incidence of generalized anxiety disorder, symptoms of depression and anxiety, and levels of worry and rumination, measured at baseline and at the same follow-up intervals. In relation to the pilot investigation of unguided internet-RFCBT (the adjunct intervention arm), we will assess the feasibility and acceptability of the data-collection procedures, levels of attrition, effect size and acceptability of the unguided internet-RFCBT intervention.Discussion: Widespread implementation is necessary for effective prevention, suggesting that the internet may be a valuable mode of delivery. Previous research suggests that guided internet-RFCBT reduces incidence rates relative to controls. We are also interested in developing and evaluating an unguided version to potentially increase the availability and reduce the costs.Trial Registration: Current Controlled Trials ISRCTN12683436 . Date of registration: 27 October 2014. [ABSTRACT FROM AUTHOR]

Rumination has been robustly implicated in the onset and maintenance of depression. However, despite empirically well-supported theories of the consequences of trait rumination (response styles theory; Nolen-Hoeksema, 1991), and of the processes underlying state episodes of goal-oriented repetitive thought (control theory; Martin & Tesser, 1989, 1996), the relationship between these theories remains unresolved. Further, less theoretical and clinical attention has been paid to the maintenance and treatment of trait depressive rumination. We propose that conceptualizing rumination as a mental habit (Hertel, 2004) helps to address these issues. Elaborating on this account, we propose a framework linking the response styles and control theories via a theoretical approach to the relationship between habits and goals (Wood & Neal, 2007). In this model, with repetition in the same context, episodes of self-focused repetitive thought triggered by goal discrepancies can become habitual, through a process of automatic association between the behavioral response (i.e., repetitive thinking) and any context that occurs repeatedly with performance of the behavior (e.g., physical location, mood), and in which the repetitive thought is contingent on the stimulus context. When the contingent response involves a passive focus on negative content and abstract construal, the habit of depressive rumination is acquired. Such habitual rumination is cued by context independent of goals and is resistant to change. This habit framework has clear treatment implications and generates novel testable predictions. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objectives: Control theory predicts that the detection of goal discrepancies initiates ruminative self-focus (Martin & Tesser, 1996). Despite the breadth of applications and interest in control theory, there is a lack of experimental evidence evaluating this prediction. The present study provided the first experimental test of this prediction. Methods: We examined uninstructed state rumination in response to the cueing of resolved and unresolved goals in a non-clinical population using a novel measure of online rumination. Results: Consistent with control theory, cueing an unresolved goal resulted in significantly greater recurrent intrusive ruminative thoughts than cueing a resolved goal. Individual differences in trait rumination moderated the impact of the goal cueing task on the extent of state rumination: individuals who had a stronger tendency to habitually ruminate were more susceptible to the effects of cueing goal discrepancies. Limitations: The findings await replication in a clinically depressed sample where there is greater variability and higher levels of trait rumination. Conclusions: These results indicate that control theories of goal pursuit provide a valuable framework for understanding the circumstances that trigger state rumination. Additionally, our measure of uninstructed online state rumination was found to be a valid and sensitive index of the extent and temporal course of state rumination, indicating its value for further investigating the proximal causes of state rumination. [Copyright &y& Elsevier]

Abstract: Background and objectives: Trauma-related rumination has been found to be an important maintaining factor for PTSD. On the background of the processing mode account of ruminative thinking, this study tested whether the relationship between rumination and analogue PTSD symptoms can be modified by training participants in a concrete mode of processing. Methods: Healthy participants were trained in either an abstract or a concrete style of processing. Afterwards, they watched a stressful film. The interactive effect of training condition and trait rumination on intrusive memories of the film was examined. Results: Following abstract training, a positive relationship between trait rumination and intrusive memories of the film emerged. As hypothesized, this relationship disappeared following concrete training. Limitations: include the lack of a no-training control group and the analogue paradigm used. Conclusions: The study provides preliminary evidence that the relationship between trait rumination and analogue PTSD symptoms can be modified. If replicated in future studies, it may be promising to examine the value of concreteness training for prevention and/or treatment of PTSD. [Copyright &y& Elsevier]

Background: The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders. Methods: The trial will be conducted in a sample (planned N = 351) of individuals aged 16–22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention). Discussion: This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people. Trial registration: https://www.drks.de, DRKS00027384. Registered on 21 February 2022—prospectively registered. [ABSTRACT FROM AUTHOR]

Background Patients with a life-limiting illness, such as cancer, and their carers experience elevated psychological distress. However, the psychological mechanisms underpinning distress in palliative care have been little studied. Recent theories predict that individuals who experience increased uncertainty in the context of ongoing difficulties, such as palliative patients and their carers, will (a) think more abstractly; (b) ruminate more; and (c) be more distressed. Methods Palliative patients ( n = 36, 90% with cancer), their carers ( n = 29), and age-matched controls ( n = 30) completed standardized questionnaires to assess anxiety, depression, and rumination, and open-ended interviews to identify their concerns and idiosyncratic levels of rumination. Concerns were analyzed linguistically for level of abstraction. Results As predicted, (i) palliative patients and carers reported significantly more uncertainty, rumination, and abstract thinking than controls; (ii) uncertainty, abstractness, and rumination were associated with psychological distress. Conclusions Abstraction and rumination are psychological mechanism potentially involved in increased psychological distress in palliative care. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Transdiagnostic models of psychopathology are increasingly prominent because they focus on fundamental processes underlying multiple disorders, help to explain comorbidity among disorders, and may lead to more effective assessment and treatment of disorders. Current transdiagnostic models, however, have difficulty simultaneously explaining the mechanisms by which a transdiagnostic risk factor leads to multiple disorders (i.e., multifinality) and why one individual with a particular transdiagnostic risk factor develops one set of symptoms while another with the same transdiagnostic risk factor develops another set of symptoms (i.e., divergent trajectories). In this article, we propose a heuristic for developing transdiagnostic models that can guide theorists in explicating how a transdiagnostic risk factor results in both multifinality and divergent trajectories. We also (a) describe different levels of transdiagnostic factors and their relative theoretical and clinical usefulness, (b) suggest the types of mechanisms by which factors at 1 level may be related to factors at other levels, and (c) suggest the types of moderating factors that may determine whether a transdiagnostic factor leads to certain specific disorders or symptoms and not others. We illustrate this heuristic using research on rumination, a process for which there is evidence it is a transdiagnostic risk factor. [ABSTRACT FROM PUBLISHER]

Abstract: Converging research findings indicate that rumination is correlated with a specific maladaptive interpersonal style encapsulating submissive (overly-accommodating, non-assertive and self-sacrificing) behaviours, and an attachment orientation characterised by rejection sensitivity. This study examined the prospective longitudinal relationship between rumination, the submissive interpersonal style, and rejection sensitivity by comparing two alternative hypotheses: (a) the submissive interpersonal style and rejection sensitivity prospectively predict increased rumination; (b) rumination prospectively predicts the submissive interpersonal style and rejection sensitivity. Currently depressed (n =22), previously depressed (n =42) and never depressed (n =28) individuals completed self-report measures assessing depressive rumination and key psychosocial measures of interpersonal style and behaviours, at baseline and again six months later. Baseline rejection sensitivity prospectively predicted increased rumination six months later, after statistically controlling for baseline rumination, gender and depression. Baseline rumination did not predict the submissive interpersonal style or rejection sensitivity. The results provide a first step towards delineating a potential casual relationship between rejection sensitivity and rumination, and suggest the potential value of clinical assessment and intervention for both rejection sensitivity and rumination in individuals who present with either difficulty. [Copyright &y& Elsevier]

Abstract: Goals, events, and actions can be mentally represented within a hierarchical framework that ranges from more abstract to more concrete levels of identification. A more abstract level of identification involves general, superordinate, and decontextualized mental representations that convey the meaning of goals, events, and actions, “why” an action is performed, and its purpose, ends, and consequences. A more concrete level of identification involves specific and subordinate mental representations that include contextual details of goals, events, and actions, and the specific “how” details of an action. This review considers three lines of evidence for considering that dysregulation of level of goal/action identification may be a transdiagnostic process. First, there is evidence that different levels of identification have distinct functional consequences and that in non-clinical samples level of goal/action identification appears to be regulated in a flexible and adaptive way to match the level of goal/action identification to circumstances. Second, there is evidence that level of goal/action identification causally influences symptoms and processes involved in psychological disorders, including emotional response, repetitive thought, impulsivity, problem solving and procrastination. Third, there is evidence that the level of goal/action identification is biased and/or dysregulated in certain psychological disorders, with a bias towards more abstract identification for negative events in depression, GAD, PTSD, and social anxiety. [Copyright &y& Elsevier]

Background: This study is the first to explore how rumination or recurrent dwelling may contribute to psychological distress in palliative care. We hypothesised that rumination is important in palliative care because: (1) rumination is triggered by significant life events; (2) the diagnosis of a life-limiting illness means the reevaluation of a number of personal goals, which may become unattainable, and, thereby, lead to rumination; (3) palliative care patients and caregivers report a number of existential concerns, which in their style and content are characteristic of rumination. Methods: This study adopted a cross-sectional design, comparing samples of palliative care patients ( n = 36), their caregivers ( n = 29), and an age-matched control group ( n = 30). Participants completed a combination of standardized questionnaires to assess their levels of anxiety, depression, and rumination, and open-ended interviews to identify the concerns they were ruminating on and their idiosyncratic experience of rumination. Results: As predicted, palliative care patients and their caregivers reported significantly more psychological distress than the control group. Palliative care patients and their caregivers also reported significantly more rumination on existential concerns (e.g., about the future) than the control group. The frequency of existential concerns and measures of rumination reported by participants positively correlated with increased psychological distress. Conclusion: The results support the importance of addressing rumination on existential concerns in palliative care because of its association with psychological distress. Rumination was identified as a mechanism that may be important in addressing psychological distress in palliative care. [ABSTRACT FROM AUTHOR]

Abstract: Theoretical models and empirical evidence suggest that brooding, the maladaptive sub-component of depressive rumination, is associated with a sub-set of depressogenic interpersonal difficulties characterised by submissive interpersonal behaviours and rejection sensitivity. This study tested whether these cognitive and interpersonal vulnerability factors independently predicted future depression and investigated their interdependence in predicting depression. A heterogeneous adult sample completed self-report measures assessing depressive symptoms, brooding, reflection, rejection sensitivity and maladaptive interpersonal behaviours, at baseline and six months later. When examined separately, brooding and an interpersonal component reflecting submissive, (overly-accommodating, non-assertive, and self-sacrificing) interpersonal behaviours each prospectively predicted increased depressive symptoms six months later, after controlling for baseline depressive symptoms and gender. When examined together, the submissive interpersonal style but not brooding predicted depression, indicating that this maladaptive interpersonal style may mediate the effect of brooding on future depression. Thus, the effects of brooding on depression may in part depend on its association with an interpersonal style characterised by submissiveness. [ABSTRACT FROM AUTHOR]

Abstract: The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p = .05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p < .01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective. To test the hypothesis that rumination contributes to poor social functioning by examining whether ruminative brooding predicts subsequent relationship satisfaction in individuals with a history of major depression. Method. Participants (N = 57) were interviewed to assess depressive symptoms and completed self-report measures of brooding and relationship satisfaction, at intake into the study (Time 1) and 3 months later (Time 2). Results. Brooding was related concurrently to relationship satisfaction at Time 2 (p < .01; approaching significance at Time 1, p = .06). Baseline brooding predicted diminished relationship satisfaction 3 months later, controlling for baseline relationship satisfaction (p < .05). Conclusions. Brooding may be an early warning sign for increasing relationship difficulties in those vulnerable to depression. [ABSTRACT FROM AUTHOR]

In this reply to the comment of McVay and Kane (2010), I consider their argument concerning how Watkins's (2008) elaborated control theory informs their perspective on the role of executive control in mind wandering. I argue that although in a number of places the elaborated control theory is consistent with the perspective of McVay and Kane that mind wandering represents a failure of executive control, their account makes a number of claims that are not articulated in the elaborated control theory-most notably, the hypothesis that level of construal moderates entry of thoughts into awareness. Moreover, the relevant literature suggests that the relationship between level of construal and executive control may be more complex, and may be determined by multiple factors beyond those proposed in this executive-control failure account of mind wandering. Finally, the implications of this model of mind wandering for understanding repetitive thought in general are considered, and it is proposed that examining level of executive control as a further moderating variable within elaborated control theory may be of value. [ABSTRACT FROM AUTHOR]

Previous research in depressed participants has supported the differentiation of self-focus into distinct modes of self- attention with distinct functional effects. In particular, Rimes and Watkins (2005) investigated the effects of self-focused rumination on overgeneral thinking and found that analytical, evaluative self-focus increased global negative self-judgments, whereas self-focus low in analytical thinking decreased such judgments in depressed participants. Given that self-focused attention and rumination have been implicated in the maintenance of social anxiety, the present study investigated the effects of these two distinct forms of self-focused attention on global negative self-judgments in an analogue sample for social anxiety (high and low fear of negative evaluation, FNE). Individuals high and low in FNE (n=41 per group) were randomly allocated to analytic (abstract, evaluative) or experiential (concrete, process- focused) self-focused manipulations. As predicted, in high FNE individuals, the experiential self-focus condition decreased ratings of the self as worthless and incompetent pre- to post-manipulation, whereas the analytical self-focus condition maintained such negative self-judgments. Analytical and experiential self-focus did not differ in their effects on mood. The results suggest that an experiential mode of self-focused rumination may be adaptive in social anxiety. [ABSTRACT FROM AUTHOR]

Rumination has been identified as a core process in the development and maintenance of depression. Treatments targeting ruminative processes may, therefore, be particularly helpful for treating chronic and recurrent depression. The development of such treatments requires translational research that marries clinical trials, process-outcome research, and basic experimental research that investigates the mechanisms underpinning pathological rumination. For example, a program of experimental research has demonstrated that there are distinct processing modes during rumination that have distinct functional effects for the consequences of rumination on a range of clinically relevant cognitive and emotional processes: an adaptive style characterized by more concrete, specific processing and a maladaptive style characterized by abstract, overgeneral processing. Based on this experimental work, two new treatments for depression have been developed and evaluated: (a) rumination-focused cognitive therapy, an individual-based face-to-face therapy, which has encouraging results in the treatment of residual depression in an extended case series and a pilot randomized controlled trial; and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression, which has beneficial findings in a proof-of-principle study in a dysphoric population. These findings indicate the potential value of process-outcome research (a) explicitly targeting identified vulnerability processes and (b) developing interventions informed by research into basic mechanisms. [ABSTRACT FROM AUTHOR]

Abstract: We hypothesized that a tendency towards abstract, general and decontextualized processing is a cognitive distortion that causally contributes to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, participants with stable dysphoria (scoring≥14 on BDI-II at 2 consecutive weekly assessments) were randomly allocated in an additive design either to an active intervention control consisting of relaxation training or relaxation training plus concreteness training. Concreteness training involved repeated mental exercises designed to encourage more concrete and specific thinking about emotional events. Both interventions involved a training session and then repeated daily use of compact disc recordings for 7 days. Relaxation training plus concreteness training resulted in significantly greater decreases in depressive symptoms and marginally significantly greater decreases in state rumination than relaxation training alone. These findings suggest the potential value of concreteness training as a guided self-help intervention for mild-to-moderate depressive symptoms. [Copyright &y& Elsevier]

Abstract: Ruminative thinking is believed to exacerbate the psychological distress that follows stressful life events. An experience-sampling study was conducted in which participants recorded negative life events, ruminative self-focus, and negative affect eight times daily over one week. Occasions when participants reported a negative event were marked by higher levels of negative affect. Additionally, negative events were prospectively associated with higher levels of negative affect at the next sampling occasion, and this relationship was partially mediated by momentary ruminative self-focus. Depressive symptoms were associated with more frequent negative events, but not with increased reactivity to negative events. Trait rumination was associated with reports of more severe negative events and increased reactivity to negative events. These results suggest that the extent to which a person engages in ruminative self-focus after everyday stressors is an important determinant of the degree of distress experienced after such events. Further, dispositional measures of rumination predict mood reactivity to everyday stressors in a non-clinical sample. [Copyright &y& Elsevier]

Abstract: It has been suggested that overgeneral memory (OGM) represents a vulnerability marker for depression [Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E., et al. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133, 122–148]. One important underlying mechanism involved is rumination [e.g., Watkins, E., & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110, 353–357; Watkins, E., & Teasdale, J. D. (2004). Adaptive and maladaptive self-focus in depression. Journal of Affective Disorders, 82, 1–8]. It is as yet unclear to what extent the relationship between rumination and OGM also applies to nonclinical groups. The present study investigated this relationship in a nonclinical student sample, using an innovative sentence completion procedure to assess OGM. As hypothesized, the experimental induction of a concrete, process-focused (or non-ruminative) thinking style (n=102) led to less OGMs as compared to the experimental induction of an abstract, evaluative (or ruminative) thinking style (n=93). The present results add to the accumulating body of evidence that abstract, evaluative (or ruminative) thinking is a crucial underlying process of OGM, and expand prior literature by extending this idea to nonclinical individuals and by using a new procedure to assess OGM. [Copyright &y& Elsevier]

The authors conducted an experience sampling study to investigate the relationship between momentary ruminative self-focus and negative affect. Ninety-three adults recorded these variables at quasi-random intervals 8 times daily for 1 week. Scores on questionnaire measures of dispositional rumination were associated with mean levels of momentary ruminative self-focus over the experience sampling week. Concurrently, momentary ruminative self-focus was positively associated with negative affect. Cross- lagged analyses revealed that whereas ruminative self-focus predicted negative affect at a subsequent occasion, negative affect also predicted ruminative self-focus at a subsequent occasion. Decomposition of the dispositional rumination measure suggested that brooding, but not reflective pondering, was associated with higher mean levels of negative affect. Though broadly consistent with Nolen-Hoeksema's (1991) response styles theory, these results suggest that a reciprocal relationship exists between ruminative self-focus and negative affect. [ABSTRACT FROM AUTHOR]

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety; and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RI occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RI, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences. [ABSTRACT FROM AUTHOR]

Watkins (2004) found that the mode of processing adopted during expressive writing following a failure influenced emotional recovery from the failure as a function of level of trait rumination. At higher levels of trait rumination, negative mood 12 hours after the failure was greater, but only in an abstract, evaluative writing condition and not in a concrete, process-focused condition. The current study examined whether this interaction of trait rumination with processing mode would generalize to emotional vulnerability to a subsequent negative stressor. Participants repeatedly focused on both positive and negative scenarios in either a concrete, process-focused or an abstract, evaluative mode, before a failure experience. As predicted, after the failure experience, higher levels of trait rumination were associated with lower levels of positive affect, but only for participants in the abstract, evaluative condition and not for participants in the concrete, process-focused condition. This finding is consistent with processing mode influencing the relationship between trait rumination and emotional vulnerability. [ABSTRACT FROM AUTHOR]

Two experiments are reported in which nondysphoric participants, not prone to excessive levels of rumination in everyday life, were asked to retrieve autobiographical memories using the Williams and Broadbent (1986) procedure (AMT). In the first experiment, two variants of a self‐related category fluency task were interleaved among sets of autobiographical memory cues. In one variant (blocked) a normal model of analytic rumination was induced by grouping prompts on a single superordinate theme together. In the other (intermixed) prompts from several different themes were grouped together. It was predicted that the blocked variant would reduce the number of specific memories recollected and increase the number of categoric memories relative to the intermixed variant. This prediction was confirmed and provides the first demonstration of a bidirectional causal influence of analytic rumination on the balance between specific and categoric retrievals. A second experiment showed no alteration in this balance when the same fluency manipulation involved animal‐related categories rather than self‐related ones. The results support a two component model of autobiographical retrieval being driven in part by the extent to which an analytic mode of processing is adopted in the short term and in part by the level of differentiation in self‐related schematic models. [ABSTRACT FROM AUTHOR]

Objectives. Future thinking is an important domain of cognitive functioning, with reduced ability to imagine positive future events associated with hopelessness in depression and parasuicide. Rumination has been shown to exacerbate negative cognitive biases in depression, and to reduce likelihood estimations for positive future events. We examine the hypothesis that, in depressed patients, rumination would reduce the ability to imagine positive future events, whilst increasing the ability to imagine negative future events. Method. The ability to imagine positive and negative future events was assessed using the future thinking paradigm (MacLeod, Rose, & Williams, 1993). Depressed and non-depressed participants completed the future thinking task after being randomly allocated to either a rumination or distraction manipulation (Nolen-Hoeksema & Morrow, 1993). Mood was measured before and after the manipulation. Participants also completed a standard verbal fluency task. Results. In the depressed group, compared to distraction, rumination increased both negative and positive future thinking, although the effect was only significant for negative future thinking once baseline levels of hopelessness were controlled for. These findings are consistent with the prediction that rumination would increase negative future thinking, but inconsistent with the prediction that rumination would reduce positive future thinking. Previous findings that, compared to controls, depressed patients generated fewer positive future events were replicated. Conclusion. Ruminative self-focus leads to greater negative future thinking in depressed patients, further confirming that rumination exacerbates negative cognitive biases in depression. The relationship between rumination and positive future thinking was unexpected, but might potentially reflect a general priming of self-related information by rumination. [ABSTRACT FROM AUTHOR]

Monte Carlo-extended linear response (MC/ELR) calculations are used to examine the binding of efavirenz analogues with the K103N mutant of HIV-1 reverse transcriptase (HIVRT). A regression equation previously reported for the wild type (WT) enzyme is shown to predict 47 experimental activities for the K103N mutant with a q2=0.55 and avg error of only 0.46 kcal/mol. Further analysis identifies the key features for binding to the K103N mutant: ligand flexibility, burial of hydrophobic surface area, and protein–ligand van der Waals interactions. [Copyright &y& Elsevier]

This paper describes the limited availability of resources for common mental disorders and the unmet need for treatment for both anxiety and depression. A specific focus is to consider whether a self-referral approach to Stress can be adapted to meet the unmet need for treatment of people with depression. Results indicate that the take-up for a self-referral Depression workshop is much lower than that for the Stress workshops, particularly between the enquiry and the Introductory Talk stage. Additionally, those who came to the Introductory Talks for the Depression workshops were very similar to psychology service referrals. Over 90% had previously been to see their GP, been diagnosed and referred on to the specialist mental health services. It was concluded that the self-referral mechanism was not successful in meeting the unmet needs of those with depression who had not been previously referred. Suggestions are made about improving take-up and engagement for this group. [ABSTRACT FROM AUTHOR]

Rumination is a vulnerability for depression and potentially linked to inhibitory control weaknesses. We aimed to replicate the association observed in adults between inhibitory control and rumination in adolescents, and to examine putative moderating roles of childhood maltreatment and perceived family cohesion in an adolescent sample at risk for depression due to familial/personal history. Ninety adolescents aged 11–17 (M = 14.6, SD = 1.8) completed self-report scales of rumination, maltreatment, and family cohesion, and performed a task assessing inhibitory control. Hierarchical regression models showed no significant relation between inhibitory control and moderator variables on rumination. However, adolescents who reported higher levels of maltreatment and who perceived lower family cohesion tended to indicate higher levels of rumination (BChilhood Maltreatment = 27.52, 95% CIs [5.63, 49.41], BFamily Cohesion = -0.40, 95% CIs [-0.65, -0.15]). These findings demonstrate an alternative understanding of factors that increase depression onset risk and recurrence in adolescents. Summary Statement: This study was funded by the National Institute of Mental Health grants R61MH116080 and F31MH117856. S.A.L. reports financial disclosures from EPI-Q, Otsuka Pharmaceutical, Development and Commercialization, Inc, and Secondary Triad, Inc, all of which are unrelated to the present work. S.A.L. is supported by National Institute of Mental Health grants (Grant Nos. MH116080, MH112705, MH120660, and MH120168). K.L.B. is supported by the National Institutes of Mental Health grant F31MH117856. All other authors have no relevant financial or non-financial interests to disclose. [ABSTRACT FROM AUTHOR]

Background: Although worry is well-known to share a robust relationship with psychopathology, whether this association is higher in generalized anxiety disorder (GAD) versus other anxiety disorders and depressive disorder, and clinical versus nonclinical populations is unclear. Methods: We conducted a meta-analysis in which the association between worry and various mental health indicators was quantitatively summarized using a random-effects model; additionally, several moderators were tested. Results: Results synthesizing data from 120 correlational studies (138 independent samples) conducted over the past 35 years indicate a strong association between worry and poor mental health (r =.53) but also high heterogeneity. This association was not systematically impacted by the study population or whether individuals had a diagnosis of GAD or major depressive disorder (MDD). Participants' age and how worry and mental health were measured moderated this association. Conclusions: The main findings suggest that (1) worry is strongly associated with poor mental health, (2) worry is associated with poor mental health even outside of GAD and clinical populations included in the current meta-analysis, and (3) there are differences in this association across the lifespan. Overall, the results from this meta-analysis support earlier calls for intense worry to be assessed and treated, regardless of whether the individual has a diagnosis of GAD or MDD. [ABSTRACT FROM AUTHOR]

We review research showing that rumination has multiple negative consequences: (a) exacerbating psychopathology by magnifying and prolonging negative mood states, interfering with problem-solving and instrumental behaviour and reducing sensitivity to changing contingencies; (b) acting as a transdiagnostic mental health vulnerability impacting anxiety, depression, psychosis, insomnia, and impulsive behaviours; (c) interfering with therapy and limiting the efficacy of psychological interventions; (d) exacerbating and maintaining physiological stress responses. The mechanisms underlying rumination are examined, and a model (H-EX-A-GO-N – Habit development, EXecutive control, Abstract processing, GOal discrepancies, Negative bias) is proposed to account for the onset and maintenance of rumination. H-EX-A-GO-N outlines how rumination results from dwelling on problematic goals developing into a learnt habit that involves the tendency to process negative information in an abstract way, particularly in the context of poor executive control and negative information-processing biases. These proximal factors integrate experimental evidence to provide a partial answer to the critical question of what maintains rumination. They constitute a pathway by which more distal biological and environmental factors increase the likelihood of rumination developing. Treatments for rumination are reviewed, with preliminary trials suggesting that psychological interventions designed to specifically target these mechanisms may be effective at reducing rumination. • We review and synthesise evidence of the multiple negative consequences of rumination. • Past models and empirical evidence are integrated to form a new theoretical account. • The H-EX-A-GO-N model outlines proximal mechanisms driving pathological rumination. • These mechanisms map well onto distal biological and environmental vulnerabilities. • Treatments specifically targeting rumination are found to be especially effective. [ABSTRACT FROM AUTHOR]

Rumination and worry are common risk factors of depression and anxiety. Internet‐based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three‐arm randomized controlled trial compared the efficacy of Internet‐based rumination‐focused cognitive behavioral therapy (RFCBT), mindfulness‐based intervention (MBI), and psychoeducation (EDU) control among 256 at‐risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post‐intervention (6 weeks), 3‐month, and 9‐month follow‐ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3‐month follow‐up among participants in RFCBT, and no significant long‐term effect among participants in MBI was noted at a 9‐month follow‐up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow‐ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence. [ABSTRACT FROM AUTHOR]

Rumination involves a repetitive, passive focus on one's thoughts and feelings and has been hypothesized as a mechanism contributing to multiple psychopathologies. The current investigation explores secondary outcomes from a pilot study to examine whether rumination-focused cognitive behavior therapy (RFCBT) alleviates symptoms of anxiety, increases behavioral activation, or increases global functioning among adolescents with a history of Major Depressive Disorder (MDD). Thirty-three adolescents were randomized to receive either RFCBT (n = 17) or assessment only (AO; n = 16) over the course of eight weeks. Mixed effects regression models were used to conduct intent-to-treat (ITT) analyses. The quadratic interaction for group-by-time-by-time was significant for anxiety. Adolescents in the RFCBT group experienced a significant decrease in anxiety across the first six weeks of intervention (F = 7.01, df = 108.49, p = 0.009). The group-by-time interaction was significant for the behavioral activation outcome (F = 4.28, df = 25.60, p = 0.049) with youth randomized to RFCBT demonstrating increasing activation compared to AO. Global functioning did not significantly differ between groups (F = 0.40, df = 1, p > 0.05). Preliminary evidence suggests that RFCBT may hold promise as an intervention that alleviates both depressive and anxiety symptoms when comorbid. Highlights: RFCBT reduces anxiety symptoms among adolescents in remission from depression. SRumination may be a mechanism in both depressive and anxious disorders. Behavioral activation increases among youth randomized to RFCBT. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a transdiagnostic process and a promising target for prevention and treatment of mental disorders. RNT is typically assessed via self-report questionnaires with most studies focusing on one type of RNT (i.e., worry or rumination) and one specific disorder (i.e., anxiety or depression). However, responses to such questionnaires may be biased by memory and metacognitive beliefs. Recently, Ecological Momentary Assessment (EMA) has been employed to minimize these biases. This study aims to develop an EMA paradigm to measure RNT as a transdiagnostic process in natural settings. Based on empirical and theoretical considerations, an item pool was created encompassing RNT content and processes. We then (1) tested model fit of a content-related and a process-related model for assessing RNT as an individual difference variable, (2) investigated the reliability and construct validity of the proposed scale(s), and (3) determined the optimal sampling design. One hundred fifty healthy participants aged 18 to 40 years filled out baseline questionnaires on rumination, worry, RNT, symptoms of depression, anxiety, and stress. Participants received 8 semi-random daily prompts assessing RNT over 14 days. After the EMA phase, participants answered questionnaires on depression, anxiety, and stress again. Multilevel confirmatory factor analysis revealed excellent model fit for the process-related model but unsatisfactory fit for the content-related model. Different hybrid models were additionally explored, yielding one model with satisfactory fit. Both the process-related and the hybrid scale showed good reliability and good convergent validity and were significantly associated with symptoms of depression, anxiety, and stress after the EMA phase when controlling for baseline scores. Further analyses found that a sampling design of 5 daily assessments across 10 days yielded the best tradeoff between participant burden and information retained by EMA. In sum, this paper presents a promising paradigm for assessing RNT in daily life. [ABSTRACT FROM AUTHOR]

Introduction: Rumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non‐suicidal self‐injury (NSSI). Despite the link between self‐reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI. Method: We collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast. Results: Lifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum. Conclusion: Difficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well‐being and neurobiological change. [ABSTRACT FROM AUTHOR]

Background: Postnatal maternal depressive symptoms are consistently associated with reduced quality of mother- infant interaction. However, there is little research examining the role of maternal cognitive factors (e.g. rumination) in the relationship between depressive symptoms and mother-infant interaction quality. This study investigated the hypotheses that: dysphoric mothers would demonstrate less sensitive behaviour towards their infants compared with nondysphoric mothers; mothers induced to ruminate would be less sensitive towards infants; rumination would moderate the relationship between maternal depressive symptoms and maternal sensitivity and the impact of the rumination induction would increase following a stressor (still face) task. Method: Mothers (N = 79; 39 dysphoric and 40 nondysphoric) and their infants were randomised to either a rumination induction or a control condition. Maternal sensitivity in mother-infant interactions was assessed before and after the induction using the CARE Index. In the second interaction task, mothers also completed the still-face procedure as a stressor. Results: Extending previous research, mixed measures ANOVAs demonstrated that dysphoric mothers had reduced quality of interaction with their infant compared with nondysphoric mothers and that mothers in the rumination condition exhibited reduced sensitivity towards their infants relative to mothers in the control condition. Further, maternal sensitivity worsened further after the still-face procedure in the rumination condition, but not in the control condition. Conclusions: This study suggests that the repetitive, internal focus of a ruminative state is causally implicated in mother-infant interaction quality, regardless of the level of depressive symptoms. This research extends understanding of specific mechanisms involved in the quality of the mother-infant relationship. [ABSTRACT FROM AUTHOR]

Background: Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training.Methods: We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure.Results: After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values <0.05). The higher the PHQ-9 total score at baseline (range: 5-14), the greater the decrease after 8 weeks. For each 5-point increase at baseline, the change from baseline to 8 weeks was bigger by 2.8 points. The more frequent the exercise habits (range: 0-2 points), the less effective the self-monitoring component. The difference in PHQ-9 change scores between presence or absence of self-monitoring was smaller by 0.94 points when the participant exercised one level more frequently. Additionally, the study suggested seven out of 36 PFs and 14 out of 160 EMs examined were candidates for future research.Limitations: Generalizability is limited to university students with subthreshold depression.Conclusions: These results provide some helpful information for the future development of individualized iCBT algorithms for depression. [ABSTRACT FROM AUTHOR]

Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA +  major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA. [ABSTRACT FROM AUTHOR]

Postnatal maternal depressive symptoms are consistently associated with impairments in maternal attunement (i.e., maternal responsiveness and bonding). There is a growing body of literature examining the impact of maternal cognitive factors (e.g., rumination) on maternal attunement and mood. However, little research has examined the role of infant temperament and maternal social support in this relationship. This study investigated the hypothesis that rumination would mediate (1) the relationship between depressive symptoms and attunement and (2) the relationship between social support and attunement. We further predicted that infant temperament would moderate these relationships, such that rumination would demonstrate mediating effects on attunement when infant difficult temperament was high, but not low. Two hundred and three mothers completed measures on rumination, depressive symptoms, attunement, perceived social support and infant temperament. Rumination mediated the effect of postnatal maternal depressive mood on maternal self-reported responsiveness to the infant when infants were low, but not high, in negative temperament. When infants had higher negative temperament, there were direct relationships between maternal depressive symptoms, social support and maternal self-reported responsiveness to the infant. This study is limited by its cross-sectional and correlational nature and the use of self-report measures to assess a mother's awareness of her infant needs and behaviours, rather than observational measures of maternal sensitivity. These findings suggest potentially different pathways to poor maternal responsiveness than those expected and provide new evidence about the contexts in which maternal cognitive factors, such as rumination, may impact on the mother–infant relationship. [ABSTRACT FROM AUTHOR]

Background Increased life expectancy has resulted in a greater provision of informal care within the community for patients with chronic physical health conditions. Informal carers are at greater risk of poor mental health, with one in three informal carers of stroke survivors experiencing depression. However, currently no psychological treatments tailored to the unique needs of depressed informal carers of stroke survivors exist. Furthermore, informal carers of stroke survivors experience a number of barriers to attending traditional face-to-face psychological services, such as lack of time and the demands of the caring role. The increased flexibility associated with supported cognitive behavioral therapy self-help (CBTsh), such as the ability for support to be provided by telephone, email, or face-to-face, alongside shorter support sessions, may help overcome such barriers to access. CBTsh, tailored to depressed informal carers of stroke survivors may represent an effective and acceptable solution. Methods/design This study is a Phase II (feasibility) randomized controlled trial (RCT) following guidance in the MRC Complex Interventions Research Methods Framework. We will randomize a sample of depressed informal carers of stroke survivors to receive CBT self-help supported by mental health paraprofessionals, or treatment-as-usual. Consistent with the objectives of assessing the feasibility of trial design and procedures for a potential larger scale trial we will measure the following outcomes: a) feasibility of patient recruitment (recruitment and refusal rates); (b) feasibility and acceptability of data collection procedures; (c) levels of attrition; (d) likely intervention effect size; (e) variability in number, length and frequency of support sessions estimated to bring about recovery; and (f) acceptability of the intervention. Additionally, we will collect data on the diagnosis of depression, symptoms of depression and anxiety, functional impairment, carer burden, quality of life, and stroke survivor mobility skill, self-care and functional ability, measured at four and six months post-randomization. Discussion This study will provide important information for the feasibility and design of a Phase III (effectiveness) trial in the future. If the intervention is identified to be feasible, effective, and acceptable, a written CBTsh intervention for informal carers of stroke survivors, supported by mental health paraprofessionals, could represent a cost-effective model of care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Repetitive negative thinking (RNT) increases vulnerability to multiple anxiety and depressive disorders and, as a common risk factor, elevated RNT may account for the high levels of comorbidity observed between emotional disorders. The aims of this study were to (a) compare two common forms of RNT (worry and rumination) across individuals with non-comorbid anxiety or depressive disorders, and (b) to examine the relationship between RNT and comorbidity. Methods: A structured diagnostic interview and measures of rumination, worry, anxiety, and depression were completed by a large clinical sample with an anxiety disorder or depression (N=513) presenting at a community mental health clinic. Results: Patients without (n=212) and with (n=301) comorbid diagnoses did not generally differ across the principal diagnosis groups (depression, generalised anxiety disorder, social anxiety disorder, panic disorder) on worry or rumination. As predicted, comorbidity was associated with a higher level of RNT. Limitations: Cross-sectional design precluded causal conclusions and findings may not generalize to excluded anxiety disorders. Conclusions: Consistent with the transdiagnostic hypothesis, RNT was associated with a range of anxiety disorders and depression and with comorbidity for those with a principal depressive disorder, supporting recent evidence that RNT is a transdiagnostic process. The presence of RNT, specifically worry and rumination, should be assessed and treated regardless of diagnostic profile. Future research may show that both pure and comorbid depressed or anxious patients receive incremental benefit from transdiagnostic protocols developed to treat core pathological processes of RNT traditionally associated with separate disorders. [Copyright &y& Elsevier]

Los autores comunicaron, en un estudio controlado aleatorizado previo, los importantes efectos beneficiosos de la terapia cognitiva en la prevención de recaídas en los pacientes con trastorno bipolar después de un año de terapia. Este estudio presenta los datos de un seguimiento adicional de 18 meses y ofrece una supervisión del efecto terapéutico durante 30 meses. Método: Pacientes con trastorno bipolar I según el DSM-IV (n = 103) que padecían recaídas frecuentes fueron asignados, de forma aleatorizada, a un grupo de terapia cognitiva más medicación o a una condición de control exclusivamente farmacológica. Examinadores independientes, que desconocían la condición del grupo de los pacientes, evaluaron a los pacientes cada 6 meses. Resultados: Durante los 30 meses, el grupo de terapia cognitiva mostró una evolución clínica significativamente más favorable en cuanto al tiempo de recaída. No obstante, el efecto de la prevención de recaídas se observó sobre todo a lo largo del primer año. En el grupo de terapia cognitiva, los 900 días que duraron los episodios bipolares también se acortaron en 110 días (IC 95% = 32 a 189) durante los 30 meses, y los 450 días de episodios bipolares de los últimos 18 meses, en 54 días (IC 95% = 3 a 105). Los análisis multifactoriales de la varianza revelaron que durante los últimos 18 meses el grupo de terapia cognitiva experimentó una mejoría significativa en las puntuaciones del estado de ánimo, el funcionamiento social, el control de los pródromos bipolares y la cognición disfuncional en cuanta a la consecución de objetivos. Conclusiones: Los episodios bipolares de los pacientes pertenecientes al grupo de terapia cognitiva duraron significativamente menos días una vez controlado el efecto del cumplimiento terapéutico. Los resultados mostraron, sin embargo, que la terapia cognitiva no redujo las recaídas de forma significativa durante los últimos 18 meses del período de estudio. Futuros estudios deberán examinar el efecto de las sesiones de refuerzo o de la terapia de mantenimiento. [ABSTRACT FROM PUBLISHER]

Objective: In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months. Method: Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. independent raters, who were blind to patient group status, assessed patients at 6-month intervals. Results: Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% Cl=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% Cl=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition. Conclusions: Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy. [ABSTRACT FROM AUTHOR]

• Depressed patients reporting severely stressful life events had worse prognoses. • Reporting three or more events was associated with considerably worse outcomes. • This held in patients with long durations and those in a first depressive episode. • Effects were attenuated by variables that might have been affected by the events. • Clinicians should routinely ask patients about life events and assess their impact. To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3–4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4–43.3)). Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode.Methods: Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted.Results: Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)).Conclusions: Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important. [ABSTRACT FROM AUTHOR]

Background: Repetitive negative thinking (RNT) is considered to be an important transdiagnostic factor in the onset, course and recurrence of both depressive and anxiety disorders. This study aimed to investigate whether an add-on group intervention 'Drop it', compared to treatment as usual, would improve RNT, anxiety and depressive symptoms, as well as quality of life and self-esteem of patients with Major Depressive Disorder (MDD) and/or Generalized Anxiety Disorder (GAD). Methods: Eighty patients were randomly allocated to 8 sessions of group intervention (n = 45) or a delayed treatment control group (n = 35). Both conditions continued their ongoing mental health care. Assessments took place before randomization, 12 weeks later (after group intervention) and at 3- and 9- months follow-up. Results: Although all outcomes improved after the intervention, only the uncontrollability of rumination, worrying, distancing oneself from one's thoughts, and quality of life remained statistically significant after Bonferroni correction compared to the delayed treatment control group. Conclusions: Group intervention improves RNT and quality of life of patients treated for MDD and/or GAD. Improvements remain stable until 9 months after treatment. Limitations of the study included the small sample size, the lack of a long-term follow-up in the delayed treatment control group and the inclusion of highly educated patients with mainly high comorbid generalized anxiety disorder and depression. [ABSTRACT FROM AUTHOR]