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Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive reactivity to sad mood refers to the degree to which a mild dysphoric state reactivates dysfunctional cognitions, or negative thinking patterns, which has been found to be a vulnerability marker of depression. Over a two year period, Kruijt et al. (2013) found that only cognitive reactivity, including baseline symptoms and negative life events, predicted first onset of depression in a multivariate model. Objectives: The current study extends the findings of Kruijt et al. (2013) by evaluating the predictive association of cognitive reactivity on depression onset and depressive relapse over a follow-up period of nine years. Methods: Data were collected during a nine-year period in a prospective cohort study for depression and anxiety in the Netherlands. At baseline, 2981 participants recruited. We analyze data using Cox hazards regression models and ROC curves using subsamples of never-depressed and remitted-depressed participants. Results: Replicating the findings of Kruijt et al (2013), cognitive reactivity is expected to be significantly associated with depression incidence. Moreover, higher CR scores at baseline are expected to predict depressive relapse over a nine-year period, even when subclinical symptoms and other relevant predictive factors are controlled for. Conclusions: Our findings strengthen the support for the theory that depression-related cognitions precede the first onset of depression and predispose individuals to a poor depression prognosis, namely depression relapse. These findings emphasize the clinical importance of targeting dysfunctional cognitions in preventing the occurrence, or recurrence, of depression. [ABSTRACT FROM AUTHOR]

Eveningness has been associated with both disturbed sleep and depression. It is unclear, however, if deprived sleep explains evening types' vulnerability to depression. The role of pre-sleep rumination in these associations also remains understudied. The present study assessed the relationship between eveningness and sleep quality, as well as the possible mediating effect of pre-sleep rumination and the moderating effect of a history of depression, under naturalistic conditions. Eighty-eight Dutch-speaking participants (87.5% females, 21.4 ± 3.7 years) were selected on the basis of their non-intermediate chronotype using the Morningness Eveningness Questionnaire (evening types (n = 53); morning types (n = 35)). Depression status was assessed through a diagnostic interview (healthy (n = 61); remitted depressed (n = 27)). Participants' sleep characteristics were monitored via actigraphy and sleep diaries for seven consecutive days and nights. Pre-sleep rumination was measured via a self-report questionnaire. Evening types had longer subjective and actigraphic sleep onset latency than morning types. Pre-sleep rumination did not mediate the former associations but predicted longer subjective sleep onset latency. Furthermore, the relationship between chronotype and subjective sleep onset latency was moderated by depression history. Remitted depressed evening types reported longer sleep onset latency than healthy evening and morning types, possibly posing the former at a higher risk for depressive relapse. Overall, the current findings address the need to further investigate the physiological signature of circadian rhythms and sleep latency. This could serve as a foundation for the development of prevention and early intervention programs, tailored for mood and sleep disorders., (© 2024 The Author(s). European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background: Suicidal ideation arises from a complex interplay of multiple interacting risk factors over time. Recently, ecological momentary assessment (EMA) has increased our understanding of factors associated with real-time suicidal ideation, as well as those predicting ideation at the level of hours and days. Here we used statistical network methods to investigate which cognitive-affective risk and protective factors are associated with the temporal dynamics of suicidal ideation., Methods: The SAFE study is a longitudinal cohort study of 82 participants with current suicidal ideation who completed 4×/day EMA over 21 days. We modeled contemporaneous ( t ) and temporal ( t + 1) associations of three suicidal ideation components (passive ideation, active ideation, and acquired capability) and their predictors (positive and negative affect, anxiety, hopelessness, loneliness, burdensomeness, and optimism) using multilevel vector auto-regression models., Results: Contemporaneously, passive suicidal ideation was positively associated with sadness, hopelessness, loneliness, and burdensomeness, and negatively with happiness, calmness, and optimism; active suicidal ideation was positively associated with passive suicidal ideation, sadness, and shame; and acquired capability only with passive and active suicidal ideation. Acquired capability and hopelessness positively predicted passive ideation at t + 1, which in turn predicted active ideation; acquired capability was positively predicted at t + 1 by shame, and negatively by burdensomeness., Conclusions: Our findings show that systematic real-time associations exist between suicidal ideation and its predictors, and that different factors may uniquely influence distinct components of ideation. These factors may represent important targets for safety planning and risk detection.

Recent research shows that sleep disturbances are linked to increased suicidal ideation. In the present longitudinal cohort study, we used subjective (ecological momentary assessment, EMA) and objective (actigraphy) measures to examine the effects of sleep parameters on next-day suicidal ideation. Further, we examined hopelessness as a mediator between insufficient sleep and increased suicidal ideation. Individuals with current suicidal ideation (N = 82) completed 21 days of EMA and actigraphy to estimate suicidal ideation, hopelessness and sleep parameters. Multilevel linear-mixed models were used to examine the effects of sleep parameters on next-day suicidal ideation, as well as for the mediating effect of hopelessness (in the morning) on the association between previous night's sleep and suicidal ideation levels the next day. Significant concordance existed between subjective and objective sleep measures, with moderate-to-large correlations (r = 0.44-0.58). Lower subjective sleep quality and efficiency, shorter total sleep time and increased time awake after sleep onset were significantly associated with increased next-day suicidal ideation (controlling for previous-day suicidal ideation). Actigraphy-measured sleep fragmentation was also a significant predictor of next-day ideation. Hopelessness mediated the effects of the subjective sleep parameters on suicidal ideation, but did not account for the association with sleep fragmentation. Therefore, individuals' psychological complaints (hopelessness, suicidal ideation) were better predicted by subjective sleep complaints than by objective sleep indices. Increased hopelessness following from perceived insufficient sleep appears an important explanatory factor when considering the link between sleep disturbances and suicidal ideation., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Parental verbal threat (vs. safety) information about strangers may induce fears of these strangers in adolescents. In this multi-method experimental study, utilizing a within-subject design, parents provided standardized verbal threat or safety information to their offspring (N = 77, M age  = 11.62 years, 42 girls) regarding two strangers in the lab. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. Adolescent's fear of strangers during social interaction tasks was assessed using cognitive (fear beliefs, attention bias), behavioral (observed avoidance and anxiety), and physiological (heart rate) indices. We also explored whether the impact of parental verbal threat information differs depending on the social anxiety levels of parents or fearful temperaments of adolescents. The findings suggest that a single exposure to parental verbal threat (vs. safety) information increased adolescent's self-reported fears about the strangers but did not increase their fearful behaviors, heart rate, or attentional bias. Furthermore, adolescents of parents with higher social anxiety levels or adolescents with fearful temperaments were not more strongly impacted by parental verbal threat information. Longitudinal research and studies investigating parents' naturalistic verbal expressions of threat are needed to expand our understanding of this potential verbal fear-learning pathway., (© 2024 The Author(s). Developmental Psychobiology published by Wiley Periodicals LLC.)

Children can acquire fears of novel stimuli as a result of listening to parental verbal threat information about these stimuli (i.e., instructional learning). While empirical studies have shown that learning via parental information occurs, the effect size of parental verbal threat information on child fear of a novel stimulus has not yet been measured in a meta-analysis. We conducted a systematic review and meta analysis to assess the effect of parents' verbal statements on their children's fear acquisition. Additionally, we explored potential moderators of this effect, namely, parent and child anxiety levels, as well as child age. WebOfScience, Pubmed, Medline, and PsycINFO were used to identify eligible studies that assessed children's (30 months to 18 years old) fear of novel stimuli after being exposed to parental verbal threat information. We selected 17 studies for the meta-analysis and 18 for the systematic review. The meta-analysis revealed a significant causal effect of parental verbal threat information on children's fear reaction towards novel stimuli [g = 1.26]. No evidence was found for a moderation of verbal learning effects, neither by child or parent anxiety levels nor by child age. The effect of parents' verbal threat information on children's fear of novel stimuli is large and not dependent on anxiety levels or child age., (© 2024. The Author(s).)

Background and Objectives: Inhibitory Learning Theory (ILT) framework implies that in-session distress variability may promote extinction learning and thereby enhance exposure therapy efficacy. Thus far, research has mainly focused on in-session distress reduction. The aim of the current study was to assess whether in-session distress variability predicts next session PTSD symptom decline in PTSD patients receiving prolonged exposure (PE)., Methods: Eighty-six patients with PTSD received 14 to 16 sessions of PE. Using dynamic panel models, we assessed the temporal relation (i.e., within-persons) between in-session distress variability and PTSD symptom decline. Moreover, we assessed the averaged relation (i.e., between-persons) between in-session distress variability and PTSD symptom decline., Results: Temporal analyses showed that in-session distress variability did not precede PTSD symptom improvement. Averaged analyses showed that distress variability was related to PTSD symptom improvement., Limitation: The operationalization of distress variability appeared to deviate from its theoretical conceptualization., Conclusions: In absence of distress reduction, distress variability can vary. However, our findings suggest that in-session distress variability does not drive symptom reduction during PE. In contrast, averaged over participants, distress variability was related to symptom improvement, suggesting that those with a more variable distress pattern across sessions show better treatment response. More empirical work is needed to shed light on the effect of distress variability during exposure sessions on treatment outcome and to offer grounds for clinical recommendations., Competing Interests: Declaration of competing interest There are no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout., Method: Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models., Results: Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout., Conclusion: In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Recent studies indicated that Prolonged Exposure (PE) is safe and effective for posttraumatic stress disorder (PTSD). It is unclear whether PE also leads to a reduction in comorbid diagnoses. Data from a large randomized controlled trial ( N  = 149) on the effects of three variants of PE for PTSD were used. We examined the treatment effects on co-morbid diagnoses of depressive, anxiety, obsessive compulsive, substance abuse, psychotic, eating and personality disorders in a sample of patients with PTSD related to childhood abuse. Outcomes were assessed with clinical interviews at baseline, post-treatment and at 6- and 12-month follow-up. All variants of PE led to a decrease from baseline to post-treatment in diagnoses of depressive, anxiety, substance use and personality disorders. Improvements were sustained during follow-up. We found an additional decrease in the number of patients that fulfilled the diagnostic criteria of a depressive disorder between 6- and 12-month follow-up. No significant changes were observed for the presence of OCD, psychotic and eating disorders. Findings suggest that it is effective to treat PTSD related to childhood abuse with trauma-focused treatments since our 14-to-16 weeks PE for PTSD resulted in reductions in comorbid diagnoses of depressive, anxiety, substance use and personality disorders.

Background: The psychological well-being of students may be especially affected by the COVID-19 pandemic; international students can lack local support systems and represent a higher risk subgroup. Methods: Self-reported depressive symptoms, suicidal ideation, anxiety, post-traumatic stress disorder (PTSD), insomnia, alcohol use, academic stress, and loneliness were examined in two cohorts of university students (March 2020 n  = 207, March 2021 n  = 142). We investigated differences i) between 2020 and 2021, ii) between domestic and international students, and ii) whether differences between the two cohorts were moderated by student status. Results: More depressive symptoms, academic stress, and loneliness were reported in 2021. International students reported more depressive symptoms, suicidal ideation, anxiety, PTSD, academic stress, and loneliness. The main effect of cohort was not moderated by student status. Conclusions : International students had worse mental health outcomes overall, but were not affected more by the COVID-19 pandemic than domestic students.

Infants can acquire fears vicariously by observing parents' fearful reactions to novel stimuli in everyday situations (i.e., modeling). To date, no systematic or meta-analytic review examined the role of modeling in parent-child transmission of fear and avoidance in early life. In our systematic review and meta-analysis, we aimed to investigate the effect of modeling parents' fearful reactions on infants' acquisition of fear and avoidance of novel stimuli and explore the moderation of this effect by child behavioral inhibition (BI) and parent trait anxiety. The search conducted in Web Of Science, Pubmed, Embase, and PsycINFO revealed 23 eligible studies for the systematic review and 19 for the meta-analysis. Eligible studies included published studies that measured infant fear and avoidance (infants aged up to 30 months) of novel stimuli following exposure to parental fearful expressions. Meta-analysis findings revealed a significant causal effect of modeling of parental fear on infants' fear [g = .44] and avoidance of novel stimuli [g = .44]. The findings support moderation by child BI on infant avoidance (not fear) acquisition, with the effects being larger for infants with higher BI. However, this moderation was only found, when including both experimental and correlational studies (p > .05), but not when exclusively including experimental studies (p = .17). This meta-analysis provides support for early parent-to-offspring fear transmission: a causal small to medium effect of parents' fearful reactions was shown on infants' fear and avoidance of novel stimuli. Elucidating parent-to-offspring anxiety transmission pathways can inform us about potential fear reduction and prevention strategies., (© 2023. The Author(s).)

Change in negative posttraumatic cognitions is a proposed mechanism through which Prolonged Exposure (PE) leads to symptom reduction of posttraumatic stress disorder (PTSD). A strong case for posttraumatic cognitions as a change mechanism in PTSD treatment can be made by establishing temporal precedence of change in cognitions. The current study examines the temporal relationship between change in posttraumatic cognitions and PTSD symptoms during PE, using the Posttraumatic Cognitions Inventory. Patients with DSM-5 defined PTSD following childhood abuse (N = 83) received a maximum of 14-16 sessions of PE. Clinician-rated PTSD symptom severity and posttraumatic cognitions were assessed at baseline, week 4, 8, and 16 (post-treatment). Using time-lagged mixed effect regression models, we found that posttraumatic cognitions predicted subsequent PTSD symptom improvement. Notably, when using the items of an abbreviated version of the PTCI (PTCI-9), we found a mutual relationship between posttraumatic cognitions and PTSD symptom improvement. Crucially, the effect of change in cognitions on PTSD symptom change was greater than the reverse effect. The current findings corroborate change in posttraumatic cognitions as a change process during PE, but cognitions and symptoms cannot be completely separated. The PTCI-9 is a short instrument that appears suitable to track cognitive change over time., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD). Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD. Method: A net-benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants ( N  = 149) randomized to three conditions: PE ( n =  48), intensified PE (i-PE, n  = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n  = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t -tests were conducted. Net-benefit analysis was used to relate costs to QALYs and to draw acceptability curves. Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p  > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively. Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.

Introduction: Theoretical and empirical evidence suggests that the effect of parental verbal threat information on the offspring's fear acquisition of novel stimuli may be causal. The current study investigated this verbal fear acquisition pathway from parents to children in the unique context of Covid-19 as a novel environmental threat for parents and children., Methods: Using an online cross-sectional survey, we collected data about fear of Covid-19, parent-child communication, parental anxiety, and child temperament, in the period between June 11th 2020 and May 28th 2021. Participants were 8 to 18-year-old children (N = 195; M age  = 14.23; 113 girls) and their parents (N = 193; M age  = 47.82; 146 mothers) living in the Netherlands., Results: Children of parents with stronger Covid-19 fears also reported stronger Covid-19 fears. Moreover, parents who were more fearful of Covid-19 provided more threat-related information about the virus to their children. More parental threat information in turn was related to stronger fear of Covid-19 in their children, and partly mediated the link between parent and child fear of the virus. The link between parental threat information and children's fear of Covid-19 was not moderated by child temperament or parental anxiety., Conclusions: Parental communication about Covid-19 may play a role in children's fear acquisition of Covid-19. The lack of moderation of this link by parental anxiety and child temperament may reflect the potentially adaptive nature of verbal fear transmission during the first year of the pandemic and the nonclinical levels of fear in this community sample., (© 2022 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on behalf of Foundation for Professionals in Services to Adolescents.)

There is growing evidence that change in distress is an indicator of change during Prolonged Exposure (PE) for posttraumatic stress disorder (PTSD). However, temporal sequencing studies investigating whether change in distress precedes PTSD symptom decline are lacking. These studies are essential since the timeline between indicators of change and treatment outcome is a key assumption for mediation. The aim of the present study was to assess the temporal relationship between within- and between-session change in subjective distress and PTSD symptom decrease. We analyzed session data from 86 patients with PTSD. Data were analyzed using dynamic panel models. We distinguished temporal effects (within-persons) from averaged effects (between-persons). Results regarding the temporal effect showed that within-session change in subjective distress preceded PTSD symptom improvement while the reversed effect was absent. Averaged within-session change in subjective distress was also related to PTSD symptom improvement. Results regarding the temporal effect of between-session change in subjective distress showed that it did not precede PTSD symptom improvement. Averaged between-session change in subjective distress was related to PTSD symptom improvement. This study provides evidence for within- but not between-session change in subjective distress as indicator of change during PE. We also found that the way of modeling potential indicators of change affects results and implications. We recommend future studies to analyze mediators during treatment using temporal rather than averaged effects., Competing Interests: Conflict of Interest Statement The authors declare that there are no conflicts of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Background: The Netherlands Study of Depression and Anxiety (NESDA; N baseline =2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders., Methods: A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders., Results: All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders., Conclusion: NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions., (Copyright © 2021. Published by Elsevier B.V.)

Background: One reason for the inclusion of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th revision of the International Classification of Diseases (ICD-11) was its suspected relevance for treatment indications. We investigated whether CPTSD predicted and moderated treatment outcomes of Prolonged Exposure (PE), intensified PE (iPE) and Skills Training in Affective and Interpersonal Regulation followed by PE (STAIR + PE). We expected that CPTSD would predict worse treatment outcomes across treatments. Secondly, we expected that CPTSD would lead to better treatment effect in STAIR + PE compared to PE and iPE., Methods: We analyzed 149 patients with childhood-abuse related PTSD from a randomized clinical trial. CPTSD diagnosis and symptom severity were measured with the International Trauma Questionnaire. The main outcome was change in clinician-assessed PTSD symptoms. Assessments took place at baseline, week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. Analyses were based on an intention-to-treat sample using mixed effect models., Results: More than half (54 %) of the patients met criteria for CPTSD at baseline. CPTSD was related to more severe PTSD symptoms and higher comorbidity at baseline. CPTSD neither predicted nor moderated treatment outcome., Limitations: Inclusion was limited to patients with PTSD related to childhood abuse. Replication is needed in different samples., Conclusions: CPTSD is associated with more severe PTSD and with higher comorbidity. CPTSD did not predict treatment outcome and did not indicate differential treatment outcome of STAIR + PE compared to PE and iPE., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background : It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective : We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method : We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity. Results : We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen's d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms ( t 135  = -2.85, p = .005, d = .49) but not clinician-assessed symptoms (t 135  = -1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported ( t 135  = -4.11, p < .001, d = .71) and clinician-assessed symptoms ( t 135  = -2.77, p = .006, Cohen's d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions. Conclusions : Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes. The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113., Competing Interests: Dr. van Minnen reports personal fees from Royalties and fees, outside the submitted work; Dr. Cloitre reports personal fees from Royalites and fees British Psychological Society San Francisco University Department of Psychiatry during the conduct of the study; Drs. Oprel, Drs. Hoeboer, Dr. Schoorl, Dr. van der Does, Drs. Wigard and Dr. de Kleine report no financial relationships with commercial interests., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: The recommendations of experts who write review articles are a critical determinant of the adaptation of new treatments by clinicians. Several types of reviews exist (narrative, systematic, meta-analytic), and some of these are more vulnerable to researcher bias than others. Recently, the interest in nutritional interventions in psychiatry has increased and many experts, who are often active researchers on this topic, have come to strong conclusions about the benefits of a healthy diet on depression. In a young and active field of study, we aimed to investigate whether the strength of an author's conclusion is associated with the type of review article they wrote., Methods: Systematic searches were performed in PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar for narrative reviews and systematic reviews with and without meta-analyses on the effects of diet on depression (final search date: May 30th, 2020). Conclusions were extracted from the abstract and discussion section and rated as strong, moderate, or weak by independent raters who were blind to study type. A benchmark on legitimate conclusion strength was based on a GRADE assessment of the highest level of evidence. This systematic review was registered with PROSPERO, number CRD42020141372., Findings: 24 narrative reviews, 12 systematic reviews, and 14 meta-analyses were included. In the abstract, 33% of narrative reviews and 8% of systematic reviews came to strong conclusions, whereas no meta-analysis did. Narrative reviews were 8.94 (95% CI: 2.17, 36.84) times more likely to report stronger conclusions in the abstract than systematic reviews with and without meta-analyses. These findings were similar for conclusions in the discussion section. Narrative reviews used 45.6% fewer input studies and were more likely to be written by authors with potential conflicts of interest. A study limitation is the subjective nature of the conclusion classification system despite high inter-rater agreements and its confirmation outside of the review team., Conclusions: We have shown that narrative reviews come to stronger conclusions about the benefits of a healthy diet on depression despite inconclusive evidence. This finding empirically underscores the importance of a systematic method for summarizing the evidence of a field of study. Journal editors may want to reconsider publishing narrative reviews before meta-analytic reviews are available., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Without relevance to this work, P. Molero reports to have received research grants from the Ministry of Education (Spain), the Government of Navarra (Spain), the Spanish Foundation of Psychiatry and Mental Health and AstraZeneca; he is a clinical consultant for MedAvanteProPhase and has received lecture honoraria from or has been a consultant for AB-Biotics, Janssen, Novumed, Roland Berger, and Scienta. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors declare no competing interests.

A growing number of studies suggest that EEG theta/beta ratio (TBR) is inversely related to executive cognitive control. Neurofeedback training aimed at reducing TBR (TBR NFT) might provide a tool to study causality in this relation and might enhance human performance. To investigate whether TBR NFT reduces TBR in healthy participants. Twelve healthy female participants were assigned (single blind) to one of three groups. Groups differed on baseline durations and one group received only sham NFT. TBR NFT consisted of eight or fourteen 25-min sessions. No evidence was found that TBR NFT had any effect on TBR. The current TBR NFT protocol is possibly ineffective. This is in line with a previous study with a different protocol.

Background: Signs and symptoms of psychopathology can be chronic but are generally regarded as less stable over time than markers of cognitive vulnerability and personality. Some findings suggest that these differences in temporal stability are modest in size but a rigorous examination across concepts is lacking. The current study investigated the temporal stability of affective symptoms, cognitive vulnerability markers and personality traits at various assessments over nine years., Methods: Participants of the Netherlands Study of Depression and Anxiety were assessed at baseline and reassessed after 2, 4, 6 and 9 years. They were grouped on the basis of waves of depression and anxiety CIDI-diagnoses into stable healthy (n = 768), stable patients (n = 352) and unstable patients (n = 821). We determined temporal stability by calculating intraclass correlation coefficients (ICC) and consistency indices of latent state-trait analyses (LST)., Results: Temporal stability was moderate to high for symptoms (range ICC's 0.54-0.73; range consistency 0.64-0.74), cognitive vulnerability (range ICC's 0.53-0.76; range consistency 0.60-0.74) and personality (range ICC's 0.57-0.80; range consistency.60 -0.75). Consistency indices for all measures were on average a bit lower in the unstable group (ICC = 0.54) compared to the stable groups (ICC = 0.61). Overall stability was similarly high after 2, 4, 6 and 9 years., Conclusion: The 9-year stability over time of symptoms of affective disorders and that of indices of cognitive vulnerability and personality are remarkably similar and relatively high., (Copyright © 2019. Published by Elsevier B.V.)

Background: Prior research indicates that the factors that trigger suicidal ideation may differ from those that maintain it, but studies into the maintenance of suicidal ideation remain scarce. Our aim was to assess the longitudinal course of suicidal ideation, and to identify predictors of persistent suicidal ideation., Methods: We used data from the Netherlands Study of Depression and Anxiety (NESDA). We performed a linear mixed-effects growth model analysis (n = 230 with current suicidal ideation at baseline) to assess the course of suicidal ideation over time (baseline through 2-, 4-, 6- and 9-year follow-up). We used logistic regression analysis (n = 195) to test whether factors previously associated with the incidence of suicidal ideation in the literature (insomnia, hopelessness, loneliness, borderline personality traits, childhood trauma, negative life events) also predict persistence of suicidal ideation (i.e., reporting ideation at two consecutive assessment points, 6- and 9-years). We controlled for socio-demographics, clinical diagnosis and severity, medication use, and suicide attempt history., Results: Suicidal ideation decreased over time, and this decrease became slower with increasing time, with the majority of symptom reductions occurring in the first two years of follow-up. More severe insomnia and hopelessness were associated with increased odds of persistent suicidal ideation, and hopelessness was a significant mediator of the relationship between insomnia and persistent suicidal ideation., Limitations: Findings may not generalize to those with more severe suicidal ideation due to dropout of those with the worst clinical profile., Conclusions: Targeting insomnia and hopelessness in treatment may be particularly important to prevent the persistence of suicidal ideation., (Copyright © 2019. Published by Elsevier B.V.)

The ratio between frontal resting-state electroencephalography (EEG) theta and beta frequency power (theta/beta ratio, TBR) is negatively related to cognitive control. It is unknown which psychological processes during resting state account for this. Increased theta and reduced beta power are observed during mind wandering (MW), and MW is related to decreased connectivity in the executive control network (ECN) and increased connectivity in the default mode network (DMN). The goal of this study was to test if MW-related fluctuations in TBR covary with such functional variation in ECN and DMN connectivity and if this functional variation is related to resting-state TBR. Data were analyzed for 26 participants who performed a 40-min breath-counting task and reported the occurrence of MW episodes while EEG was measured and again during magnetic resonance imaging. Frontal TBR was higher during MW than controlled thought and this was marginally related to resting-state TBR. DMN connectivity was higher and ECN connectivity was lower during MW. Greater ECN connectivity during focus than MW was correlated to lower TBR during focus than MW. These results provide the first evidence of the neural correlates of TBR and its functional dynamics and further establish TBR's usefulness for the study of executive control, in normal and potentially abnormal psychology., (© 2019 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.)

Stress can impair cognitive performance, as commonly observed in cognitive performance anxiety (CPA; e.g., test anxiety). Cognitive theories indicate that stress impairs performance by increasing attention to negative thoughts, a phenomenon also known as threat-interference. These theories are mainly supported by findings related to self-report measures of threat-interference or trait anxiety. Our main aim was to test, for the first time in a single study, the hypotheses that acute CPA-related stress negatively affects both working memory (WM) performance and objectively assessed threat-interference during performance. In addition, we aimed to assess the validity of a new stress-induction procedure that was developed to induce acute CPA. Eighty-six females were randomly assigned to a CPA-related stress group (n = 45) or a control group. WM performance and threat-interference were assessed with an n-back task (2-back and 3-back memory loads), using CPA-related words as distracters. The stress group showed higher state anxiety and slower WM performance. Both effects were moderated by trait CPA: the effects were stronger for individuals with higher trait CPA. Finally, trait CPA moderated the effect of stress on threat-interference during higher cognitive load: individuals with higher trait CPA in the stress group showed higher threat-interference. We conclude that acute CPA increases threat-interference and impairs WM performance, especially in vulnerable individuals. The role of threat-interference, cognitive load, and trait anxiety should be taken into account in future research. Finally, our method (combining our stressor and modified n-back task) is effective for studying stress-cognition interactions in CPA., Competing Interests: The authors have declared that no competing interests exist.

Frontal EEG theta/beta ratio (TBR; negatively associated with attentional control, or AC) was previously reported to moderate threat-level dependent attentional bias in a pictorial dot-probe task, interacting with trait anxiety. Unexpectedly, this was independent from processing stage (using cue-target delays of 200 and 500 ms) and also not observed for self-reported trait AC. We therefore aimed to replicate these effects of TBR and trait anxiety and to test if effects of early versus late processing stages are evident for shorter cue-target delays. This study also revisited the hypothesis that TBR and self-reported trait AC show similar effects. Fifty-three participants provided measurements of frontal TBR, self-reported trait AC, trait anxiety, and dot-probe task bias for mild and high threat pictures using the same dot-probe task, but this time with 80- and 200-ms cue-target delays. Results indicated that higher TBR predicted more attention to mild than high threat, but this was independent from trait anxiety or delay. Lower self-reported trait AC predicted more attention to mild than high threat, only after 200 ms (also independent of trait anxiety). We conclude that the moderating effect of TBR on threat-level dependent dot-probe task bias was replicated, but not the role of trait anxiety, and this study partially confirms that effects of trait AC are more dominant in later processing., (© 2018 Society for Psychophysiological Research.)

The aim of this study was to assess the extent to which discrepancy between self-reported and clinician-rated severity of depression are due to inconsistent self-reports. Response inconsistency threatens the validity of the test score. We used data from a large sample of outpatients ( N = 5,959) who completed the self-report Beck Depression Inventory-II (BDI-II) and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS). We used item response theory based person-fit analysis to quantify the inconsistency of the self-report item scores. Inconsistency was weakly positively related to patient-clinician discrepancy (i.e., higher BDI-II scores relative to MADRS scores). The mediating effect of response inconsistency in the relationship between discrepancy and demographic (e.g., ethnic origin) and clinical variables (e.g., cognitive problems) was negligible. The small direct and mediating effects of response inconsistency suggest that inaccurate patient self-reports are not a major cause of patient-clinician discrepancy in outpatient samples. Future research should investigate the role of clinician biases in explaining clinician-patient discrepancy.

Objectives: Cognitive reactivity (CR) to sad mood is a risk factor for major depressive disorder (MDD). CR is usually measured by assessing change on the Dysfunctional Attitudes Scale (DAS-change) after sad mood-induction. It has, however, been suggested that the versions of the DAS (A/B) are not interchangeable, impacting the reliability and validity of the change score. The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) is an alternative self-report measure of CR. Studies examining the relationship between LEIDS-R and DAS-change have shown mixed results. We examined whether scores of these CR measures differed between remitted MDD and controls, the relationship between these CR measures, and the effect of order of DAS administration on DAS-change., Design: Cross-sectional design with two groups (remitted MDD and controls)., Methods: Sixty-eight MDD patients remitted from ≥2 previous episodes, not taking antidepressants, and 43 never-depressed controls participated in a mood-induction and filled in the DAS-A/B in randomized order before and after mood-induction, and LEIDS-R separately., Results: LEIDS-R scores and pre-mood-induction DAS scores were significantly higher in remitted MDD than controls (p < .001, Cohen's d = 1.48; p = .001, Cohen's d = 0.66, respectively). DAS-change did not differ between these groups (p = .67, Cohen's d = 0.08). LEIDS-R correlated with DAS-change (r = .30, p = .042), but only in the group that filled in DAS-B before DAS-A. In remitted MDD, DAS-change was dependent on the order of DAS versions before and after mood-induction (10.6 ± 19.0 vs. -1.2 ± 10.5, for order B-A and A-B, respectively), with a significant group × order interaction (p = .012)., Conclusions: Existing DAS versions are not interchangeable, which compromises the usefulness of mood-inductions in clinical practice. The LEIDS-R seems a valid measure of cognitive vulnerability to depression., Practitioner Points: Clinical implications: Cognitive reactivity (CR) is a risk factor of depressive recurrence. The current measurement of CR, by assessing change on the Dysfunctional Attitudes Scale (DAS) after mood-induction, is not reliable. The Leiden Index Depression Sensitivity-Revised (LEIDS-R) is an alternative CR measure. In contrast to mood-induction, it reliably assesses depression vulnerability. The use of mood-inductions for clinical/research purposes is unnecessary., Limitations of the Study: We were not able to examine the effect of previous treatment, which could have affected results as psychological treatments probably have differential effects on CR. Examining un-medicated patients may have led to selection of a sample not completely representative for the general MDD population. We did not administer both parallel versions of the DAS (A/B) before and after mood-induction. This might have provided better understanding of their differential sensitivity to change., (© 2018 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

High scores on markers of psychological vulnerability have been associated with a worse course of affective disorders. However, little is known about the specificity of those associations in predicting the course of different depressive and anxiety disorders. We examined the impact of psychological vulnerability on the short- and long-term course of depressive and anxiety disorders. Participants from the Netherlands Study of Depression and Anxiety with a current diagnosis of depression or anxiety (n = 1256) were reassessed after 2 and 6 years. Diagnostic status and chronic duration (>85% of the time) of symptoms were the outcomes. Predictors were neuroticism, extraversion, locus of control, cognitive reactivity (rumination and hopelessness reactivity), worry and anxiety sensitivity. High neuroticism, low extraversion and external locus of control predicted chronicity of various affective disorders. Rumination, however, predicted chronicity of depressive but not anxiety disorders. Worry specifically predicted chronicity of GAD and anxiety sensitivity predicted chronicity of panic disorder and social anxiety disorder. These patterns were present both at short-term and at long-term, without losing predictive accuracy. Psychological vulnerabilities that are theoretically specific to certain disorders indeed selectively predict the course of these disorders. General markers of vulnerability predicted the course of multiple affective disorders. This pattern of results supports the notion of specific as well as transdiagnostic predictors of the course of affective disorders and is consistent with hierarchical models of psychopathology., (Copyright © 2018. Published by Elsevier Ltd.)

Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) may accelerate fear extinction in healthy humans. Here, we aimed to investigate this hypothesis in healthy young participants in a prepared learning paradigm, using spider pictures as conditioned stimuli. After a fear conditioning phase, participants were randomly allocated to receive tVNS (final N = 42) or sham stimulation (final N = 43) during an extinction phase. Conditioned fear was assessed using US expectancy ratings, skin conductance and fear potentiated startle responses. After successful fear acquisition, participants in both groups showed a reduction of fear over the course of the extinction phase. There were no between-group differences in extinction rates for physiological indices of fear. Contrary to previous findings, participants in the tVNS condition also did not show accelerated declarative extinction learning. Participants in the tVNS condition did have lower initial US expectancy ratings for the CS- trials than those who received sham stimulation, which may indicate an enhanced processing of safety cues due to tVNS. In conclusion, the expected accelerated extinction due to tVNS was not observed. The results from this study call for more research on the optimal tVNS stimulation intensity settings.

Background: Spontaneous EEG theta/beta ratio (TBR) probably marks prefrontal cortical (PFC) executive control, and its regulation of attentional threat-bias. Caffeine at moderate doses may strengthen executive control through increased PFC catecholamine action, dependent on basal PFC function., Goal: To test if caffeine affects threat-bias, moderated by baseline frontal TBR and trait-anxiety., Methods: A pictorial emotional Stroop task was used to assess threat-bias in forty female participants in a cross-over, double-blind study after placebo and 200 mg caffeine., Results: At baseline and after placebo, comparable relations were observed for negative pictures: high TBR was related to low threat-bias in low trait-anxious people. Caffeine had opposite effects on threat-bias in low trait-anxious people with low and high TBR., Conclusions: This further supports TBR as a marker of executive control and highlights the importance of taking baseline executive function into consideration when studying effects of caffeine on executive functions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Low spontaneous EEG theta/beta ratio (TBR) is associated with greater executive control. Their role in regulation of attentional bias for stimuli of different threat-levels is unknown., Objectives: To provide the first relations between frontal TBR, trait anxiety and attentional bias to mildly and highly threatening stimuli at different processing-stages., Methods: Seventy-four healthy volunteers completed spontaneous EEG measurement, a self-report trait anxiety questionnaire and a dot-probe task with stimuli of different threat-level and 200 and 500 ms cue-target delays., Results: Participants with high TBR directed attention towards mildly threatening and avoided highly threatening pictures. Moreover, the most resilient participants, (low TBR and low trait anxiety) showed attention towards highly threatening stimuli. There were no effects of delay., Conclusions: These data confirm that executive control is crucial for the study of threat-related attentional bias and further support the notion that TBR is a marker of cognitive control over emotional information., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: It has been claimed that the quality of a diet is associated with the incidence of depressive disorders. We sought to investigate the evidence for this claim., Methods: Systematic searches were performed up to March 6th, 2017 in order to identify prospective cohort studies that reported on exposure to dietary patterns or food groups and the incidence of depression/depressive symptoms. Data from 24 independent cohorts (totalling 1,959,217 person-years) were pooled in random-effects meta-analyses., Results: Adherence to a high-quality diet, regardless of type (i.e., healthy/prudent or Mediterranean), was associated with a lower risk of depressive symptoms over time (odds ratios ranged 0.64-0.78 in a linear dose-response fashion [P < 0.01]). A relatively low dietary inflammatory index was also associated with a somewhat lower incidence of depressive symptom (odds ratio = 0.81), although not in a dose-response fashion. Similar associations were found for the consumption of fish and vegetables (odds ratios 0.86 and 0.82 respectively) but not for other high quality food groups (e.g., fruit). Studies that controlled for depression severity at baseline or that used a formal diagnosis as outcome did not yield statistically significant findings. Adherence to low quality diets and food groups was not associated with higher depression incidence., Limitations: Our ability to detect confounders was only limited., Conclusion: There is evidence that a higher quality of a diet is associated with a lower risk for the onset of depressive symptoms, but not all available results are consistent with the hypothesis that diet influences depression risk. Prospective studies that control for relevant confounders such as obesity incidence and randomized controlled prevention trials are needed to increase the validity of findings in this field., (Copyright © 2017 Elsevier B.V. All rights reserved.)