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The COVID-19 pandemic has had a profound impact on the global economy, physical health, and mental health. This pandemic, like previous viral outbreaks, has resulted in spikes in anxiety, depression, and stress. Even though millions of individuals face the physical health consequences of infection by COVID-19, even more individuals are confronted with the mental health consequences of this pandemic. This significantly increased demand for mental health services cannot be easily met by existing mental health systems, which often rely on courses of therapy to be delivered over months. Single session interventions (SSIs) may be one important approach to meeting this increased demand, as they are treatments designed to be delivered over the course of a single meeting. SSIs have been found to be effective for a range of mental health challenges, with durable effects lasting months to years later. Here, we describe an SSI designed for the COVID-19 pandemic. This Brief Assessment-informed Skills Intervention for COVID-19 (BASIC) program draws upon therapeutic skills from existing empirically supported treatments to target common presenting complaints due to this pandemic. We discuss the process of developing and implementing this intervention, as well as explore feasibility and initial clinical insights. In short, BASIC is an easy-to-adopt intervention that is designed to be effective in a single session, making it well-suited for handling the increased demand for mental health services due to COVID-19.

OBJECTIVE: Attention bias modification training (ABMT) is purported to reduce depression by targeting and modifying an attentional bias for sadness-related stimuli. However, few tests of this hypothesis have been completed. METHOD: The current study examined whether change in attentional bias mediated a previously reported association between ABMT condition (active ABMT, sham ABMT, assessments only; N = 145) and depression symptom change among depressed adults. The pre-registered, primary measure of attention bias was a discretized eye tracking metric that quantified the proportion of trials where gaze time was greater for sad stimuli than neutral stimuli. RESULTS: Contemporaneous longitudinal simplex mediation indicated that change in attentional bias early in treatment partially mediated the effect of ABMT on depression symptoms. Specificity analyses indicated that in contrast to the eye-tracking mediator, reaction time assessments of attentional bias for sad stimuli (mean bias and trial level variability) and lapses in sustained attention did not mediate the association between ABMT and depression change. Results also suggested that mediation effects were limited to a degree by suboptimal measurement of attentional bias for sad stimuli. CONCLUSION: When effective, ABMT may improve depression in part by reducing an attentional bias for sad stimuli, particularly early on during ABMT. PUBLIC HEALTH STATEMENT: Prior work has shown that ABMT reduces depression but it is unclear why this is so. The current study confirms that ABMT works by reducing a tendency to focus attention on negative information, which in turn reduces symptoms of depression.

Background Poor attentional control, defined as difficulty focusing attention on a task or shifting attention flexibly between tasks, is a transdiagnostic construct theorized to confer risk for, and maintain, depression and anxiety. Research to date in non-clinical samples has suggested a dissociable relationship between the two factors of self-reported attentional control and psychopathology, with depression being associated with difficulties shifting and anxiety being associated with focusing. However, to our knowledge no study has tested this differential set of relationships in a clinical sample. Methods Adults (N = 493) presenting for psychiatric treatment completed measures of depressive and anxiety symptom severity and self-reported attentional control. Hierarchical linear regression and Zou's (2007) confidence interval method were used to examine the relationship between clinical symptoms and attentional control. Results Both shifting and focusing were significantly correlated with anxiety and depressive symptoms in this sample. However, focusing was more strongly associated with clinical symptomatology than shifting, which showed a weak correlation. Limitations All constructs were measured cross-sectionally by self-report questionnaires. Conclusions In contrast to studies conducted in non-clinical samples, attentional focusing appears to be more relevant than attentional shifting in a clinical sample for both depression and anxiety symptoms. These findings lend support to efforts to develop neurocognitive interventions that improve focusing. Replication of these findings, particularly in longitudinal studies, is warranted.

Theoretical models and empirical research point to negatively biased attention as a maintaining factor in depression. Although preliminary studies suggest experimentally modifying attentional biases (i.e., attentional bias modification; ABM) reduces depression symptoms and depression risk, relatively few rigorous studies with clinical samples have been completed. This clinical trial examines the impact of ABM on a sample of adults (N = 123) with elevated depression severity who also exhibit at least modest levels of negatively biased attention prior to treatment. Participants will be randomly assigned to either active ABM, placebo ABM, or an assessment-only control condition. Individuals assigned to ABM will complete 5 trainings per week (2 in-clinic, 3 brief trainings at-home) during a four-week period. Throughout this four-week period, participants will complete weekly assessments of symptom severity and putative treatment mediators measured across different levels of analysis (e.g., eye tracking, behavioral measures, and functional Magnetic Resonance Imaging). This article details the rationale and design of the clinical trial, including methodological issues that required more extensive consideration. Our findings may not only point to an easily-accessible, efficacious treatment for depression but may also provide a meaningful test of whether a theoretically important construct, negatively biased attention, maintains depression.

Positive aspects of self-compassion (i.e., self-kindness and nonjudgmental acceptance of personal experiences) as well as negative aspects (i.e., high self-criticism and self-coldness) are strong predictors of anxiety, depression, worry, and quality of life. To date, however, relatively little is known about (a) how both aspects of self-compassion change during naturalistic treatment, (b) whether and how such changes relate to symptom improvement, and (c) which processes might explain the potential benefits of self-compassion. To address these gaps, the present study examined whether relations between changes in both aspects of self-compassion and treatment outcomes in a brief partial hospital setting for acute psychology could be explained by associated changes in repetitive negative thinking (RNT), an established maladaptive cognitive process involved in anxiety and depressive disorders. In a sample of 582 people receiving cognitive-behavioral (CBT) and dialectical behavior therapy over the course of 1–2 weeks, increases in positive aspects of self-compassion and decreases in negative aspects related to improvements in depression and anxiety. RNT mediated the relationship between decreases in negative aspects of self-compassion and improvements in anxiety and depression. However, a reverse model also showed that decreases in negative aspects of self-compassion could also explain relations between RNT and depressive symptom improvement only. These findings suggest that negative aspects of self-compassion and RNT may constitute important targets for treatment in acute settings. Future studies should investigate the impact of greater focus on self-compassion on RNT and symptom improvement using longitudinal experimental designs with multiple assessment points, examining causality and directionality.

Disgust may play an important role in several mental disorders, in part because disgust seems impervious to corrective information, a feature noted long before it was studied by clinical psychologists. A deeper understanding of disgust could improve not only the treatment of mental disorders, but also other societal problems involving this peculiar emotion. In this paper, we review the measurement of disgust and identify issues that hold back progress in understanding how to treat this emotion. First, self-report measures of disgust, although optimized in terms of reliability, are compromised in terms of validity due to the “lexical fallacy,” that is, the assumption that vernacular usage of emotion terms reveals natural kinds. Improved self-report measures that parse disgust from neighboring states of discomfort and disapproval can address this limitation, but these approaches are absent in clinical psychology. Second, “objective” measures of disgust, although free of vernacular limitations, require greater psychometric scrutiny. In a critical review, we find that most instrument-based measures fail to demonstrate adequate reliability, rendering them unsuitable for the individual differences research crucial to clinical psychology. In light of this assessment, we provide several recommendations for improving the reliability and validity of disgust measurement, including renewed attention to theory.

Attentional dysfunction is commonly found in depressed individuals in the form of impairment on measures of selective attention as well as attentional biases for negative information. Although a relationship between nonvalenced and valenced aspects of attention has been suggested based on theory, functional neuroanatomy, and studies in other populations, this relationship has not been explicitly explored in depressed individuals. A total of 91 individuals who were currently depressed, formerly depressed, or never depressed completed tasks assessing neuropsychological functioning and attentional bias. Depression status was associated with decreased selective attention (but not set shifting) and stronger attention biases. Selective attention was also found to mediate the relationship between group status and attentional bias, but only in currently depressed individuals. These findings suggest depression is associated with specific impairments in attention and moreover that impairments in nonvalenced aspects of attention are associated with attentional bias to valenced stimuli in currently depressed individuals.

Background: Individual differences in reward-related processes, such as reward responsivity and approach motivation, appear to play a role in the nature and course of depression. Prior work suggests that cognitive biases for valenced information may contribute to these reward processes. Yet there is little work examining how biased attention, processing, and memory for positively- and negatively-valenced information may be associated with reward-related processes in samples with depression symptoms. Methods: We used a data-driven, machine-learning (elastic net) approach to identify the best predictors of self-reported reward-related processes using multiple tasks of attention, processing, and memory for valenced information measured across behavioral, eye tracking, psychophysiological, and computational modeling approaches (N = 202). Participants were adults (ages 18 - 35) who ranged in depression symptom severity from mild to severe. Results: Models predicted between 5.0-12.2% and 9.7-28.0% of held-out test sample variance in approach motivation and reward responsivity, respectively. Low self-referential processing of positively-valenced information was the most robust, albeit modest, predictor of low approach motivation and reward responsivity. Conclusions: Self-referential processing of positive information is the strongest predictor of reward responsivity and approach motivation in a sample ranging from mild to severe depression symptom severity. Experiments are now needed to clarify the causal relationship between self-referential processing of positively-valenced information and reward processes in depression.

Objective Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings. Method Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms. Results Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement. Conclusions Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.

Objective Despite the effectiveness of cognitive behavioral therapy (CBT) for depression, a significant number of patients do not respond. Data examining predictors of treatment response in settings in which CBT is delivered naturalistically are lacking. Method Treatment outcome data collected at a CBT-based partial hospital (n = 956) were used to examine predictors of two types of treatment response: (a) a reliable and clinically significant change in depressive symptoms and (b) a self-rating of “very much” or “much” improved. In multiple logistic regression models, we examined predictors of response in the total sample and separately for patients with a primary diagnosis of major depressive disorder (MDD) versus patients with other primary diagnoses. Results In the total sample, higher treatment outcome expectations and fewer past hospitalizations predicted clinically significant improvement in depression symptoms, and higher treatment expectations and ethnoracial minority background predicted global improvement. In patients with primary MDD, higher treatment outcome expectations and being referred from the community (vs. inpatient hospitalization) predicted better depression response, and higher treatment outcome expectations predicted global improvement. In patients with other primary diagnoses, higher treatment outcome expectations and fewer borderline personality disorder traits predicted depression reduction, and higher treatment outcome expectations, less relationship difficulty, and female gender predicted global improvement. Conclusions Results are generally consistent with data from randomized controlled trials on longer term outpatient CBT. Interventions that increase treatment expectancy and modifications to better target men may enhance treatment outcome. Future research should include objective outcome measures and examine mechanisms underlying treatment response.

Background The PHQ-9 was originally developed as a screener for depression in primary care and is commonly used in medical settings. However, surprisingly little is known about its psychometric properties and utility as a severity measure in psychiatric populations. We examined the full range of psychometric properties of the PHQ-9 in patients with a range of psychiatric disorders (i.e., mood, anxiety, personality, psychotic). Methods Patients ( n =1023) completed the PHQ-9 upon admission and discharge from a partial hospital, as well as other self-report measures of depression, anxiety, well-being, and a structured diagnostic interview. Results Internal consistency was good ( α =.87). The PHQ-9 demonstrated a strong correlation with a well-established measure of depression, moderate correlations with related constructs, a weak correlation with a theoretically unrelated construct (i.e., disgust sensitivity), and good sensitivity to change, with a large pre- to post-treatment effect size. Using a cut-off of ≥13, the PHQ-9 demonstrated good sensitivity (.83) and specificity (.72). A split-half exploratory factor analysis/confirmatory factor analysis suggested a two-factor solution with one factor capturing cognitive and affective symptoms and a second factor reflecting somatic symptoms. Psychometric properties did not differ between male and female participants. Limitations No clinician-rated measure of improvement, and the sample lacked ethnoracial diversity. Conclusions This first comprehensive validation of the PHQ-9 in a large, psychiatric sample supported its use as a severity measure and as a measure of treatment outcome. It also performed well as a screener for a current depressive episode using a higher cut-off than previously recommended for primary care samples.

Background Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model. Methods Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator. Results The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant. Limitations Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report. Conclusions Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions).

Background Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment. Identifying factors associated with improved outcomes can facilitate individualized treatment choices. We investigated whether patterns of neural connectivity predicted treatment responses and whether treatment type, cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), moderated this effect. Methods Participants with SAD (n = 34) underwent fMRI prior to treatment and completed implicit and explicit emotion regulation tasks. Neural connectivity measures were estimates of amygdala-prefrontal cortex connectivity. Treatment responder status was defined using the ‘clinically significant change index’ ( Loerinc et al., 2015 ). Results Right amygdala-right ventrolateral prefrontal cortex connectivity during implicit emotion regulation was a significant predictor of treatment response (OR = 9.01, 95% CI = 1.77, 46.0, p = .008). Stronger inverse connectivity was associated with greater likelihood of treatment response. There were no significant neural moderators of treatment response to CBT versus ACT. Limitations The primary limitation of this work was the small sample size which restricted the power to detect significant moderation effects, and results should be interpreted as preliminary. Conclusions Amygdala-vlPFC connectivity during affect labeling predicted treatment responder status following CBT or ACT for social anxiety disorder. This suggests that the functioning of neural circuitry supporting emotion regulation capacities may be a ‘gateway’ to receiving benefit from psychological treatments. Future work should aim to replicate this effect in a larger sample and consider methods for enhancing functional connectivity within this circuitry as a potential treatment adjunct.

BACKGROUND: Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. METHOD: Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. RESULTS: Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen’s d(z) = .61) and positive urgency (p < .001, Cohen’s d(z) = .39) significantly decreased during treatment. DISCUSSION: Findings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.

Objective Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. Method We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. Results Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. Conclusions Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.

Depression has been associated with poor performance following errors, but the clinical implications, response to treatment and neurobiological mechanisms of this post-error behavioral adjustment abnormality remain unclear. To fill this gap in knowledge, we tested depressed patients in a partial hospital setting before and after treatment (cognitive behavior therapy combined with medication) using a flanker task. To evaluate the translational relevance of this metric in rodents, we performed a secondary analysis on existing data from rats tested in the 5-choice serial reaction time task after treatment with corticotropin-releasing factor (CRF), a stress peptide that produces depressive-like signs in rodent models relevant to depression. In addition, to examine the effect of treatment on post-error behavior in rodents, we examined a second cohort of rodents treated with JDTic, a kappa-opioid receptor antagonist that produces antidepressant-like effects in laboratory animals. In depressed patients, baseline post-error accuracy was lower than post-correct accuracy, and, as expected, post-error accuracy improved with treatment. Moreover, baseline post-error accuracy predicted attentional control and rumination (but not depressive symptoms) after treatment. In rats, CRF significantly degraded post-error accuracy, but not post-correct accuracy, and this effect was attenuated by JDTic. Our findings demonstrate deficits in post-error accuracy in depressed patients, as well as a rodent model relevant to depression. These deficits respond to intervention in both species. Although post-error behavior predicted treatment-related changes in attentional control and rumination, a relationship to depressive symptoms remains to be demonstrated.

Although research on depression and memory has been widespread and varied, examining depression as a factor related to impairment of recall generally as well as a factor associated with facilitated recall of negative information, few previous studies have sought to examine both phenomena in the same experimental framework. In this study, we used an Articulated Thoughts in Simulated Situations (ATSS) paradigm as a vehicle for testing recall along with a standardized memory test in order to investigate what factors may play a role in the relationship between depression and memory. ATSS scenarios of negative, neutral and positive valencewere presented to 67 subjects for response and subsequent recall alongwith thememory battery, with rumination, depression severity and gender examined as potentially important factors. Of the 67 subjects, 19 were depressed (CES-D>16). There were no demographics differences displayed among the depressed and non-depressed groups, nor between males and females. Depressed individuals displayed no differences in recall on the variety of valenced (recall of valenced ATSS scenarios) and non-valenced (Rivermead Behavioral Memory Test) memory measures compared to non-depressed participants (ns). Gender and rumination did not provide any significant additional associationwithmemory performancewhen added into the canonical regression equation. These findings add to the body of mixed results regarding how depression affects memory, highlighting the need for more fine grained examination of potential moderators of the relationship between depression and memory.