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Cognitive distortions are negative biases in thinking that are theorized to represent vulnerability factors for depression and dysphoria. Despite the emphasis placed on cognitive distortions in the context of cognitive behavioural theory and practice, a paucity of research has examined the mechanisms through which they impact depressive symptomatology. Both adaptive and maladaptive styles of humor represent coping strategies that may mediate the relation between cognitive distortions and depressive symptoms. The current study examined the correlations between the frequency and impact of cognitive distortions across both social and achievement-related contexts and types of humor. Cognitive distortions were associated with reduced use of adaptive Affiliative and Self-Enhancing humor styles and increased use of maladaptive Aggressive and Self-Defeating humor. Reduced use of Self-Enhancing humor mediated the relationship between most types of cognitive distortions and depressed mood, indicating that distorted negative thinking may interfere with an individual's ability to adopt a humorous and cheerful outlook on life (i.e., use Self-Enhancing humor) as a way of regulating emotions and coping with stress, thereby resulting in elevated depressive symptoms. Similarly, Self-Defeating humor mediated the association of the social impact of cognitive distortions with depression, such that this humor style may be used as a coping strategy for dealing with distorted thinking that ultimately backfires and results in increased dysphoria.

Risk for depression is expressed across multiple levels of analysis. For example, parental depression and cognitive vulnerability are known markers of depression risk, but no study has examined their interactive effects on children's cortisol reactivity, a likely mediator of early depression risk. We examined relations across these different levels of vulnerability using cross-sectional and longitudinal methods in two community samples of children. Children were assessed for cognitive vulnerability using self-reports (Study 1; n = 244) and tasks tapping memory and attentional bias (Study 2; n = 205), and their parents were assessed for depression history using structured clinical interviews. In both samples, children participated in standardized stress tasks and cortisol reactivity was assessed. Cross-sectionally and longitudinally, parental depression history and child cognitive vulnerability interacted to predict children's cortisol reactivity; associations between parent depression and elevated child cortisol activity were found when children also showed elevated depressotypic attributions as well as attentional and memory biases. Findings indicate that models of children's emerging depression risk may benefit from the examination of the interactive effects of multiple sources of vulnerability across levels of analysis.

The psychometric properties and predictive validity of the Depression Change Expectancy Scale (DCES), a modification of an expectancy scale originally developed for patients with anxiety disorders, were examined in two studies. In Study 1, the 20-item scale was administered along with a battery of questionnaires to a sample of 416 dysphoric undergraduate students and demonstrated good internal consistency. A two-factor solution most parsimoniously accounted for the variance, with one factor containing all pessimistically worded items (DCES-P) and the second containing all optimistically worded items (DCES-O). The DCES-P showed patterns of correlations with other measures of related constructs consistent with hypothesized relationships; the DCES-O showed similar, but weaker, relationships with the other measures. Multilevel modeling was used to examine the predictive utility of the DCES in a clinical sample of 63 adults (Study 2). Improved depressive symptoms (over 6 weeks) were strongly associated with optimistic expectancies but were unrelated to pessimistic expectancies for change. The DCES appears to be a promising measure of expectancies for improvement among individuals with depressive symptoms., (© The Author(s) 2013.)

Objective: Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds' discipline were recruited when they visited their family physician at 1 of 24 practices., Methods: After completing mailed baseline measures, parents were randomly assigned to receive usual care or the Parenting Matters intervention along with usual care. Parenting Matters combined a self-help booklet with two calls from a telephone coach during a 6-week treatment period. Follow-up assessments were completed at 7 weeks post-randomization, and 3 and 6 months later., Results: Behaviour problems (Eyberg Child Behaviour Inventory) decreased significantly more in the Parenting Matters condition compared with Usual Care alone, based on a significant time by treatment group effect in intent-to-treat, growth curve analyses (P = 0.033). The Parenting Matters group also demonstrated greater and more rapid improvement than in usual care alone in terms of overall psychopathology (Child Behaviour Checklist, P = 0.02), but there were no group differences in parenting. The overall magnitude of group differences was small (d = 0.15 or less)., Conclusion: A brief early intervention combining a self-help booklet and telephone coaching is an effective way to treat mild behaviour problems among young children. This minimal-contact approach addresses the need for interventions in primary health care settings and may be a useful component in step-care models of mental health.

Objective: The Beck Depression Inventory (BDI) has been used more than any other self-report questionnaire in research on depression in cardiovascular disease. However, no studies have examined whether BDI scores may be influenced by somatic symptoms common after myocardial infarction (MI) that may overlap with symptoms of depression. The objective of this study was to examine whether BDI scores of post-MI patients may be influenced by somatic symptoms that commonly occur after MI, but may not be related to depression., Method: Post-MI patients and psychiatric outpatients were matched on BDI cognitive-affective symptom scores, sex, and age, and their BDI somatic symptom scores were compared using independent samples t tests., Results: Somatic symptoms accounted for 57% of BDI total scores for 296 post-MI patients (mean total BDI = 8.8), compared with 50% for 296 matched psychiatric outpatients (mean total BDI = 7.6). Overall, BDI somatic scores of post-MI patients were 1.3 points higher than for psychiatric outpatients (95% CI 0.68 to 1.82; P < 0.001), equivalent to 14% of total scores of post-MI patients., Conclusions: The relative influence of somatic symptoms on BDI total scores was higher for post-MI patients than for psychiatric outpatients matched on cognitive-affective scores, sex, and age. This finding stands in contrast to that from a previous study that used similar methods and sample comparisons and found that post-MI and psychiatric outpatients did not differ in their endorsement of somatic symptoms on the BDI-II. The BDI-II may be preferable to the BDI in post-MI patients.

Despite the extensive use of the Emotional Stroop task in depression, only qualitative reviews have been produced to date, and these reviews conclude that Stroop performance in depression is equivocal. The present meta-analysis addressed the need to summarize the data quantitatively. A thorough search of the literature was conducted and 47 published studies and unpublished doctoral dissertations were included in the analyses. The meta-analysis revealed large and robust depression-related Stroop effects (e.g., for clinically depressed versus control participants on negative stimuli, g=.98, and on positive stimuli, g=.87). Although the effects did not reflect a strong emotion-congruent bias, they did distinguish among levels of depressive experience, in that greater levels of depression severity were associated with larger between-groups effect sizes. Moreover, these effects have been obtained without priming procedures, or the presentation of self-relevant or disorder-congruent stimuli. These findings challenge schema-based theories of the Emotional Stroop effect and predictions based on previous qualitative reviews of the literature. The findings also suggest that further comparative behavioural research on the depression-related Stroop effect, at least among clinically depressed populations, is not necessary. Future research should address questions about underlying mechanisms and focus on a more direct measure of depression-related attentional bias., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To explore the functional neural correlates of emotional numbing symptoms in individuals with posttraumatic stress disorder (PTSD)., Method: The study was conducted between September 2006 and June 2008 at the University of Western Ontario. Women with (n = 14) and without (n = 16) PTSD (based on DSM-IV criteria) completed a standardized emotional imagery task while undergoing functional magnetic resonance imaging, in addition to an assessment for emotional numbing symptoms. The study design was correlational, with primary outcome measures being blood oxygenation level-dependent (BOLD) response to emotional imagery task and self-reported severity of emotional numbing symptoms. Women without PTSD were not trauma exposed., Results: In women with PTSD, emotional numbing symptoms predicted less positive affect in response to positive-valence scripts (P < .05) and less BOLD response within the dorsomedial prefrontal cortex during imagery of positive and negative scripts that were explicitly socially relevant (P < .001). In contrast, in women without PTSD, emotional numbing symptoms, while unrelated to subjective emotional responses, predicted greater response within the ventromedial prefrontal cortex during positive and negative scripts, in addition to scripts that elicited fear anxiety by nonsocial means (all P values < .001). The findings could not be attributed to dysphoria., Conclusions: These findings are consistent with previous research regarding emotional numbing and emotional awareness. Less response within the medial prefrontal cortex during emotional imagery in individuals with high emotional numbing may indicate deficient conscious and reflective emotional processing. Further study is required to elucidate associations between state and trait emotional numbing and the neural correlates of psychological treatments specific to emotional numbing., (© Copyright 2012 Physicians Postgraduate Press, Inc.)

Objectives: To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits., Data Sources: All relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org), electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION: Adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual., Study Appraisal and Synthesis Methods: Three teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data., Results: Of 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI]) = -2.61 (-5.28, 0.07), p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI) = -4.46 (-12.21, 3.30), p = 0.26., Conclusions: Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.

Background: Women have a higher prevalence of Major Depressive Disorder (MDD) and report more severe depressive symptoms than men. Several studies have suggested that gender differences in depression may occur because women report higher levels of somatic symptoms than men. Those studies, however, have not controlled or matched for non-somatic symptoms. The objective of this study was to examine if women report relatively more somatic symptoms than men matched on cognitive/affective symptoms., Methods: Male and female patients receiving treatment for MDD in outpatient psychiatric clinics in New Jersey and Pennsylvania, USA were matched on Beck Depression Inventory-II (BDI-II) cognitive/affective symptom scores. Male and female BDI-II somatic symptom scores were compared using independent samples 2-tailed t-tests., Results: Of 472 male and 1,026 female patients, there were 470 male patients (mean age = 40.1 years, SD = 15.1) and 470 female patients (mean age = 43.1 years, SD = 17.2) successfully matched on BDI-II cognitive/affective symptom scores. Somatic symptoms accounted for 35% of total BDI-II scores for male patients versus 38% for matched female patients. Female patients had somatic symptom scores on average 1.3 points higher than males (p<.001), equivalent to 4% of the total BDI-II scores of female patients. Only 5% of male patients and 7% of female patients scored 2 or higher on all BDI-II somatic symptom items., Conclusions: Gender differences in somatic scores were very small. Thus, differences in the experience and reporting of somatic symptoms would not likely explain gender differences in depression rates and symptom severity.

Symptoms of anhedonia, or deficits in the ability to experience positive affect, are increasingly recognized as an outcome of traumatic stress including in individuals with PTSD. However, little research has investigated negative affective responses to what would normally be considered pleasant events (e.g., receiving a compliment or gift, physical affection) in traumatized persons. We demonstrate not only self-reported decreased positive affect but also increased negative affect in response to positive events in 55 women with PTSD, in comparison with 35 women without PTSD, via their response to a Hedonic Deficit & Interference Scale (HDIS). The HDIS demonstrated strong internal validity, convergent and incremental validity relative to other measures of anhedonia, and discriminant validity in relation to depression versus anxiety symptoms in this sample. In addition, in response to imagery of social versus non-social positive events, HDIS scores predicted self-report positive and negative affective responses. In a sub-sample of participants completing the imagery task while undergoing fMRI (n=12), HDIS scores also predicted BOLD response within the left orbitofrontal cortex, ventromedial prefrontal cortex, amygdala, and cerebellum. Future research and clinical directions are discussed.

Depression and interpersonal dysfunction are inextricably linked. Interpersonal behaviors in individuals with depression, specifically excessive reassurance seeking (ERS) and negative feedback seeking (NFS), have recently emerged as possible risk factors for interpersonal rejection and future depression. However, existing models integrating ERS and NFS in individuals with depression lack empirical support and fail to provide an adequate explanation for the negative social and psychological consequences that concurrent ERS and NFS create. The proposed model, based on the bias and accuracy literature in close relationships, suggests that individuals with depression desire and elicit global enhancement (through ERS) and specific verification (through NFS) from close others. This model has strong theoretical and empirical foundations and suggests that depression chronicity and interpersonal distress stem from the influence that early core-beliefs about relationships and self-views have on the seemingly adaptive combination of global enhancement and specific verification., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Little is known about factors differentiating more and less effective therapists or the mechanisms through which therapists influence outcome. In the present study, the performance of a small sample of 4 therapists was compared in the context of delivering cognitive-behavioral psychotherapy (CBT) to 32 clients with generalized anxiety disorder. More effective therapists were characterized by higher observer-rated CBT competence, higher client outcome expectations and client treatment credibility assessments, and higher early treatment client ratings of therapeutic alliance quality. Higher early CBT competence was associated with higher client midtreatment outcome expectations, which in turn were associated with better posttreatment outcomes. Although these findings are preliminary given the small sample of therapists and clients, they suggest that the common factor of outcome expectations might be a mechanism through which the specific factor of psychotherapist competence exerts its influence on treatment outcome. The implications of these findings and directions for future research are discussed., ((c) 2011 APA, all rights reserved.)

Emotion theory emphasizes the distinction between social vs non-social emotional-processing (E-P) although few functional neuroimaging studies have examined whether the neural systems that mediate social vs non-social E-P are similar or distinct. The present fMRI study of script-driven imagery in 20 women demonstrates that social E-P, independent of valence, more strongly recruits brain regions involved in social- and self-referential processing, specifically the dorsomedial prefrontal cortex, posterior cingulate/precuneus, bilateral temporal poles, bilateral temporoparietal junction and right amygdala. Functional response within brain regions involved in E-P was also significantly more pronounced during negatively relative to positively valenced E-P. Finally, the effect for social E-P was increased for positive relative to negative stimuli in many of these same regions. Future research directions for social and affective neuroscience are discussed.

Cognitive therapy is a system of psychotherapy with a powerful theoretical infrastructure, which has received extensive empirical support, and a large body of research attesting to its efficacy for a wide range of psychiatric and medical problems. This article provides a brief overview of the conceptual and practical components of cognitive therapy and highlights some of the empirical evidence regarding its efficacy. Cognitive therapy (often labeled generically as cognitive behavior therapy) is efficacious either alone or as an adjunct to medication and provides a prophylaxis against relapse and recurrence.

This study tested the diathesis-stress component of Beck's (1967) cognitive theory of depression. Initially, participants completed measures assessing cognitive organization of the self-schema and depressive symptoms. One year later, participants completed measures assessing cognitive organization of the self-schema, depressive symptoms, and negative life events. Hierarchical multiple regression analyses, controlling for initial depression, indicated that more tightly interconnected negative content was associated with greater elevations in depressive symptoms following the occurrence of life events. More diffusely interconnected positive content for interpersonal self-referent information also interacted with life events to predict depressive symptoms. Cognitive organization dimensions showed moderate to high stability across the follow-up, suggesting that they may be trait-like vulnerability factors. Implications for the cognitive vulnerability-stress model of depression are discussed., (© 2010 Wiley Periodicals, Inc.)

Background: Depression measures that include somatic symptoms may inflate severity estimates among medically ill patients, including those with cardiovascular disease., Aims: To evaluate whether people receiving in-patient treatment following acute myocardial infarction (AMI) had higher somatic symptom scores on the Beck Depression Inventory-II (BDI-II) than a non-medically ill control group matched on cognitive/affective scores., Method: Somatic scores on the BDI-II were compared between 209 patients admitted to hospital following an AMI and 209 psychiatry out-patients matched on gender, age and cognitive/affective scores, and between 366 post-AMI patients and 366 undergraduate students matched on gender and cognitive/affective scores., Results: Somatic symptoms accounted for 44.1% of total BDI-II score for the 209 post-AMI and psychiatry out-patient groups, 52.7% for the 366 post-AMI patients and 46.4% for the students. Post-AMI patients had somatic scores on average 1.1 points higher than the students (P<0.001). Across groups, somatic scores accounted for approximately 70% of low total scores (BDI-II <4) v. approximately 35% in patients with total BDI-II scores of 12 or more., Conclusions: Our findings contradict assertions that self-report depressive symptom measures inflate severity scores in post-AMI patients. However, the preponderance of somatic symptoms at low score levels across groups suggests that BDI-II scores may include a small amount of somatic symptom variance not necessarily related to depression in post-AMI and non-medically ill respondents.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed.

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.

Consistent research evidence supports the existence of threat-relevant cognitive bias in anxiety, but there remains controversy about which stages of information processing are most important in the conferral of cognitive vulnerability to anxiety. To account for both theoretical and empirical discrepancies in the literature, an integrative multi-process model is proposed wherein core assumptions of dual-systems theories from social and cognitive psychology are adapted to explain attentional and interpretive biases in the anxiety disorders. According to the model, individual differences in associative and rule-based processing jointly influence orientation, engagement, disengagement, and avoidance of threat-relevant stimuli, as well as negatively-biased interpretation of ambiguous stimuli in anxious populations. By linking anxiety-related symptoms to basic principles of information processing, the model parsimoniously integrates different kinds of cognitive biases in anxiety, providing a useful framework for future research and clinical intervention.

Recent research has suggested that the measure most commonly used to assess rumination, the Response Style Questionnaire (RSQ; L. D. Butler & S. Nolen-Hoeksema, 1994), may be heavily biased by depressive symptoms, thereby restricting the scope of research exploring this construct. This article offers a broader conceptualization of rumination, which includes positive, negative, and neutral thoughts as well as past and future-oriented thoughts. The first two studies describe the development and evaluation of the Ruminative Thought Style Questionnaire (RTS), a psychometrically sound measure of the general tendency to ruminate. Further, the scale is comprised of a single factor and shows high internal consistency, suggesting that rumination does encompasses the factors mentioned. The final study involved a longitudinal diary investigation of rumination and mood over time. Results suggest that the RTS assesses a related, but separate, construct than does the RSQ. RTS scores predicted future depressed mood beyond the variance accounted for by initial depressed mood whereas RSQ scores did not. The implications of these results and directions for future research are discussed., ((c) 2008 Wiley Periodicals, Inc.)

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.

Individuals with posttraumatic stress disorder (PTSD) often exhibit deficits in emotional experience and expression, which suggests that certain individuals with PTSD may be alexithymic. In this study, in a sample of 105 individuals with PTSD, clinical correlates of alexithymia included reexperiencing, hyperarousal, numbing, dissociative symptoms, and retrospectively reported experiences of childhood emotional neglect. In a subsample of 26 individuals with PTSD related to a motor vehicle accident, functional neural responses to trauma-script imagery were associated with severity of alexithymia, including increased right posterior-insula and ventral posterior-cingulate activation and decreased bilateral ventral anterior-cingulate, ventromedial prefrontal, anterior-insula, and right inferior frontal cortex activation. Clinical and theoretical implications and future research directions are discussed., ((c) 2008 APA, all rights reserved)

Two decades of research conducted to date has examined selective visual attention to threat and reward stimuli as a function of individual differences in anxiety using the dot-probe task. The present study tests a connectionist neural-network model of meta-analytic and key individual-study results derived from this literature. Attentional bias for threatening and reward-related stimuli is accounted for by connectionist model implementation of the following clinical psychology and affective neuroscience principles: 1) affective learning and temperament, 2) state and trait anxiety, 3) intensity appraisal, 4) affective chronometry, 5) attentional control, and 6) selective attention training. Theoretical implications for the study of mood and anxiety disorders are discussed.

This article reviews the methods and results of published neuroimaging studies of the effects of structured psychological interventions for mood and anxiety disorders. The results are consistent with neural models of improved affective- and self-regulation, as evidenced by psychotherapeutic modulation of brain metabolic activity within the dorsolateral, ventrolateral, and medial prefrontal cortices, the anterior cingulate, the posterior cingulate/precuneus, and the insular cortices. Specific recommendations for future studies are outlined, and the clinical and theoretical significance of this research is discussed.

Previous meta-analyses assessing the effectiveness of Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) used general measures of anxiety to assess symptom severity and improvement (e.g., Hamilton Anxiety Ratings Scale or a composite measure of anxiety). While informative, these studies do not provide sufficient evidence as to whether CBT significantly reduces the cardinal symptom of GAD: pathological worry. The current meta-analysis employed stringent inclusion criteria to evaluate relevant outcome studies, including the use of the Penn State Worry Questionnaire as the main outcome variable. Results showed a large overall effect size (ES) that was moderated by age and modality of treatment. Specifically, the largest gains were found for younger adults and for individual treatment. Analyses also revealed overall maintenance of gains at 6- and 12-month follow-up. Clinical implications of different treatment packages are discussed, as well as potential explanations for the differential effectiveness of CBT.

Belief in one's ability to change is an important cognitive variable related to treatment gains. This study investigated pretreatment expectancy for anxiety change and early homework compliance in relation to initial and total cognitive change in group cognitive-behavioral therapy (CBT) for anxiety. Participants, who met diagnostic criteria for at least 1 anxiety disorder, completed 10 sessions of group CBT. Early homework compliance mediated the relationship between expectancy for anxiety change at baseline and initial change in CBT. In addition, initial cognitive symptom improvement mediated the relationship between homework compliance and posttreatment outcome. These results suggest that expectancy for change is an important cognitive variable that may provide the initial impetus and subsequent momentum for therapeutic involvement and gains., (Copyright 2007 APA.)

To be considered a vulnerability marker for depression, a variable should, in addition to demonstrating sensitivity and specificity, also show evidence of temporal stability (i.e., remain present in the absence of depressive symptomatology). Although many cognitive factors are associated with depression, the majority of them appear to be episode rather than vulnerability markers. This study examined cognitive organization of positive and negative interpersonal and achievement content in clinically depressed, remitted, and nonpsychiatric controls. At initial assessment, a sample of 54 clinically depressed individuals and 37 never-depressed controls completed self-report measures of positive and negative automatic thoughts and two cognitive organizational tasks. They were retested 6 months later when half of the depressed group no longer met diagnostic criteria for major depression. Negative automatic thoughts decreased and positive automatic thoughts increased significantly in individuals who had improved clinically. The organization of negative interpersonal content remained stable despite symptom amelioration, but negative achievement content was less interconnected at follow-up in those patients who had improved. The structure of relational schemas, in particular, appears to be stable and may be an important cognitive vulnerability factor for depression.

Two studies examined correlates of alexithymia in posttraumatic stress disorder (PTSD). In study 1 (n = 77 individuals with PTSD and 45 controls) Toronto alexithymia scale (TAS-20) scores were positively correlated with PTSD symptoms, dissociation, and childhood abuse and neglect. In study 2, TAS-20 scores were examined as correlates of functional magnetic resonance imaging (fMRI) blood oxygen level dependent (BOLD) response to trauma script imagery. In 16 controls, TAS-20 scores correlated positively with response in medial prefrontal cortex (mPFC), and negatively with response in anterior cingulate cortex (ACC) and thalamus. In 26 individuals with PTSD, TAS-20 scores correlated positively with response in insula, posterior cingulate cortex (PCC), and thalamus, and negatively with response in ACC.

Background: The comorbidity between the mood and anxiety is extensive and it is probable that individuals with these disorders share a number of cognitive characteristics. However, comorbidity rates with depression are not uniform among the various anxiety disorders. This study examined the common and distinguishing features of self-schematic structure in major depressive disorder and social anxiety compared to other anxiety disorders in general and to no psychiatric disturbance., Methods: Participants completed the Psychological Distance Scaling Task, which provided an index of the cognitive organization of positively and negatively valenced interpersonal and achievement self-referent content., Results: The depression and social phobia groups were statistically equivalent on all indices of cognitive organization, and showed greater interconnectedness among interpersonal negative content than both control groups, and less interconnectedness among both positive interpersonal and achievement content than did nonpsychiatric controls. Psychiatric groups were equivalent on negative achievement content but showed greater interconnectedness than controls., Limitations: This study had a modest sample size and the findings are constrained to females., Conclusions: Negative interpersonal content is more densely interconnected in individuals with social phobia and depression compared with both other anxiety disorder and nonpsychiatric controls. In addition, both social phobia and depression were associated with less interconnected positive content. These findings are indicative of similarities in the way self-schematic content may be organized in individuals with depression and social phobia. Theoretical explanations of these results and future research directions are discussed.

This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one's anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas=.89-.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changing anxiety.

The Fear of Negative Evaluation Scale [FNE; J. Consult. Clin. Psychol. 33 (1969) 448] is a commonly used measure of social anxiety. A brief version of the scale (FNEB) is available for convenient administration. Despite being widely advocated for use, the psychometric properties of the FNEB have not been evaluated with clinically anxious samples. The present study addressed the reliability and validity of the FNEB in a clinical sample of individuals with either social phobia (n = 82) or panic disorder (n = 99) presenting for treatment. Factor analysis supported the construct validity of the FNEB. The validity of the FNEB was further demonstrated through significant correlations with social avoidance and depression, and non-significant correlations with agoraphobic avoidance and demographic variables. The scale obtained excellent inter-item reliability (alpha = .97) and 2-week test-retest reliability (r = .94). Discriminant function analysis also supported validity of the FNEB. For example, individuals with social phobia scored significantly higher on the FNEB than those with panic disorder and a group of non-psychiatric community controls (n = 30). The FNEB was sensitive to pre- to post-CBT changes in both social anxiety and panic disorder, and changes on the FNEB correlated significantly with other measures of treatment responsiveness, such as reductions in somatic arousal, depression and other anxiety symptomatology. These research findings strongly support the validity of the FNEB and its clinical utility as an outcome measure in social anxiety treatment.

Epidemiological studies have identified high prevalence rates of anxiety and depression in North America [e.g., J. of Nerv. Ment. Dis. 182 (1994) 290]. However, only a small percentage of these individuals access effective treatment. The undertreatment of anxiety and depression is a major public health issue and is associated with significant personal, social, and economic burden. This article describes the existing discrepancy between prevalence of anxiety and depression and access to effective treatment for adults and children, the contributors to this discrepancy, and suggests various means through which access to effective treatment may be enhanced. We begin with a brief overview of the prevalence and associated personal, societal, and systemic burdens of anxiety and depression. This is followed by a review of current rates of access to treatment and possible individual, provider, and systemic barriers to accessing treatment. Recommendations for bridging the gap between the high rates of these disorders and limited accessibility of effective care are then presented.

Readiness for change is increasingly cited as an important variable in the health behaviours literature, yet there remains a dearth of research related to this construct in mental health. This study examined the psychometric properties of the University of Rhode Island Change Assessment (URICA) scale in two samples. In Study 1 (n = 252), undergraduates completed the URICA and were administered measures of hopelessness, the consequences of worry, self-esteem, anxious symptomatology, and social desirability. The reliability and validity of the URICA were generally supported, although the goodness-of-fit with the intended subscales was only moderate. The Precontemplation, Contemplation and Maintenance subscales correlated as expected with ancillary measures, but the Action subscale did not. In Study 2 (n = 81), individuals with panic disorder were administered the URICA at initial assessment and following cognitive behavioural therapy. The URICA demonstrated excellent reliability, significantly predicted treatment retention and dropout, and showed modest utility for predicting treatment outcome. Confirmatory factor analysis, however, revealed an inadequate fit to the intended subscales. The implications of these findings are discussed and directions for future research highlighted.

The Stroop task has been adapted from cognitive psychology to be able to examine attentional biases in various forms of psychopathology, including the eating disorders. This paper reviews the research on the Stroop task in the eating disorders research area in both descriptive and meta-analytic fashions. Twenty-eight empirical studies are identified, which predominantly examine food and body/weight stimuli in bulimic, anorexic, or dieting/food-restricted samples. It is concluded that there is evidence of an attentional bias in bulimia for a range of stimuli but that the effect seems to be limited to body/weight stimuli in anorexia. The evidence to date is that there is no attentional bias in dieting samples. Limitations of the methodology employed in the extant literature include small sample sizes, unstandardized Stroop methodology, restricted gender, and a general lack of consideration of individual differences variables. Recommendations for future research are provided.

In this study, the psychometric properties of the Hamilton Depression Inventory (HDI; Reynolds & Kobak, 1995a) were examined in a sample of 249 undergraduate participants. The HDI exhibited high internal consistency and support for its construct validity was demonstrated by the HDI's patterns of correlations with other measures of depression, anxiety, and depression-relevant cognition. Factor analyses of the full (23-item) and 17-item versions of the HDI each yielded 4 factors, which accounted for 49% and 53% of the variance in participants' responses, respectively. The utility of the HDI's use of multiple-weighted subitems was also assessed by comparing a less complicated scoring system to the standard scoring format. The standard HDI added significantly to the prediction of criterion indexes after controlling for the variance accounted for by the "simplified" HDI. Moreover, the operating characteristics of the standard HDI outperformed the simplified HDI in the prediction of the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) classification. The results provide strong support for the HDI as a reliable and valid instrument for the assessment of depressive severity

The assessment of cognition and cognitive change is important for case conceptualization, monitoring the efficacy of specific interventions, and evaluating treatment outcome in cognitive-behavioral therapy. Unfortunately, a paucity of normative data exists on cognitive measures used for psychotherapy outcome research in depression, and little information is available to guide a practitioner's understanding of the magnitude and clinical significance of a patient's cognitive change. This article presents normative data on 6 self-report instruments that assess negative and positive automatic thoughts, hopelessness, cognitive biases and errors, and dysfunctional attitudes. Normative data were derived from studies published from the date of inception of a given cognitive index to the year 2000. Recommendations for the use of these normative data are provided.

This study longitudinally investigated information processing and cognitive organization in clinical depression. The main hypothesis was that individuals whose depression had remitted would show a significant cognitive shift on information processing (e.g., deactivation of negative processing) but not on cognitive organizational tasks, Forty-five individuals with clinical depression completed 2 information processing and 2 cognitive organizational tasks at initial assessment. At 6-month follow-up, the sample (23 remitted, 22 stable depressed) was readministered the tasks. As expected, information processing shifted significantly in individuals who had improved symptomatically, whereas negative cognitive organizational indices remained stable. The implications of these results are discussed as they pertain to the cognitive vulnerability, maintenance, treatment, and recurrence of depression. Directions for future research are suggested.

This study investigated information processing and cognitive organization in clinical depression. The specificity of various cognitive mechanisms to depression was also examined. Twenty-six depressed/anxious individuals, 24 pure depressives, 25 never-depressed anxious controls, and 25 nonpsychiatric controls completed a modified Stroop task, the Self-Referent Encoding Task, and two tasks designed to assess cognitive structure. Comorbid depressed/anxious, depressed, and anxious groups performed similarly to one another but differed significantly from nonpsychiatric controls, on the processing and organization of negative content. Specificity to depression was also obtained, as both depressed groups endorsed and recalled less positive information and organized positive self-relevant information with less interconnectedness than anxious individuals and nonpsychiatric controls. These results suggest that depressed individuals have an interconnected negative self-representational system and lack a well-organized positive template of self. These findings are discussed in terms of cognitive models of depression and the tripartite model of depression and anxiety.

Researchers have typically used factor-analytic composite measures of coping, instead of individual scales, to predict rehabilitation outcome. There are, however, both advantages and disadvantages to using individual or composite scores. This study extended the findings of Jensen et al. (1992), by prospectively comparing the individual and composite scores of the Coping Strategies Questionnaire (CSQ) in the prediction of 4 types of adjustment to low back pain. Two-hundred patients completed the CSQ, the Oswestry Index, the SCL-90R, and 4 lifting tasks at admission and discharge from a multidisciplinary pain clinic. Return to work was determined at 9-month follow-up. The CSQ scales were factor-analyzed to devise composite indices, and the 3 resultant factors were compared to the individual scales in the prediction of pain and other outcomes. The results indicated that the relative predictive utility of the composite or individual scales depended on which outcome measure was used to define adjustment.