Cognitive predictors of stress-induced mood malleability in depression.

BACKGROUND & OBJECTIVES: Basic attentional control, negative biases in attention and interpretation, and rumination are all cognitive processes associated with depression; however, less is known about their predictive role in depressive mood reactivity and -recovery in response to stress, and their relation to severity of depression. DESIGN & METHODS: We experimentally induced stress based on an autobiographical imagery script in a sample of 92 participants with Major Depressive Disorder with or without comorbid anxiety disorders. We used simple regression analysis for investigating the roles of state- and trait rumination, attentional networks, and attentional and interpretation biases for predicting stress-induced depressive mood reactivity and -recovery, respectively, and whether they in parallel mediated the association between cognitive processes and depression severity. RESULTS: Stress-induced depressive mood reactivity was predicted by better orienting ability and more state rumination. Better recovery was predicted by better orienting efficiency and lower negative interpretation bias. Furthermore, the relation between state rumination and depression severity was partially mediated by depressive mood reactivity, however limited by the lack of temporal precedence in the analysis. CONCLUSIONS: We characterized the relation between cognitive processes and mood malleability in response to stress. Findings could refine theoretical models of depression if causality is established. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04137367.

Combining antidepressants and attention bias modification in primary health care (DEPTREAT): Protocol for a pragmatic randomized controlled trial.

BACKGROUND: Major depressive disorder (MDD) is a highly prevalent psychiatric condition associated with significant disability, mortality and economic burden. A large proportion of MDD patients are treated in primary health care in the local community. Attentional Bias Modification (ABM) training in combination with antidepressants could be an effective treatment. Here we test the hypothesis that adding an ABM procedure to regular treatment with antidepressants in primary health care will result in further improvement of symptoms compared to treatment with antidepressants alone (treatment as usual, TAU) and as compared to an active comparison condition. METHODS: A total of 246 patients with a diagnosis of MDD will be included in this study. The study is a three-armed pragmatic randomized controlled trial comparing the efficacy of ABM as add-on to treatment with antidepressants in primary care (ABM condition) compared to standard antidepressant treatment (TAU condition). In a third group participants will complete the same schedule of intermediate assessments as the ABM condition in addition to TAU, but no ABM, thus controlling for the non-training-specific aspects of the ABM condition (Antidepressant active comparison group). DISCUSSION: The clinical outcome of this study may help develop easily accessible, low-cost treatment of depression in primary health care. Moreover, the study aims to broaden our knowledge of optimal treatment for patients with a MDD by providing adjunct treatment to facilitate recovery and long-term gain.

The long-term effects of ABM on symptom severity in patients with recurrent depression: A randomized sham-controlled trial.

BACKGROUND: The present study reports on long-term outcomes of ABM over one year in self-reported and clinician-rated depression symptoms, anxiety symptoms, and relapse rates. METHODS: We conducted a double-blind randomized sham-controlled trial in 301 participants with recurrent major depression disorder between January 2015 and October 2016 (#NCT02658682). Participants were allocated to ABM or sham condition twice daily for 14 consecutive days. Long-term effects of ABM were assessed by BDI-II, HDRS and BAI at one-, six-, and 12-months follow-up. Relapse rates at 12-months follow-up were also assessed. RESULTS: There was no long-term effect of ABM (as compared to sham) on clinician-rated depression symptoms, on anxiety symptoms, nor in relapse rates. By 12 months follow-up, there was a small effect on self-reported depression favoring ABM over sham. LIMITATIONS: The lack of an assessment-only condition hinders comparison to natural trajectories of depression symptoms. CONCLUSIONS: The overall long-term effect of ABM was limited, and currently there is no convincing evidence for implementing this as a viable treatment option in clinical populations. We speculate if the sham condition should be replaced by another control condition when investigating the clinical utility of ABM.

The effect of attention bias modification on depressive symptoms in a comorbid sample: a randomized controlled trial.

BACKGROUND: Studies investigating the long-term effect of attention bias modification (ABM) in clinical samples are lacking. This study investigates the 6-months follow-up effect of ABM on depressive symptoms in participant with major depressive disorder with and without comorbid disorders. METHODS: We conducted a double-blind randomized sham-controlled trial in 101 participants between 19 November 2019, and 17 August 2021. Follow-up ended 3 April 2022. Participants were allocated to ABM or sham condition twice daily for 14 consecutive days. Primary outcomes were the total score on the Beck Depression Inventory-II (BDI-II) at 6 months, mean Brief State Rumination Inventory (BSRI) score post-treatment and reduction in BSRI post-treatment. Secondary outcome was change in attentional bias (AB). The trial was preregistered in ClinicalTrials.gov (#NCT04137367). RESULTS: A total of 118 patients aged 18-65 years were assessed for eligibility, and 101 were randomized and subjected to intention-to-treat analyses. At 6 months, ABM had no effect on depression and anxiety compared to a sham condition. While rumination decreased during the intervention, there was no effect of condition on rumination and AB. Predictor analysis did not reveal differences between participants with ongoing major depressive episode or comorbid anxiety. CONCLUSION: Compared to sham training, there was no effect of ABM on depressive symptoms at 6-months follow-up. Since the intervention failed at modifying AB, it is unclear whether changes in AB are related to long-term outcomes.

Cognitive rehabilitation in post-COVID-19 condition: A study protocol for a randomized controlled trial.

BACKGROUND: Post-COVID-19 condition is frequently comprised of persistent cognitive sequela, including deficits in attention and executive functions (EFs), which can act as a barrier for regaining pre-illness functional levels. Goal Management Training (GMT) is a cognitive rehabilitation (CR) intervention for improving attention and EFs that has received empirical support in studies of other patient groups. The present study aims to determine the efficacy of GMT for improving everyday attention and EFs in adults who experience persistent cognitive deficits after COVID-19. METHODS: This study protocol describes an open-label randomized controlled trial comparing the efficacy of GMT to a wait list control condition (WL), for improving persistent (> 2 months) cognitive sequela in post-COVID-19 condition. The study aims to recruit 240 participants aged 18 to 65 years with a history of SARS-CoV-2 infection and perceived attentional and EF difficulties in daily life. Participants will be block randomized (computer-algorithm) to either group-based GMT (n = 120) or WL (n = 120). GMT will be internet-delivered to groups of six participants in six two-hour sessions delivered once a week. The primary outcome will be the Metacognition Index of the Behavior Rating Inventory of Executive Function - Adult Version, a self-report measure assessing everyday EF difficulties, specifically metacognition, at six months post-treatment. Secondary outcomes include performance-based neurocognitive measures, and tertiary outcomes include rating scales of cognition, emotional health, quality of life, and fatigue. CONCLUSION: Study findings could contribute to providing an evidence-based treatment option for symptoms that are frequent and debilitating following a prevalent condition. TRIAL REGISTRATION NUMBER: NCT05494424.

Symptom severity moderates the outcome of attention bias modification for depression: An exploratory study.

A recent meta-analysis has questioned the relevance of attention bias modification (ABM) for depression outcomes. However, there might be patient characteristics not yet accounted for, that are relevant to the outcome. In the context of personalized treatment, the lack of moderator studies have limited the potential for matching ABM-treatment to individual patient characteristics. Subjects (N = 301) were randomly assigned 1:1 to receive either active or placebo Attention Bias Modification (ABM) twice daily for 14 days in a double-blind design (placebo n = 148; ABM n = 153). The outcome was change in symptoms based on the Hamilton Depression Rating Scale (HDRS). Moderator variables were self-reported depression (Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety Inventory; BAI) and attentional bias (AB) assessed at baseline. This trial was registered with ClinicalTrials.gov, number NCT02658682. Only BAI (p for interaction = .01, Bootstrap 95% CI [0.046, 0.337]) moderated the effects of ABM on change in clinician rated depressive symptoms. Interactions were significant for BAI scores ≥8. The relative effect of the intervention increased with the highest symptom load. ABM was not effective in patients with the lowest symptom load. Future research should validate this finding and continue investigating moderators of the ABM-intervention to further enhance personalization of treatment to individual symptom characteristics.

Is (poly-) substance use associated with impaired inhibitory control? A mega-analysis controlling for confounders.

Many studies have reported that heavy substance use is associated with impaired response inhibition. Studies typically focused on associations with a single substance, while polysubstance use is common. Further, most studies compared heavy users with light/non-users, though substance use occurs along a continuum. The current mega-analysis accounted for these issues by aggregating individual data from 43 studies (3610 adult participants) that used the Go/No-Go (GNG) or Stop-signal task (SST) to assess inhibition among mostly "recreational" substance users (i.e., the rate of substance use disorders was low). Main and interaction effects of substance use, demographics, and task-characteristics were entered in a linear mixed model. Contrary to many studies and reviews in the field, we found that only lifetime cannabis use was associated with impaired response inhibition in the SST. An interaction effect was also observed: the relationship between tobacco use and response inhibition (in the SST) differed between cannabis users and non-users, with a negative association between tobacco use and inhibition in the cannabis non-users. In addition, participants' age, education level, and some task characteristics influenced inhibition outcomes. Overall, we found limited support for impaired inhibition among substance users when controlling for demographics and task-characteristics.

Do Executive Functions Predict Binge-Drinking Patterns? Evidence from a Longitudinal Study in Young Adulthood.

Background: Impairments in executive functions (EFs) are related to binge drinking in young adulthood, but research on how EFs influence future binge drinking is lacking. The aim of the current report is therefore to investigate the association between various EFs and later severity of, and change in, binge drinking over a prolonged period during young adulthood. Methods: At baseline, 121 students reported on their alcohol habits (Alcohol use disorder identification test; Alcohol use questionnaire). Concurrently, EFs [working memory, reversal, set-shifting, response inhibition, response monitoring and decision-making (with ambiguity and implicit risk)] were assessed. Eighteen months later, information on alcohol habits for 103 of the participants were gathered. Data were analyzed by means of multilevel regression modeling. Results: Future severity of binge drinking was uniquely predicted by performance on the Information sampling task, assessing risky decision-making (ß = -1.86, 95% CI: -3.69, -0.04). None of the study variables predicted severity or change in binge drinking. Conclusion: Future severity of binge drinking was associated with making risky decisions in the prospect for gain, suggesting reward hypersensitivity. Future studies should aim at clarifying whether there is a causal association between decision-making style and binge drinking. Performance on all executive tasks was unrelated to change in binge drinking patterns; however, the finding was limited by overall small changes, and needs to be confirmed with longer follow-up periods.

Inhibitory control and response monitoring are not systematically related to weekly alcohol consumption in the general population.

BACKGROUND: In alcohol use disorder, deficits in cognitive control (i.e., inhibition and response monitoring) might underlie the loss of self-control and, thereby, failure to adjust alcohol consumption in response to associated negative consequences. According to the continuum hypothesis, the magnitude of these deficits should be related in a stair-case manner, with the greatest deficits among its heaviest consumers. The current study aims at investigating this association in the general population. METHODS: This is a cross-sectional study of 397 participants aged 18-64 years, who self-reported their mean weekly alcohol consumption and were assessed with the stop-signal task, estimating inhibitory efficiency (stop-signal reaction time; SSRT) and response monitoring (post-error slowing; PES). Set-shifting ability was investigated by the intra-extra dimensional (IED) set-shifting task. Three ANCOVAs were performed with SSRT, PES, and IED as the dependent variables (DV), respectively, and alcohol consumption levels as the independent variable. Covariates were included when they were significantly associated with the DV. RESULTS: Compared to the teetotalers, all levels of alcohol consumption were significantly associated to lower SSRT, which implies more efficient inhibitory control; however, there was no significant difference in SSRT between other consumption levels. The two highest consumption groups had significantly shorter PES when compared to teetotalers and/or the lowest consumption group, implying less behavioral adjustment after failures. IED was not significantly related to the alcohol consumption levels. CONCLUSIONS: There was no stair-case relation between weekly consumption levels and cognitive control functions within this general population, which might be due to the limited consumption range investigated.

Binge Drinkers Are Fast, Able to Stop - but They Fail to Adjust.

Binge drinking leads to brain damage. However, at present few studies have taken into account the continuity in the binge drinking phenomenon, and treated binge drinking as a clearly separable category from other types of drinking patterns. The aim of the present study was to investigate whether severity of binge drinking can predict specific neurocognitive changes in healthy young adults. A total of 121 students aged 18 to 25 were assessed by means of the three last questions of the Alcohol Use Questionnaire combined into binge score. The binge score was entered as a predictor of cognitive performance of the CANTAB Stop Signal Task including reaction time, inhibition processing time, and response adjustment. Anxiety and depression symptoms were also measured. Binge score significantly predicted less adjustment following failures, and faster reaction times. Binge score did not predict inhibition performance. Symptoms of depression and anxiety were not significantly related to binge score. Binge drinking in healthy young adults predicts impairment in response adjustment and fast reaction time, but is unrelated to inhibition. The study supports the view that binge drinking is a continuous phenomenon, rather than discrete category, and the findings are possibly shedding light on why binge drinkers continue their drinking pattern despite negative consequences. (JINS, 2016, 22, 38-46).

Inhibition and response to error in remitted major depression.

Depression is a common illness which tends to have a relapsing progression. Revealing vulnerability factors is an important step towards improved treatment and prevention. Previous studies of individuals in remission indicate that inhibitory control is more strongly impaired than other cognitive functions. Studies have mostly used Stroop tasks; it is unclear how this population performs on other measures of inhibition. Abnormal reactions to errors may also promote depression relapse, but this has rarely been studied in remitted depression. We used a Stop Signal task and Stroop inhibition task to investigate inhibitory function and post-error reaction time adjustments in 54 individuals with a history of depression and 185 never-depressed controls. Inhibitory processing was slower among the remitted depressed individuals on the Stop Signal task, but no difference was found in Stroop inhibition. The groups were not different on post-error adjustments. This finding extends the understanding of inhibitory deficiency in this population and offers insight into trait markers of depression.

Which facets of impulsivity predict binge drinking?

BACKGROUND: Impulsive binge drinking is a serious public health issue, and to reveal predisposing factors to this consumption pattern is, therefore, required. Impulsivity-related traits are important predictors of alcohol use and abuse. Nonetheless, previous research in binge drinking has been confounded by various definitions and cut-off scores, implying that existing studies contributed to limited comprehension on the specific role of different impulsivity facets. The current study thus disentangles the role of impulsivity facets in binge drinking by adopting a dimensional approach, considering the condition on a continuum, to avoid relying on debatable and non-definitive criteria. METHODS: 162 students underwent assessment of alcohol consumption, including drinking patterns and impulsive traits, as captured in the UPPS-P framework (i.e., negative urgency, positive urgency, sensation seeking, lack of perseverance, lack of premeditation). Multiple regression analyses were utilized in order to investigate the predictive role of each impulsivity facet in binge drinking. RESULTS: Binge drinking was associated with sensation seeking. However, when statistically controlling for gender, age and global alcohol consumption, this effect disappeared, and negative urgency remained the only impulsivity component that significantly predicted binge drinking. CONCLUSION: We found the severity of binge drinking to be associated with negative urgency, suggesting that the binge drinking pattern is displayed in reaction to negative emotional states, and can be conceptualized as a maladaptive and short-term emotional coping. The study calls for prevention and treatment interventions designed to improve self-control, and more adaptive emotion regulation strategies.