The network structure of psychopathological and resilient responses to the pandemic: A multicountry general population study of depression and anxiety.

Commonly identified patterns of psychological distress in response to adverse events are characterized by resilience (i.e., little to no distress), delayed (i.e., distress that increases over time), recovery (i.e., distress followed by a gradual decrease over time), and sustained (i.e., distress remaining stable over time). This study aimed to examine these response patterns during the COVID-19 pandemic. Anxiety and depressive symptom data collected across four European countries over the first year of the pandemic were analyzed (N = 3,594). Participants were first categorized into groups based on the four described patterns. Network connectivity and symptom clustering were then estimated for each group and compared. Two thirds (63.6%) of the sample displayed a resilience pattern. The sustained distress network (16.3%) showed higher connectivity than the recovery network (10.0%) group, p = .031; however, the resilient network showed higher connectivity than the delayed network (10.1%) group, p = .016. Regarding symptom clustering, more clusters emerged in the recovery network (i.e., three) than the sustained network (i.e., two). These results replicate findings that resilience was the most common mental health pattern over the first pandemic year. Moreover, they suggest that high network connectivity may be indicative of a stable mental health response over time, whereas fewer clusters may be indicative of a sustained distress pattern. Although exploratory, the network perspective provides a useful tool for examining the complexity of psychological responses to adverse events and, if replicated, could be useful in identifying indicators of protection against or vulnerability to future psychological distress.

Unlocking the past: efficacy of guided self-compassion and benefit-focused online interventions for managing negative personal memories.

Positive reappraisal strategies have been found to reduce negative affect following the recall of negative personal events. This study examined the restorative effect of two mood-repair instructions (self-compassion vs benefit-focused reappraisal) and a control condition with no instructions following a negative Mood Induction Procedure by using the guided recall of a negative autobiographical event. A total of 112 university students participated in the online study (81% women, Mage: 21.0 years). Immediately following the negative memory recall, participants were randomised to each condition [(self-compassion: n = 36, benefit-focused: n = 39) or a control condition (n = 37)]. Repeated measures ANOVAs 3 (Repair condition) × 3 (Time of mood assessment: pre-recall, post-recall, post-regulation) showed that, as expected, negative mood (sadness, shame, and guilt) worsened significantly after the guided recall in all groups (p < .001). After the mood-repair intervention, participants in the self-compassion and benefit-focused conditions showed a significant reduction in negative mood (p < .019), while such improvement was not observed in the control group. Self-compassion and benefit-focused reappraisal functioned similarly as mood repair strategies after experiencing negative affect induced by the recall of negative personal memories. Implications in the context of autobiographical memory biases are discussed.

An integrative analysis of potential mechanisms of reduced positive affect in daily life in depression: an ESM study.

Decreased levels of positive affect (PA) are a hallmark of depression. Current models propose as potential main mechanisms a dysfunctional use of emotion regulation (ER) strategies (i.e. dampening, positive rumination), and a maladaptive activation of pro-hedonic goals. However, the role of these mechanisms in PA in daily life remains understudied. We used a 10-day ESM design to assess how these mechanisms influence each other and contribute to depressive symptomatology-related low momentary PA in 139 individuals. Higher depressive symptoms were associated with lower PA, pro-hedonic goals, more frequent use of positive rumination, and higher use of dampening. Further, experiencing higher levels of PA predicted lower following time point use of dampening in individuals with higher symptoms. Finally, using positive rumination was more beneficial (i.e. predicted higher PA increases one moment later) for individuals with higher symptomatology. Our findings suggest that moment-to-moment changes in PA daily life are affected by, and have an effect on, both pro-hedonic goals and the use of dampening and positive rumination, highlighting specific cognitive-affective mechanisms that should be considered when designing interventions aimed at improving low PA characterising depression symptomatology.

Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic.

BACKGROUND: The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country. METHOD: Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models. RESULTS: Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning. CONCLUSIONS: The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain.

Attentional patterns as emotion regulation strategies during the anticipation of repetitive emotional scenes: an eye-tracker study.

As difficulties in managing the anticipation of situations is one of the characteristics of emotional problems, the study of regulatory strategies during anticipatory period anticipation is important. In the present study, attentional patterns during the anticipation period were studied. The ability of those attentional patterns to regulate mood after the event's occurrence was analyzed. An experimental paradigm was designed in which participants repeatedly anticipated emotional information. Attentional patterns in response to emotionally expressive faces (happy and sad) were recorded with an eye tracker. The results showed that the valence of the expected outcomes did affect attentional preferences. Specifically, participants spent more time looking at sad faces when they anticipated a negative rather than a positive outcome. The opposite pattern was found for happy faces. With respect to the ability to regulate the emotions of these attention patterns, it was found that emotions experienced after a negatively anticipated event were independent of previous attention patterns, while happiness experienced after a previously anticipated positive event was found to be related to attentional patterns. Specifically, people who spent more time looking at happy faces during the anticipation of a positive outcome reported higher levels of happiness after the event. In conclusion, these results indicate that during the anticipation of emotional outcomes participants implement attentional strategies, although the emotions associated with experiencing those outcomes were independent of those attentional patterns in the negative anticipation, they were found to magnify positive emotions in positive anticipation.

Emotional SNARC: emotional faces affect the impact of number magnitude on gaze patterns.

The Spatial-Numerical Association of Response Codes (SNARC) effect is characterised by a spatial cognitive representation of low numbers to the left side of space and high numbers to the right side of space. This effect has been found using a diversity of stimuli and experimental paradigms. However, the influence of emotional stimuli on this effect remains unclear. In this study, the SNARC effect is analysed in relation to pairs of emotional facial stimuli (happy-neutral, sad-neutral and happy-sad pairs). Gaze patterns of 151 participants were analysed when exposed to a free-viewing eye-tracking paradigm consisting of pairs of emotional faces preceded by small and large numbers. Replicating previous results, a standard SNARC effect was found independently of the emotional expressions of the faces (i.e., there was a significant linear trend of number magnitude in the frequency of first fixations of the gaze to the left side space). However, specific slope analyses revealed that the SNARC effect was influenced by the spatial position of each emotion presented in the emotional pairs. Specifically, the effect disappeared in happy-neutral trials, when the happy faces were allocated in the right position and also in happy-sad trials when two emotional stimuli were simultaneously displayed. The study revealed that the SNARC effect is sensitive to the spatial position of emotional stimuli which further adds to other known limits of the phenomenon. The limitations of the study and its implications in the area of cognition and emotion are also discussed.

Post-Traumatic Growth and Stress-Related Responses During the COVID-19 Pandemic in a National Representative Sample: The Role of Positive Core Beliefs About the World and Others.

Given the need to understand both the negative and positive psychological consequences of the current global COVID-19 pandemic (Brewin et al. in Perspectives in Public Health 10.1177/1757913920957365 2020), the aim of this study was to test a cognitive model of post-traumatic symptoms (PTS) and post-traumatic growth (PTG) during confinement caused by the SARS-COV-2 epidemic. In line with cognitive models of trauma elaboration (Park in Psychological Bulletin 10.1037/a0018301), we included in our model some beliefs associated to the world (e.g., primal beliefs about a good world), to the self (e.g., death anxiety or orientation toward the future) and to others (e.g., suspiciousness or identification with humanity). To evaluate the explanatory model, a national representative sample of adults between the ages of 18 and 75 (N = 1951) was surveyed between 7th and 13th April, 2020, in the middle of a strict 7-week national confinement. Structural equation modelling yielded a very similar model to the one initially specified. The results highlight the role of both negative and positive core beliefs, which are pertinent to the current pandemic threat, in the appearance of PTS and PTG, respectively. In short, primal beliefs about a good world, openness to the future and identification with humanity were associated with PTG; while suspiciousness, intolerance of uncertainty, anxiety about death and also identification with humanity were associated with PTS and consequent impairment. This is an innovative study of different pathways to traumatic responses and growth during a pandemic. Future research is needed to replicate its findings.

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review.

BACKGROUND: Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility. METHODS: Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of "network analysis" with the terms "anxiety," "affective disorders," "depression," "schizophrenia," "psychosis," "personality disorders," "substance abuse" and "psychopathology." RESULTS: The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence. CONCLUSIONS: A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

Methodological Recommendations for Trials of Psychological Interventions.

Recent years have seen major developments in psychotherapy research that suggest the need to address critical methodological issues. These recommendations, developed by an international group of researchers, do not replace those for randomized controlled trials, but rather supplement strategies that need to be taken into account when considering psychological treatments. The limitations of traditional taxonomy and assessment methods are outlined, with suggestions for consideration of staging methods. Active psychotherapy control groups are recommended, and adaptive and dismantling study designs offer important opportunities. The treatments that are used, and particularly their specific ingredients, need to be described in detail for both the experimental and the control groups. Assessment should be performed blind before and after treatment and at long-term follow-up. A combination of observer- and self-rated measures is recommended. Side effects of psychotherapy should be evaluated using appropriate methods. Finally, the number of participants who deteriorate after treatment should be noted according to the methods that were used to define response or remission.

CBT and positive psychology interventions for clinical depression promote healthy attentional biases: An eye-tracking study.

BACKGROUND: Although there is a growing interest in the role of attentional biases in depression, there are no studies assessing changes in these biases after psychotherapeutic interventions. METHODS: We used a validated eye-tracking procedure to assess pre-post therapy changes in attentional biases toward emotional information (i.e., happy, sad, and angry faces) when presented with neutral information (i.e., neutral faces). The sample consisted of 75 participants with major depression or dysthymia. Participants were blindly assigned to one of two 10 weekly sessions of group therapy: a cognitive behavior therapy intervention (N = 41) and a positive psychology intervention (N = 34). RESULTS: Both treatments were equally efficacious in improving depressive symptoms (p = .0001, η² = .68). A significant change in attentional performance after therapy was observed irrespective of the intervention modality. Comparison of pre-post attentional measures revealed a significant reduction in the total time of fixations (TTF) looking at negative information (i.e., sad and angry faces) and a significant increase in the TTF looking at positive information (i.e., happy faces)-all p < .02. CONCLUSIONS: Findings reveal for the first time that psychotherapeutic interventions are associated with a significant change in attentional biases as assessed by a direct measure of attention. Furthermore, these changes seem to operate in the same direction typically found in healthy populations (i.e., a bias away from negative information and a parallel bias toward positive information). These findings illustrate the importance of considering attentional biases as clinical markers of depression and suggest the viability of modifying these biases as a potential tool for clinical change.

The impact of economic recessions on depression and individual and social well-being: the case of Spain (2006-2013).

PURPOSE: Although there is abundant evidence about the impact of economic crises on depression and other mental health problems, little is known about the protective role of variables linked to positive functioning (i.e., psychological well-being). METHODS: We analyzed data from Spain, one of the European countries most affected by the 2008-2013 economic recession, collected in Round 3 (R3, 2006) and Round 6 (R6, 2013) of the European Social Survey interviews. Both surveys included measures of psychological well-being, social well-being and depression. Both samples were nationally representative of the general population (R3: 1877 participants, 49.2% men; R6: 1889 participants, 48.9% men). RESULTS: Data from the R6 survey showed that, compared to data gathered in R3 (i.e., before the onset of the recession) Spanish citizens showed significantly less life satisfaction (95% CIs 0.37-0.63), less personal optimism (95% CIs 0.03-0.15), less social optimism (95% CIs 0.75-0.85), and higher levels of depressive symptoms (95% CIs - 0.74 to - 0.19). Structural equation modeling revealed that protective factors for depression changed in both rounds. In R3 (2006), close relationships, social optimism and social trust were significant mediators between well-being and depression. However, social optimism and social trust were no longer significant in R6 (2013), whereas close relationships remained a partial mediator of the effects of psychological well-being on depression. CONCLUSIONS: Economic crises are associated with a significant increase in depressive symptoms. Furthermore, financial crises seem to have a corrosive impact on mental health by reducing the mediating effects of positive beliefs regarding the good nature of society.

A failure to show the efficacy of a dot-probe attentional training in dysphoria: Evidence from an eye-tracking study.

OBJECTIVE: This study examines whether a 4-day dot-probe attentional training to orient attention toward positive words could lead participants with dysphoria to change selective attention to emotional faces. It was also explored whether this positive attentional bias training could lead to a decrease in depressive symptoms. METHODS: Participants were randomly assigned to Positive Training Group (PTG) and No Training Group (NTG). PTG was composed of 16 subjects, whereas NTG was composed of 15 subjects. All participants were women with a mean age of 22.87 (SD = 3.21). RESULTS: Results showed that dysphoric participants in the PTG did not show changes in attentional patterns to emotional faces. Furthermore, depressive symptoms did not significantly change after the 4-session training. CONCLUSIONS: These results suggest that cognitive training procedures based on dot-probe paradigms are probably not adequate to modify attentional patterns in individuals with depressive symptoms. The theoretical and practical implications are discussed.

Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations.

Attentional bias modification in depression through gaze contingencies and regulatory control using a new eye-tracking intervention paradigm: study protocol for a placebo-controlled trial.

BACKGROUND: Attentional biases, namely difficulties both to disengage attention from negative information and to maintain it on positive information, play an important role in the onset and maintenance of the disorder. Recently, researchers have developed specific attentional bias modification (ABM) techniques aimed to modify these maladaptive attentional patterns. However, the application of current ABM procedures has yielded, so far, scarce results in depression due, in part, to some methodological shortcomings. The aim of our protocol is the application of a new ABM technique, based on eye-tracker technology, designed to objectively train the specific attentional components involved in depression and, eventually, to reduce depressive symptoms. METHODS: Based on sample size calculations, 32 dysphoric (BDI ≥13) participants will be allocated to either an active attentional bias training group or a yoked-control group. Attentional training will be individually administered on two sessions in two consecutive days at the lab. In the training task series of pairs of faces (i.e. neutral vs. sad; neutral vs. happy; happy vs. sad) will be displayed. Participants in the training group will be asked to localize as quickly as possible the most positive face of the pair (e.g., the neutral face in neutral vs. sad trials) and maintain their gaze on it for 750 ms or 1500 ms, in two different blocks, to advance to the next trial. Participants' maintenance of gaze will be measured by an eye-tracking apparatus. Participants in the yoked-control group will be exposed to the same stimuli and the same average amount of time than the experimental participants but without any instruction to maintain their gaze or any feedback on their performance. Pre and post training measures will be obtained to assess cognitive and emotional changes after the training. DISCUSSION: The findings from this research will provide a proof-of-principle of the efficacy of eye-tracking paradigms to modify attentional biases and, consequently, to improve depressed mood. If the findings are positive, this new training approach may result in the improvement of cognitive bias modification procedures in depression. TRIAL REGISTRATION: This trial was retrospectively registered on July 28, 2016 with the ClinicalTrials.gov NCT02847793 registration number and the title 'Attentional Bias Modification Through Eye-tracker Methodology (ABMET)'.

Beyond resilience: Positive mental health and the nature of cognitive processes involved in positive appraisals.

Although the PASTOR model provides a comprehensive framework to study resilience, it faces some challenges. First, some higher-order concepts (e.g., meaning) may be difficult to model in the laboratory. Second, defining resilience as an absence of pathology might be conceptually restrictive. Finally, the proposal that the severity of the event is associated to different appraisal mechanisms needs further evidence.

Rumination and specificity of autobiographical memory in dysphoria.

Low autobiographical memory specificity has been a commonly recurring phenomenon in depression. Difficulty in remembering specific details in autobiographical memory tests has been related to rumination, although the nature of this relation is not clear yet. In the present study, we evaluated differences in overgeneral memory patterns between dysphoric (n=65) and nondysphoric participants (n=74) using a free-recall method that may be more suitable for detecting overgeneral memory patterns than previously used methods. Furthermore, this study examined whether a specific maladaptive component of rumination (i.e., brooding response style) is particularly related to autobiographical memory patterns in depression. Our results showed that dysphoric participants reported less positive specific memories, and more extended and categoric memories than nondysphoric individuals. Furthermore, correlation analyses showed that the maladaptive component of rumination (i.e., brooding), but not the adaptive component of rumination (i.e., reflection), was specifically associated to the reduced autobiographical memory specificity found in dysphoric participants.

Gaze-fixation and pupil dilation in the processing of emotional faces: the role of rumination.

Sustained attentional processing of negative information plays a significant role in the development and maintenance of depression. The present study examines the relationships between rumination, a relevant factor in information processing in depression, and the attentional mechanisms activated in individuals with different levels of depression severity when attending to emotional information (i.e., sad, angry and happy faces). Behavioural and physiological indicators of sustained processing were assessed in 126 participants (39 dysphoric and 87 non-dysphoric) using eye-tracking technology. Pupil dilation and total time attending to negative faces were correlated with a global ruminative style in the total sample once depression severity was controlled. Furthermore, in dysphoric participants the brooding component of rumination was specifically associated with the total time attending to sad faces. Finally, bootstrapping analyses showed that the relationships between global rumination and pupil diameter to emotional faces were accounted by total time attending to emotional faces, specifically for participants reporting lower levels of depression severity. The results support the idea that sustained processing of negative information is associated with a higher ruminative style and indicate differential associations between these factors at different levels of depressive symptomatology.

Overt head movements moderate the effect of depressive symptoms on mood regulation.

A dysfunction in the regulation of negative mood states is one of the core symptoms of depression. Research has found that levels of depression are associated with the intensity of the mood-regulation deficit. The present study aimed to explore the role the body plays in mood-regulation processes. More specifically, we studied whether head movements can influence mood persistence in dysphoric states. Subsequent to a sad-mood induction, participants were presented with a set of positive pictures immediately after performing either vertical (i.e., nodding) or lateral (i.e., shaking) head movements. We considered changes in mood from before to after the experimental task as an index of the effectiveness of mood regulation. As expected, the results showed that higher initial levels of depressive symptoms were associated with greater persistence of sad mood. More importantly, this association was present in participants who shook their heads, but not in those who nodded. These results show that body movements can contribute to mood-regulation processes, thus expanding our knowledge of the psychopathology of mood disorders.

Correction: Epigenetic, psychological, and EEG changes after a 1-week retreat based on mindfulness and compassion for stress reduction in healthy adults: Study protocol of a cross-over randomized controlled trial.

[This corrects the article DOI: 10.1371/journal.pone.0283169.].

Construction and validation of a measure of integrative well-being in seven languages: the Pemberton Happiness Index.

PURPOSE: We introduce the Pemberton Happiness Index (PHI), a new integrative measure of well-being in seven languages, detailing the validation process and presenting psychometric data. The scale includes eleven items related to different domains of remembered well-being (general, hedonic, eudaimonic, and social well-being) and ten items related to experienced well-being (i.e., positive and negative emotional events that possibly happened the day before); the sum of these items produces a combined well-being index. METHODS: A distinctive characteristic of this study is that to construct the scale, an initial pool of items, covering the remembered and experienced well-being domains, were subjected to a complete selection and validation process. These items were based on widely used scales (e.g., PANAS, Satisfaction With Life Scale, Subjective Happiness Scale, and Psychological Well-Being Scales). Both the initial items and reference scales were translated into seven languages and completed via Internet by participants (N = 4,052) aged 16 to 60 years from nine countries (Germany, India, Japan, Mexico, Russia, Spain, Sweden, Turkey, and USA). RESULTS: Results from this initial validation study provided very good support for the psychometric properties of the PHI (i.e., internal consistency, a single-factor structure, and convergent and incremental validity). CONCLUSIONS: Given the PHI's good psychometric properties, this simple and integrative index could be used as an instrument to monitor changes in well-being. We discuss the utility of this integrative index to explore well-being in individuals and communities.