Prevalence and Determinants of Insomnia After a Myocardial Infarction.

OBJECTIVES: This study analyzed cross-sectional data to examine the prevalence of insomnia and to identify factors associated with insomnia after a myocardial infarction (MI). METHODS: The participants were 209 individuals with a recent MI. At approximately 5 weeks post-MI, participants completed standardized self-report measures assessing insomnia (Insomnia Severity Index) and various sociodemographic, clinical, behavioral, and psychosocial variables, including stressful life events, depressive symptoms, and dysfunctional beliefs about sleep. RESULTS: Overall, 36% of the sample reported clinical symptoms of insomnia (Insomnia Severity Index score ≥ 10) and an additional 9% reported milder/subthreshold symptoms (Insomnia Severity Index score ≥ 8). Among patients with insomnia, a much higher proportion (62.7%) were experiencing symptoms consistent with depressed mood compared to good sleepers (13.4%). Multivariate linear regression showed that younger age, use of prescribed medication for sleep, more depressive symptoms, and greater dysfunctional beliefs about sleep were associated with insomnia severity. CONCLUSIONS: Many patients after MI experience insomnia, which may increase the illness burden and hamper recovery during the cardiac rehabilitation phase. Our findings provide a theoretical basis for evaluating cognitive-behavioral approaches for the management of insomnia in patients after MI.

Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial.

BACKGROUND: Neural reactivity to dysphoric mood induction indexes the tendency for distress to promote cognitive reactivity and sensory avoidance. Linking these responses to illness prognosis following recovery from Major Depressive Disorder informs our understanding of depression vulnerability and provides engagement targets for prophylactic interventions. METHODS: A prospective fMRI neuroimaging design investigated the relationship between dysphoric reactivity and relapse following prophylactic intervention. Remitted depressed outpatients (N = 85) were randomized to 8 weeks of Cognitive Therapy with a Well-Being focus or Mindfulness Based Cognitive Therapy. Participants were assessed before and after therapy and followed for 2 years to assess relapse status. Neural reactivity common to both assessment points identified static biomarkers of relapse, whereas reactivity change identified dynamic biomarkers. RESULTS: Dysphoric mood induction evoked prefrontal activation and sensory deactivation. Controlling for past episodes, concurrent symptoms and medication status, somatosensory deactivation was associated with depression recurrence in a static pattern that was unaffected by prophylactic treatment, HR 0.04, 95% CI [0.01, 0.14], p < .001. Treatment-related prophylaxis was linked to reduced activation of the left lateral prefrontal cortex (LPFC), HR 3.73, 95% CI [1.33, 10.46], p = .013. Contralaterally, the right LPFC showed dysphoria-evoked inhibitory connectivity with the right somatosensory biomarker CONCLUSIONS: These findings support a two-factor model of depression relapse vulnerability, in which: enduring patterns of dysphoria-evoked sensory deactivation contribute to episode return, but vulnerability may be mitigated by targeting prefrontal regions responsive to clinical intervention. Emotion regulation during illness remission may be enhanced by reducing prefrontal cognitive processes in favor of sensory representation and integration.

Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy.

BACKGROUND: To investigate whether usage of treatment-acquired regulatory skills is associated with prevention of depressive relapse/recurrence. METHOD: Remitted depressed outpatients entered a 24-month clinical follow up after either 8 weekly group sessions of cognitive therapy (CT; N = 84) or mindfulness-based cognitive therapy (MBCT; N = 82). The primary outcome was symptom return meeting the criteria for major depression on Module A of the SCID. RESULTS: Factor analysis identified three latent factors (53% of the variance): decentering (DC), distress tolerance (DT), and residual symptoms (RS), which were equivalent across CT and MBCT. Latent change score modeling of factor slopes over the follow up revealed positive slopes for DC (ß = .177), and for DT (ß = .259), but not for RS (ß = -.017), indicating posttreatment growth in DC and DT, but no change in RS. Cox regression indicated that DC slope was a significant predictor of relapse/recurrence prophylaxis, Hazard Ratio (HR) = .232 90% Confidence Interval (CI) [.067, .806], controlling for past depressive episodes, treatment group, and medication. The practice of therapy-acquired regulatory skills had no direct effect on relapse/recurrence (ß = .028) but predicted relapse/recurrence through an indirect path (ß = -.125), such that greater practice of regulatory skills following treatment promoted increases in DC (ß = .462), which, in turn, predicted a reduced risk of relapse/recurrence over 24 months (ß = -.270). CONCLUSIONS: Preventing major depressive disorder relapse/recurrence may depend upon developing DC in addition to managing residual symptoms. Following the acquisition of therapy skills during maintenance psychotherapies, DC is strengthened by continued skill utilization beyond treatment termination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Considering Meta-Analysis, Meaning, and Metaphor: A Systematic Review and Critical Examination of "Third Wave" Cognitive and Behavioral Therapies.

In this review, we examine common usage of the term "third wave" in the scientific literature, systematically review published meta-analyses of identified "third wave" therapies, and consider the implications and options for the use of "third wave" as a metaphor to describe the nature of and relationships among cognitive and behavioral therapies. We demonstrate that the "third wave" term has grown in its use over time, that it is commonly linked with specific therapies, and that the majority of such therapies have amassed a compelling evidence base attesting to their clinical and public health value. We also consider the extent to which the "third wave" designation is an effective guide for the future, and we encourage scientific inquiry and self-reflection among those concerned with cognitive and behavioral therapies and the scientific basis of psychotherapy more broadly.

Inhibition of personally-relevant angry faces moderates the effect of empathy on interpersonal functioning.

While empathy is typically assumed to promote effective social interactions, it can sometimes be detrimental when it is unrestrained and overgeneralized. The present study explored whether cognitive inhibition would moderate the effect of empathy on social functioning. Eighty healthy young adults underwent two assessments six months apart. Participants' ability to suppress interference from distracting emotional stimuli was assessed using a Negative Affective Priming Task that included both generic and personally-relevant (i.e., participants' intimate partners) facial expressions of emotion. The UCLA Life Stress Interview and Empathy Quotient were administered to measure interpersonal functioning and empathy respectively. Multilevel modeling demonstrated that higher empathy was associated with worse concurrent interpersonal outcomes for individuals who showed weak inhibition of the personally-relevant depictions of anger. The effect of empathy on social functioning might be dependent on individuals' ability to suppress interference from meaningful emotional distractors in their environment.