How do care-related beliefs contribute to depression and anxiety in family caregivers of people with dementia? Testing a cognitive vulnerability-stress model.

OBJECTIVES: Care-related beliefs are considered risk factors for decreased mental health in family caregivers of people with dementia. However, their exact role in the caregiver stress process remains unclear. Hence, we tested a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. METHOD: A cross-sectional study was conducted using baseline data from a caregiver intervention trial (N = 322). Within Bayesian moderated mediation analysis, we examined mediation of effects of objective demands (severity of dementia, challenging behavior, caregiving intensity, caregiving duration) on depression and anxiety via subjective caregiver burden and moderation by care-related beliefs in four domains (dysfunctional caregiving standards, dysfunctional attitudes towards dementia, functional self-care-related beliefs, functional acceptance-related beliefs). RESULTS: The relation between objective demands and subjective burden was amplified by dysfunctional caregiving standards and dysfunctional attitudes towards dementia and mitigated by functional self-care-related beliefs. Further, functional acceptance-related beliefs attenuated the effect of subjective caregiver burden on depression. CONCLUSION: The study provides preliminary evidence for a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. The results indicate that the four-domain model of care-related beliefs is a valuable framework for future research and may serve as a heuristic model for cognitive-behavioral therapy in this population.

The role of interpretation biases and safety behaviours in social anxiety: an intensive longitudinal study.

BACKGROUND: Interpretation bias and safety behaviours (Safe-B) have been proposed as factors perpetuating social anxiety (SA). However, longitudinal research on how they contribute to SA in everyday life is scarce. AIM: The aim was to examine whether interpretation bias predicts daily Safe-B and SA. A mediated moderation was hypothesized, where the relationship between daily social stressors and Safe-B would be moderated by interpretation bias, and Safe-B, in turn, would mediate the association between stressors and SA levels. In addition, it was hypothesized that prior levels of SA would predict higher Safe-B use, especially in co-occurrence with stressors. METHOD: An intensive longitudinal design was employed, with 138 vocational training students (51% men, mean age 20.15 years). They completed initial measures of SA and interpretation bias and 7-day diaries with measures of social stressors, Safe-B, and SA. They reported SA levels two months later. RESULTS: Both stressors and interpretation bias in ambiguous situations predicted Safe-B, which in turn predicted daily SA levels. However, neither interpretation bias nor Safe-B predicted SA levels at the follow-up, and interpretation bias did not moderate the association between stressors and daily SA. In addition, the relationship between stressors and Safe-B was stronger in people with higher initial SA levels. CONCLUSIONS: The results suggest that Safe-B are a mechanism through which earlier SA levels and interpretation bias contribute to higher SA levels in daily life.

The development of depressogenic self-schemas: Associations with children's regional grey matter volume in ventrolateral prefrontal cortex.

Cognitive theories of depression contend that biased cognitive information processing plays a causal role in the development of depression. Extensive research shows that deeper processing of negative and/or shallower processing of positive self-descriptors (i.e., negative and positive self-schemas) predicts current and future depression in adults and children. However, the neural correlates of the development of self-referent encoding are poorly understood. We examined children's self-referential processing using the self-referent encoding task (SRET) collected from 74 children at ages 6, 9, and 12; around age 10, these children also contributed structural magnetic resonance imaging data. From age 6 to age 12, both positive and negative self-referential processing showed mean-level growth, with positive self-schemas increasing relatively faster than negative ones. Further, voxel-based morphometry showed that slower growth in positive self-schemas was associated with lower regional gray matter volume (GMV) in ventrolateral prefrontal cortex (vlPFC). Our results suggest that smaller regional GMV within vlPFC, a critical region for regulatory control in affective processing and emotion development, may have implications for the development of depressogenic self-referential processing in mid-to-late childhood.

Pathways from developmental vulnerabilities in early childhood to schizotypy in middle childhood.

OBJECTIVES: Childhood disturbances in social, emotional, language, motor and cognitive functioning, and schizotypy have each been implicated as precursors of schizophrenia-spectrum disorders. We investigated whether relationships between early childhood developmental vulnerabilities and childhood schizotypy are mediated by educational underachievement in middle childhood. METHODS: Participants were members of a large Australian (n = 19,216) population cohort followed longitudinally. Path analyses were used to model relationships between developmental vulnerabilities at age ~5 years, educational underachievement from ages ~8 to 10 years and three distinct profiles of schizotypy at age ~11 years (true, introverted and affective schizotypy). RESULTS: Early childhood developmental vulnerabilities on five broad domains (related to physical, emotional, social, cognitive and communication development) were associated with schizotypy profiles in middle childhood. Educational underachievement in middle childhood was associated with all schizotypy profiles, but most strongly with the true schizotypy profile (OR = 3.92, 95% CI = 3.12, 4.91). The relationships between schizotypy profiles and early childhood developmental vulnerabilities in 'language and cognitive skills (school-based)' and 'communication skills and general knowledge' domains were fully mediated by educational underachievement in middle childhood, and the relationships with early childhood 'physical health and well-being' and 'emotional maturity' domains were partially mediated. CONCLUSION: Developmental continuity from early childhood developmental vulnerabilities to schizotypy in middle childhood is mediated by educational underachievement in middle childhood. While some domains of early developmental functioning showed differential relationships with distinct schizotypy profiles, these findings support a developmental pathway to schizotypy in which cognitive vulnerability operates from early childhood through to middle childhood.

Rumination as a widespread emotion-based cognitive vulnerability in borderline personality disorder: A meta-analytic review.

OBJECTIVE: The current quantitative review aims at comprehensively clarifying the role of rumination in borderline personality disorder (BPD) considering its relevance for several clinical models of the disorder. METHOD: This meta-analysis included 29 independent studies assessing different forms of rumination-general tendency to engage in ruminative thinking patterns and four types of emotion-based rumination among both nonclinical subjects reporting BPD features and patients with BPD. Furthermore, the study tested whether rumination could be considered a widespread emotion-based cognitive vulnerability in BPD. RESULTS: Meta-analytic procedures were based on 46 r coefficients that showed large pooled effect sizes for all forms of rumination. With the exception of interpersonal rumination, the remaining forms of rumination were equally involved in BPD features. CONCLUSIONS: Rumination should be considered a widespread emotion-based cognitive vulnerability in BPD. Future studies should provide longitudinal and contextual-based evaluations of rumination among treatment-seeking individuals with BPD.

Linking Maternal Depression to Adolescent Internalizing Symptoms: Transmission of Cognitive Vulnerabilities.

The mechanisms of the well-documented relationship between maternal depression and offspring psychopathology are not yet fully understood. Building upon cognitive theories of depression and the modeling hypothesis, path analyses tested whether maternal depression history predicted adolescent internalizing symptoms via the transmission of cognitive vulnerabilities within a sample of 635 adolescents (Mage = 13.1 years, range = 11.2-17.2 years; 53% female; 48% African American/Black) and their primary female caregivers. Maternal depression history did not directly predict adolescent symptoms. Two significant indirect effects were found; maternal depression history was associated with maternal negative cognitive style, which predicted greater adolescent negative generalization, which, in turn, predicted adolescents' greater depressive and anxiety symptoms. These findings suggest that the transmission of cognitive vulnerabilities may link maternal depression and offspring internalizing psychopathology.

Body image-related cognitive fusion and disordered eating: the role of self-compassion and sad mood.

PURPOSE: The extent to which body image-related thoughts are endorsed and drive behaviors, a process known as Body Image-Related Cognitive Fusion (BI-CF), is an important contributor to disordered eating. Moreover, negative mood and negative self-referential processes (e.g., low self-compassion) have been reportedly associated with disordered eating; however, their associations with BI-CF are not known. The aim of this study was to investigate, among young adults, the association between (1) BI-CF and disordered eating attitudes and behaviors (2) BI-CF and self-compassion, and (3) whether sad mood influences BI-CF. METHOD: Participants completed online questionnaires that assessed BI-CF, self-compassion, negative affect, cognitive reactivity and disordered eating (N = 601). A subsample (n = 51) underwent an in-lab session in which they were exposed to a validated psychological sad mood induction task followed by the assessment of BI-CF. RESULTS: 67.8% of variation in disordered eating was accounted for by BI-CF while controlling for covariates. Self-compassion was the strongest predictor of BI-CF levels, irrespective of other eating disorder or depression risk factors (p < 0.001). Increases in sad mood did not influence levels of BI-CF. CONCLUSION: The endorsement of body image-related thoughts seems to play an important role in disordered eating. Compassionate self-responding may have positive influences on reducing negative body image-related thoughts. Furthermore, BI-CF appears to be a relatively stable phenomenon, irrespective of change in mood state. Results offer implications for the improvements in prevention and intervention models targeted towards disordered eating through self-compassion and cognitive defusion. LEVEL OF EVIDENCE: Part I: Level V, cross-sectional descriptive study. Part II: Level I, experimental study.

Cognitive risk, coping-oriented substance use, and increased avoidance tendencies among depressed outpatients: A prospective investigation.

OBJECTIVE: The present study was designed to assess the interplay between depressive cognition, coping-oriented substance use, and future behavioral disengagement tendencies. Cognitive risk subtypes examined include brooding rumination, attributional bias (internal/stable/global), and dysfunctional attitudes. METHOD: Individuals were recruited from outpatient treatment settings and met criteria for a unipolar depressive disorder (N = 70; 66% female; 81% White; Mage = 31; SDage = 13.2). Participants completed self-report measures of brooding rumination, attributional style, dysfunctional attitudes, coping-oriented substance use, and behavioral disengagement tendencies following a 3-week period. RESULTS: Brooding rumination, stable attributional style, and dysfunctional attitudes were positively associated with later behavioral disengagement tendencies. Coping-oriented substance use moderated associations between both internal attributional style, as well as dysfunctional attitudes onto later behavioral disengagement. CONCLUSIONS: With regard to stress-related avoidance, subsyndromal substance use may play a detrimental role among cognitively vulnerable, depressed outpatients when said drug or alcohol use serves as a means of coping.

Overestimating Self-Blame for Stressful Life Events and Adolescents' Latent Trait Cortisol: The Moderating Role of Parental Warmth.

Cognitive interpretations of stressful events impact their implications for physiological stress processes. However, whether such interpretations are related to trait cortisol-an indicator of individual differences in stress physiology-is unknown. In 112 early adolescent girls (M age = 12.39 years), this study examined the association between self-blame estimates for past year events and latent trait cortisol, and whether maternal warmth moderated effects. Overestimating self-blame (versus objective indices) for independent (uncontrollable) events was associated with lower latent trait cortisol, and maternal warmth moderated the effect of self-blame estimates on latent trait cortisol for each dependent (at least partially controllable) and interpersonal events. Implications for understanding the impact of cognitive and interpersonal factors on trait cortisol during early adolescence are discussed.

Unique and predictive relationships between components of cognitive vulnerability and symptoms of depression.

BACKGROUND: Cognitive vulnerability theories of depression outline multiple, distinct inferential biases constitutive of cognitive vulnerability to depression. These include attributing negative events to internal, stable, and global factors, assuming that negative events will lead to further negative consequences, and inferring that negative events reflect negative characteristics about the self. Extant research has insufficiently examined these biases as distinct, limiting our understanding of how the individual cognitive vulnerability components interrelate and confer risk for depression symptoms. Thus, we conducted exploratory network analyses to examine the relationships among the five components of negative cognitive style and explore how components may differentially relate to depressive symptoms in adolescents. METHODS: Participants completed measures of negative cognitive style twice over a two-year period. We estimated Graphical Gaussian Models using contemporaneous data and computed a cross-lagged panel network using temporal data from baseline and 2-year follow-up. RESULTS: Results reveal interesting structural dynamics among facets of negative cognitive style and depressive symptoms. For example, results point to biases towards stable and future-oriented inferences as highly influential among negative cognitive style components. The temporal model revealed the internal attributions component to be heavily influenced by depressive symptoms among adolescents, whereas stable and global attributions most influenced future symptoms. CONCLUSIONS: This study presents novel approaches for investigating cognitive style and depression. From this perspective, perhaps more precise predictions can be made about how cognitive risk factors will lead to the development or worsening of psychopathology.

Negative cognitive styles as risk factors for the occurrence of PMS and PMDD.

Background: The purpose of our study is to verify whether elements of cognitive vulnerability to affective disorders may enhance the occurrence of PMS/PMDD. Methods: In total, 293 women with regular cycles took part in the study. The subjects were exposed to failure during the follicular phase or luteal phase, as appropriate, and the attributional style of failure, cognitive triad inventory (CTI) and presence of biased information processing were determined. The mood of the subjects before and after failure was measured, and the depressive mood was screened by CES-D. The occurrence of PMS/PMDD was assessed on the basis of PSST. Results: The women suffering from PMS/PMDD differed from those without PMS in terms of the cognitive triad, the use of positive and negative adjectives when describing themselves and biased information processing. In the luteal cycle phase, considerably greater sadness and irritation were observed in women with PMS/PMDD after experiencing failure, but only in those from the group not taking oral contraceptives. Conclusions: Negative cognitive styles are an important factor in the development of PMS/PMDD. PMDD is similar to major depression regarding cognitive vulnerability. Only in the case of PMDD was biased information processing in the luteal cycle phase recorded.

Association between cognitive vulnerability to depression - dysfunctional attitudes and glycaemic control among in-patients with type 2 diabetes in a hospital in Beijing: a multivariate regression analysis.

This cross-sectional study aimed to investigate the relationship between glycosylated haemoglobin (HbA1c) and cognitive vulnerability to depression (dysfunctional attitudes) in patients with type 2 diabetes mellitus. A total of 245 valid records from June 2016 to December 2016 were collected from a hospital in Beijing. Participants were asked to complete four questionnaires (Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire, Zung Self-rating Depression Scale, and World Health Organization Quality of Life Instrument-Short Form) to assess mental health and quality of life. Multivariate regression analysis was conducted to determine the correlations between HbA1c, mental health, quality of life and other clinical variables. The results showed that dysfunctional attitudes were associated with HbA1c, with a standardized regression coefficient (ß) of .13 (p = .01), although 1 h C-peptide (ß = -.75, p < .0001) was the most significant predictor of HbA1c in the regression model. The results indicated that dysfunctional attitudes, as a cognitive vulnerability to depression, were a relevant factor in HbA1c, although further studies are needed to establish the nature of the connection between dysfunctional attitudes and glycaemic control in diabetes patients.

Interaction of Biological Stress Recovery and Cognitive Vulnerability for Depression in Adolescence.

Major Depressive Disorder is a common mental illness with rates increasing during adolescence. This has led researchers to examine developmental antecedents of depression. This study examined the association between depressive symptoms and the interaction between two empirically supported risk factors for depression: poor recovery of the biological stress system as measured through heart rate and cortisol, and cognitive vulnerabilities as indexed by rumination and a negative cognitive style. Adolescents (n = 127; 49 % female) completed questionnaires and a social stress task to elicit a stress response measured with neuroendocrine (cortisol) and autonomic nervous system (heart rate) endpoints. The findings indicated that higher depressive symptoms were associated with the combination of higher cognitive vulnerabilities and lower cortisol and heart rate recovery. These findings can enhance our understanding of stress responses, lead to personalized treatment, and provide a nuanced understanding of depression in adolescence.

Influence of maternal depression on children's brooding rumination: Moderation by CRHR1 TAT haplotype.

There is growing evidence that brooding rumination plays a key role in the intergenerational transmission of major depressive disorder (MDD) and may be an endophenotype for depression risk. However, less is known about the mechanisms underlying this role. Therefore, the goal of the current study was to examine levels of brooding in children of mothers with a history of MDD (n = 129) compared to children of never depressed mothers (n = 126) and to determine whether the variation in a gene known to influence hypothalamic-pituitary-adrenal axis functioning--corticotropin-releasing hormone receptor 1 (CRHR1)--would moderate the link between maternal MDD and children's levels of brooding. We predicted children of mothers with a history of MDD would exhibit higher levels of brooding than children of mothers with no lifetime depression history but that this link would be stronger among children carrying no copies of the protective CRHR1 TAT haplotype. Our results supported these hypotheses and suggest that the development of brooding among children of depressed mothers, particularly children without the protective CRHR1 haplotype, may serve as an important mechanism of risk for the intergenerational transmission of depression.

Cognitive schemas as longitudinal predictors of self-reported adolescent depressive symptoms and resilience.

Given that depression risk intensifies in adolescence, examining associates of depressive symptoms during the shift from childhood to adolescence is important for expanding knowledge about the etiology of depression symptoms and disorder. A longitudinal youth report was employed to examine the trajectory of both the content and structure of positive and negative schemas in adolescence and also whether these schemas could prospectively predict depressive symptoms and youth-reported resilience. One hundred and ninety-eight participants (aged 9 to 14) were recruited from four schools to complete measures of youth depressive symptoms, resilience, and schema content and structure. Those who consented to a follow-up study completed the same measures online (50 participants completed). Negative and positive schema content and structure were related over time. After controlling depressive symptoms/resilience at Time 1, negative schema content was the only significant predictor (trend level) of depressive symptoms and resilience at Time 2. Implications for cognitive theories and clinical practice are discussed.

Impaired conscious memory in non-clinical schizotypy.

INTRODUCTION: Impaired controlled and preserved/enhanced automatic memory processes have been reported in schizotypy. This memory pattern has been considered as a marker of vulnerability to schizophrenia. Our aim was to further explore this memory pattern in non-clinical schizotypy in order to determine which specific dimensions of schizotypy (i.e., positive, negative or disorganised), and more specifically which components of the dimensions, are most closely related to memory dysfunctions. METHODS: Fifty-seven undergraduate students performed a category-production task. This was adapted for use with the process dissociation procedure in order to dissociate between automatic and controlled memory processes. The level of schizotypy was assessed using the Schizotypal Personality Questionnaire. RESULTS: Regression analyses confirmed that controlled memory processes decreased as schizotypy increased. The positive factors (more specifically, the ideas of reference subscale) and disorganised factors (more specifically, the odd or eccentric behaviour subscale) were negatively correlated with the controlled memory processes. CONCLUSIONS: Our study supports the idea that impaired controlled processes are an early cognitive marker of vulnerability to schizophrenia and confirm that the disorganised factor contributes the most to vulnerability to memory dysfunction. It also emphasises the importance of dissociating between each of the features characterising schizotypy rather than considering it as a whole.

The depression distress amplification model in adolescents: A longitudinal examination of anxiety sensitivity cognitive concerns, depression and suicidal ideation.

Adolescents with comorbid anxiety and depression are at significantly increased risk of suicide. The recently proposed depression distress amplification model appears to have promise for explaining the relations between anxiety, depression, and suicidality, but it has not been tested in adolescents. Participants were 524 adolescents followed over two years. Baseline data for the current report were collected by trained interviewers while the adolescents were in eighth grade. Data were obtained in the same manner when the adolescents were in tenth grade. Baseline anxiety sensitivity cognitive concerns significantly predicted suicidal ideation two years later, above and beyond baseline suicidal ideation and depression. Further, consistent with the depression distress amplification model, anxiety sensitivity cognitive concerns interacted with depressive symptoms to predict suicidal ideation. This report extends the empirical and theoretical support for a relationship between anxiety sensitivity cognitive concerns and suicidality.

The interaction of affective states and cognitive vulnerabilities in the prediction of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is a serious public health concern and remains poorly understood. This study sought to identify both cognitive and affective vulnerabilities to NSSI and examine their interaction in the prediction of NSSI. A series of regressions indicated that low levels of positive affect (PA) moderated the relationships between self-criticism and brooding and NSSI. The associations of self-criticism and brooding with greater frequency of NSSI were attenuated by higher levels of PA. The interaction of cognitive and affective vulnerabilities is discussed within the context of current NSSI theory.

Pubertal timing and vulnerabilities to depression in early adolescence: differential pathways to depressive symptoms by sex.

Although research implicates pubertal processes in the emergence of the sex difference in depression during adolescence, few studies have examined how cognitive and affective vulnerabilities influence the effect of pubertal timing on depressive symptoms. The current study prospectively examined whether early pubertal timing predicted increases in depressive symptoms among adolescents with more negative cognitive styles and lower emotional clarity, and whether this risk was specific to adolescent girls. In a diverse sample of 318 adolescents, early pubertal timing predicted increases in depressive symptoms among adolescent boys and girls with more negative cognitive styles and adolescent girls with poor emotional clarity. These findings suggest that earlier pubertal maturation may heighten the risk of depression for adolescents with pre-existing vulnerabilities to depression, and that early maturing adolescent girls with lower levels of emotional clarity may be particularly vulnerable to depressive symptoms, representing one pathway through which the sex difference in depression may emerge.

Proximity, relationship closeness, and cognitive vulnerability: predicting enduring depressive reactions to a college campus tragedy.

OBJECTIVE: To test the hypothesis that enduring depressive reactions to tragedy are due to a unique combination of three factors-close physical proximity to the event, close relationship with the victim(s), and high levels of cognitive vulnerability. METHOD: Participants were 70 undergraduates (66% female; mean age = 18) from a midsized private university. Cognitive vulnerability and depressive symptoms were assessed 2 years before a college campus tragedy; physical proximity, relationship with the victim, and depressive symptoms were assessed 2 months after the tragedy. RESULTS: Individuals with a combination of high levels of cognitive vulnerability and close physical proximity to the event were at greater risk for enduring depression, but only if they did not have a very close relationship with the victim. CONCLUSION: This article puts forth a testable theory that helps to explain why some individuals are at risk for enduring depressive reactions to tragedy. Implications for research and practice are discussed.