Acceptance and Change as Dialectic of Recovery: Examples of Storytelling, Fairy Tale and Psychopharmacotherapy as Therapeutic Modalities.

"Narative medicine" promotes theraputic healing and recovery using fairy tales and traditional folk stories. Individuals are capable of shaping their lives through various narrative strategies and re-authoring alternative stories that are concerned with different aspects of acceptance and change. Psychotherapy through the eyes of stories and fairy tales can have two perspectives. Firstly, fairy tale acts like a weft around which the very story/script of the patient is formed, which in itself becomes the basis for interpreting the occurrence of a mental disorder. The second perspective is the perspective of healing or getting out of a "fairytale" story/script by changing an incoherent life narrative into an alternative coherent narrative (reframing). The aim of this pilot case studies approach was to use a narrative approach based on stories and fairy tales in order to promote psychological growth, meaning in life, resilience, self-realization and improved well-being and highlight the dialectic of recovery, an interplay of acceptance and change (reframing). With properly applied personalized narrative psychopharmacotherapy, the patient is capable of changing their beliefs in order to reach a new meaning of life, and thus to facilitate the lowering of symptomatology, its dissaperance and possibly even a cure, whatever that may mean for an individual. Considering its promising results, clinical implications and possible further applications are discussed.

Personally salient, emotionally negative task contexts provoke goal neglect in depression.

BACKGROUND: Goal neglect refers to a dissociation between intended and actual action. Although commonly associated with frontal brain damage, this phenomenon is also characteristic of clinical depression. To date, tests of goal neglect typically require individuals to switch between subtasks populated with neutral stimuli. This study examined the impact of affective and personally salient stimulus contexts on goal neglect in clinical depression. METHODS: Participants were randomly allocated to either positively or negatively-valenced versions of the Affective Six Elements Test (A-SET). We hypothesised that depressed individuals (n = 30) would exhibit an overall impairment in A-SET performance by neglecting entire subtasks and allocating suboptimal time to each task, relative to never-depressed peers (n = 30), with effects being strongest for the negatively-valenced version. RESULTS: Findings showed that depressed individuals exhibited specific deficits, relative to controls on these measures in the negative A-SET only, with a magnitude comparable to that found in brain injured patients. CONCLUSIONS: Individuals with depression are impaired in their ability to monitor performance and implement strategies that are optimal for the purpose of pursuing an overarching goal when the task context is negatively-valenced. Potential mechanisms are discussed.

Impact of culture on autobiographical life structure in depression.

OBJECTIVES: Distortions in autobiographical memory have been implicated in major depressive disorder (MDD). Those with MDD demonstrate a 'depressogenic' autobiographical life structure. Research has not examined how culture influences this process. We investigated whether Malay individuals (members of an interdependent culture) with MDD demonstrated a 'depressogenic' autobiographical life structure similar to that of British individuals (members of an independent culture) with MDD. DESIGN: A 2 (Culture; Malay, British) × 2 (Mood; depressed, control) cross-sectional design using a card sort task and self-report measures was used. METHODS: Malay individuals with MDD or no history of MDD completed the life-structure card-sorting task, which provided a novel method for investigating organizational structure of the life narrative. These data were compared to previously collected data in which British individuals with MDD or without MDD had completed the same task within the same experimental protocol. RESULTS: Pan-culturally those with MDD had greater negativity (i.e., used more negative attributes), negative redundancy (i.e., used the same negative attributes repeatedly across life chapters) and negative emodiversity (i.e., had greater variety and relative abundance of negative attributes), and reduced positive redundancy (i.e., used the same positive attributes repeatedly across chapters) in their structuring relative to controls. While the British MDD group had greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters) than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls. CONCLUSIONS: The findings suggest culture may shape aspects of the autobiographical life structure in MDD. PRACTITIONER POINTS: The majority of the literature investigating depression pertains to individuals from European Western cultures, despite recognition that depression ranks as one of the most debilitating diseases worldwide. This raises questions as to whether current depression models and interventions can be applied universally or whether they are limited to European Western groups. The current study found that pan-culturally those with MDD had similar structuring of their life story relative to controls. However, there were some cultural differences that need to be considered (e.g., Malay individuals provided less detailed, less elaborate and less emotionally diverse life stories and while the British MDD group had greater compartmentalization than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls). Limitations of the study included group differences in gender and mood at the time of testing. Cultural differences in the number of attributes used may have influenced findings. Only the Malay group completed the individualism-collectivism measure.

Is prolonged grief distinct from bereavement-related posttraumatic stress?

Prolonged grief disorder (PGD) (previously called complicated grief (CG)) is proposed as a distinct post loss syndrome, with its own core symptoms. A key issue concerning the diagnostic validity of PGD is whether it can reliably be distinguished from related psychiatric outcomes following bereavement. This study therefore sought to determine whether the core symptoms of PGD could be distinguished from those of bereavement-related anxiety, depression and posttraumatic stress disorder (PTSD). Data were derived from a community sample of 223 bereaved adults in Croatia. PGD symptomatology was measured using the Revised Inventory of Complicated Grief. Depression and anxiety symptoms were measured using the Beck Depression and Anxiety Inventories, respectively. The intrusion and avoidance symptoms of PTSD were assessed using the Revised Impact of Event Scale. The distinctiveness of the five symptom clusters was examined using principal component analysis (PCA). Symptoms of prolonged grief, depression, anxiety, PTSD-intrusion, and PTSD-avoidance clustered together into five distinct factors. These results support the phenomenological distinctiveness of prolonged grief symptoms, from those of bereavement-related anxiety, depression and, for the first time, PTSD.

Memory category fluency, memory specificity, and the fading affect bias for positive and negative autobiographical events: Performance on a good day-bad day task in healthy and depressed individuals.

In mentally healthy individuals, autobiographical memory is typically biased toward positive events, which may help to maintain psychological well-being. Our aim was to assess a range of important positive memory biases in the mentally healthy and explore the possibility that these biases are mitigated in those with mental health problems. We administered a novel recall paradigm that required recollection of multiple good and bad past events (the Good Day-Bad Day task) to healthy and depressed individuals. This allowed us to explore differences in memory category fluency (i.e., the ability to generate integrated sets of associated events) for positive and negative memories, along with memory specificity, and fading affect bias-a greater reduction in the intensity of memory-related affect over time for negative versus positive events. We found that healthy participants demonstrated superior category fluency for positive relative to negative events but that this effect was absent in depressed participants. Healthy participants exhibited a strong fading affect bias that was significantly mitigated, although still present, in depression. Finally, memory specificity was reduced in depression for both positive and negative memories. Findings demonstrate that the positive bias associated with mental health is maintained by multiple autobiographical memory processes and that depression is as much a function of the absence of these positive biases as it is the presence of negative biases. Results provide important guidance for developing new treatments for improving mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emotional complexity across the life story: Elevated negative emodiversity and diminished positive emodiversity in sufferers of recurrent depression.

BACKGROUND: Greater diversity in the experience of negative and positive emotions - emodiversity - is associated with better mental health outcomes in the general population (Quoidbach et al. 2014). However, conceptual accounts of depression suggest this might differ in clinical depression. In this study, the diversity of negative and positive emotion experiences as remembered by a recurrently depressed sample and a never-depressed control group were compared. METHODS: Emodiversity was assessed using a life structure card sort task which allowed for the assessment of memory for emotional experience over the life course. Depressed (n=34) and non-depressed (n=34) participants completed the card sort task, from which emodiversity metrics were calculated for negative and positive emotion experience. RESULTS: Depressed individuals showed recollections of enhanced emodiversity across negative emotion but reduced emodiversity across positive emotion, relative to never-depressed individuals. LIMITATIONS: This study involved a relatively small sample size. DISCUSSION: This study indicates that greater diversity of negative emotion experience, which has been interpreted as a protective factor against depressed mood in community samples (Quoidbach et al., 2014), instead characterises the remembered experience of recurrent clinical depression. The finding that positive emodiversity is adaptive in depression suggests that therapeutic outcomes may be improved by facilitating exposure to a diverse range of positive emotions. These findings indicate that the relationship between emotion diversity and mental health is more complex than hitherto assumed.

Reduced autobiographical memory specificity and posttraumatic stress: exploring the contributions of impaired executive control and affect regulation.

Reduced specificity of autobiographical memories retrieved to word cues on the Autobiographical Memory Test (AMT) is associated with increased posttraumatic stress in traumatized samples. Theoretical debates concerning the dominant influences on this effect have focused on affect regulation, whereby specific personal information is avoided more by those experiencing greater distress, versus compromised executive control, whereby increased distress is associated with an inability to set aside inappropriately general responses on the AMT. The present study compared these 2 views in a correlational design using a reversed version of the AMT (the AMT-R) for which trauma-exposed participants (N=36) had to generate general memories from the past and avoid specific memories. An emphasis on the role of affect regulation would predict that distress would be associated with reduced specificity (as in the standard AMT), whereas emphasis on the role of executive control would predict that this relationship would be reversed. The data supported the affect regulation account, with greater posttraumatic stress being associated with reduced memory specificity.

Reduced specificity of emotional autobiographical memories following self-regulation depletion.

The present study used a Color Stroop task, involving naming the ink colors of incongruous color words, to deplete self-regulation resources prior to retrieving a series of autobiographical memories to emotional and neutral cue words--the Autobiographical Memory Test (AMT). Control participants either read color words written in black ink or performed no task prior to the AMT. Difficulty accessing specific memories on the AMT has been shown to index key aspects of the onset and maintenance of depression and other emotional disorders. Our hypothesis that depleted participants would retrieve fewer specific memories to cues on the AMT relative to controls was supported, even when levels of depressed and anxious mood, an index of clinical depression, posttraumatic stress, and verbal intelligence were covaried. The results indicate that self-regulation depletion via a neutral, unrelated task can impact on emotion-related autobiographical memory processes that have been shown to be dysfunctional in emotionally disordered populations.

The Impact of Affective Context on Autobiographical Recollection in Depression.

Across two studies we investigated the influence of contextual cues on autobiographical memory recall. In Study 1, participants (N = 37) with major depressive disorder, in episode or in varying degrees of remission, were administered a Negative Autobiographical Memory Task (NAMT) that required them to retrieve negatively valenced memories in response to positive cue words (a positive context). We reasoned that increased depression symptom severity would be associated with a reduced ability to override priming from this disadvantageous context. Consequently, we hypothesized that increased depressive severity would counterintuitively be associated with reduced negativity ratings for retrieved personal memories to positive cues on the NAMT. This hypothesis was supported. Study 2, using a community sample (N = 63), demonstrated that a similar reduction in memory negativity was observed in individuals with lower working memory capacity-an index of executive control. Implications for autobiographical memory and executive training paradigms for depression are discussed.

Affective enhancement of working memory is maintained in depression.

We currently know little about how performance on assessments of working memory capacity (WMC) that are designed to mirror the concurrent task demands of daily life are impacted by the presence of affective information, nor how those effects may be modulated by depression-a syndrome where sufferers report global difficulties with executive processing. Across 3 experiments, we investigated WMC for sets of neutral words in the context of processing either neutral or affective (depressogenic) sentences, which had to be judged on semantic accuracy (Experiments 1 and 2) or self-reference (Experiment 3). Overall, WMC was significantly better in the context of depressogenic compared with neutral sentences. However, there was no support for this effect being modulated by symptoms of depression (Experiment 1) or the presence of recurrent major depressive disorder (MDD; Experiments 2 and 3). Implications of these findings for cognitive theories of the role of WM in depression are discussed in the context of a growing body of research showing no support for a differential impact of depressogenic compared with neutral information on WM accuracy. (PsycINFO Database Record

Reduced specificity of autobiographical memory and depression: the role of executive control.

It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1-4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6-8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.

Levels of specificity of autobiographical memories and of biographical memories of the deceased in bereaved individuals with and without complicated grief.

Traumatized individuals experiencing posttraumatic stress have difficulty retrieving specific autobiographical memories to cue words on the Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). This may represent a generalized, functional avoidance of the personal past. However, such individuals also often report specific intrusive memories of their trauma in the day-to-day. This raises the possibility that memories tied to the source of the person's distress are immune to this putative avoidance process. This was investigated in bereaved individuals with complicated grief (CG) who reported intrusive, specific memories from the life of their deceased loved one, and matched bereaved controls without CG. Participants performed the AMT and two Biographical Memory Tests (BMTs), cueing memories from the life of the deceased (BMT-Deceased) and from a living significant other (BMT-Living). To negative word cues, the CG group showed reduced specificity for the AMT and BMT-Living, relative to controls, but this effect was reversed on the BMT-Deceased. These data support the proposal that memories tied to the source of an individual's distress are immune to the processes that underlie the standard reduced specificity effect.

Dysfunctional attitudes in seasonal affective disorder.

Research examining dysfunctional attitudes in Seasonal Affective Disorder (SAD) has produced contrasting results. The present study sought to resolve this contradiction by addressing some methodological problems of the previous studies. The study examined dysfunctional attitudes using the Dysfunctional Attitudes Scale (DAS) in individuals with SAD and never-depressed controls. The SAD group were tested both when depressed in the winter (Time 1) and during their remission period (Time 2). At Time 1 the SAD group displayed a relatively elevated DAS compared to controls and to their Time 2 scores. These data therefore provide potential support for a view that SAD is characterized by underlying dysfunctional attitudes.

Reduced specificity of autobiographical memories following a negative mood induction.

Reduced autobiographical memory specificity (AMS) to emotional and neutral cue words appears to be a stable cognitive marker of clinical depression. For example, reduced AMS is present in remitted/recovered depressed patients and shows no reliable relationship with current levels of depressed mood in correlational studies. The present study examined whether reduced AMS could be induced in healthy volunteers with no history of depression, using a negative mood manipulation and whether levels of AMS and induced mood were positively correlated. Results showed a reduction in AMS following negative mood induction, compared to a neutral induction, whereas positive mood induction had no effects on AMS. Furthermore, lower happiness following the induction phase correlated positively with reduced AMS, and the extent of happiness reduction from pre- to post-induction correlated positively with reduction in AMS. These results suggest that AMS is, at least in part, a function of current emotion state. The implications for the literature on AMS as a stable marker of clinical depression are discussed.

Processing of emotional information in seasonal depression across different cognitive measures.

This study examined memory for emotional material, endorsement of emotional adjectives, and negative attributional style (NAS) in seasonal affective disorder (SAD). SAD patients showed elevated NAS and increased endorsement of negative self-referent adjectives, but no memory bias for negative material, when compared with never-depressed controls. Longitudinal analyses revealed that none of these cognitive measures significantly predicted later symptom levels independent of initial symptom levels, in the SAD patients. The cross-sectional findings for adjective endorsement and memory were replicated in a second experiment. These data provide further evidence that depression-related memory effects in SAD are different from those found in nonseasonal depression. Accounts of these differences involving putative mood-repair processes and/or an absence of dysfunctional negative schemas in SAD are discussed.

Facets of pejorative self-processing in complicated grief.

OBJECTIVE: Complicated grief (CG) has been proposed as a psychiatric response to bereavement distinct from established mood and anxiety disorder diagnoses. Little is known about the nature of cognitive-affective processing in CG, nor any similarities or differences compared with the processing profiles associated with other emotional disorders. Three studies therefore investigated 3 broad facets of negative self-processing associated with either elevated symptoms of, or diagnosis of, CG--namely, self-related attributions or blame, self-devaluation, and cognitions about the future self. METHOD: These self-processing domains were assessed using a variety of self-report and scenario-based measures either linked specifically to the bereavement or more general in their focus. Study 1 used a correlational design in a community bereaved sample. Study 2 employed an extreme-groups approach looking at individuals high versus low in CG symptoms, and Study 3 compared those with a CG diagnosis to healthy bereaved controls. RESULTS: The data revealed a profile of processing in CG characterized by significant relationships between CG symptoms or diagnosis and both self-devaluation and negative self-related cognitions about the future, but the data provided no support for a similar relationship with negative self-related attributions. CONCLUSIONS: These findings extend our understanding of self-related cognitive processing in CG. They also suggest that CG is characterized by a cognitive-affective processing profile that is distinct from that associated with other disorders, notably major depression, in the literature. This has potential implications for the psychological treatment of CG and for its nosological status as a post-loss syndrome distinct from depression.

The structure of past and future lives in depression.

This study assessed the organization of past autobiographical knowledge in individuals with either current major depressive disorder (MDD), MDD in remission, or no history of MDD (the control group). Participants generated personal lists of "life chapters," dividing both their past and potential future into subjectively meaningful episodes or themes (e.g., "married life"). They were then given a list of potentially chapter-descriptive positive or negative attributes and sorted them according to the different chapters. Results revealed that, relative to the control group, MDD participants selected more negative attributes overall, showed greater redundancy for negative attributes (i.e., using the same ones repeatedly across chapters) and reduced redundancy for positive attributes, and exhibited greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters). A similar pattern emerged for the remitted MDD group relative to controls, with the exception of negative redundancy, which was not elevated. For future chapters, there were no group differences. Finally, a greater number of past depressive episodes was associated with increasingly reduced positive redundancy. These data reveal a "depressogenic" structuring of past (but not future) knowledge in MDD that is also evident in a remitted MDD group, with the exception of negative redundancy, which appears to be a marker of the acute state. These findings shed light on important aspects of the organization of past knowledge that are likely to be linked to maladaptive processing biases in those with a depression history.

Age shall not weary us: deleterious effects of self-regulation depletion are specific to younger adults.

Self-regulation depletion (SRD), or ego-depletion, refers to decrements in self-regulation performance immediately following a different self-regulation-demanding activity. There are now over a hundred studies reporting SRD across a broad range of tasks and conditions. However, most studies have used young student samples. Because prefrontal brain regions thought to subserve self-regulation do not fully mature until 25 years of age, it is possible that SRD effects are confined to younger populations and are attenuated or disappear in older samples. We investigated this using the Stroop color task as an SRD induction and an autobiographical memory task as the outcome measure. We found that younger participants (<25 years) were susceptible to depletion effects, but found no support for such effects in an older group (40-65 years). This suggests that the widely-reported phenomenon of SRD has important developmental boundary conditions casting doubt on claims that it represents a general feature of human cognition.