Communication modality matters: Co-rumination via in-person versus digital modalities has different prospective associations with depression and friendship quality.

INTRODUCTION: Co-rumination is an interpersonal emotion regulation strategy in which negative feelings and problems are discussed perseveratively with another person. Although co-rumination is salient in adolescence, research to date has focused on co-rumination occurring in person and has not kept pace with the surge in digital communication that begins in adolescence. This study examined the degree, associations among, and consequences (i.e., depressive symptoms, and friendship quality) of adolescents' co-rumination via in-person, text, social media, and phone modalities. METHODS: Adolescents (n = 109; 51 girls, 57 boys, 1 nonbinary; Mage = 12.83 years) residing in Canada, completed self-report questionnaires on co-rumination, depressive symptoms, and friendship quality for up to 2 years. RESULTS: Adolescents engaged in co-rumination across all modalities, particularly in-person. Findings indicated a negative association between in-person co-rumination at baseline and in-person co-rumination over time. Whereas less text co-rumination was associated with increased depressive symptoms over time, greater phone co-rumination was associated with increased depressive symptoms over time. Although greater in-person co-rumination was positively associated with friendship quality concurrently, it was negatively associated with friendship quality prospectively. CONCLUSIONS: Taken together, co-rumination outcomes may vary depending on communication modality. Implications for adolescents' mental and social wellbeing are discussed.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents.

INTRODUCTION: Early adolescence represents a time of heightened vulnerability for depression. Negative interpretation biases have been associated with increases in depressive symptoms during this developmental period; however, the mechanisms underlying the association between interpretation biases and depression remain poorly understood. Cognitive theories posit that interpretation biases give rise to depression by modulating daily affect, particularly in the context of stress. However, this has not yet been directly examined. The present study tested affect intensity and instability as mechanisms linking negative interpretation biases with change in adolescent depressive symptoms. METHODS: Ninety-four adolescents (aged 11-13 years; 51% boys) from Vancouver, Canada, were recruited for this longitudinal study. At baseline (Time 1), participants self-reported depressive symptoms and completed the Scrambled Sentences Task to assess negative interpretation biases. Next, participants completed daily diaries to assess positive affect (PA) and negative affect (NA) during a naturalistic stressor-the first 2 weeks of high school (Time 2). Finally, participants self-reported depressive symptoms 3 months later (Time 3). Path models were conducted to test whether PA and NA intensity and instability mediated prospective associations between negative interpretation biases and depressive symptom changes. RESULTS: Although NA intensity, NA instability, and PA instability predicted increases in depressive symptoms, only NA intensity mediated associations between interpretation biases and symptom changes. Neither PA intensity nor instability mediated these associations. CONCLUSIONS: Elevated daily NA represents a specific mechanism through which stronger negative interpretation biases predict increases in depressive symptoms in adolescence.

Co-rumination across in-person and digital communication: Associations with affect and relationship closeness in adolescents.

INTRODUCTION: Despite the prominence of interpersonal emotion regulation, particularly during adolescence, it is a relatively understudied area of investigation. Co-rumination is an interpersonal emotion regulation strategy that is frequently used by adolescents. Traditional examinations of co-rumination have focused on its occurrence in person, while largely overlooking digital modes of communication. This study was the first to investigate adolescents' co-rumination across multiple communication modalities (i.e., in person, text, social media, phone) and its downstream association with affect and relationship closeness. Specifically, we examined: (1) the frequency of co-rumination across modalities, (2) the effect of co-rumination in one modality on the future use of co-rumination within that same modality (i.e., stability) and across other modalities (i.e., generalization); and (3) the prospective relation of co-rumination on negative affect, positive affect, and relationship closeness. METHODS: Adolescents (n = 71; 33 girls and 38 boys; Mage = 12.70 years) residing in Canada completed twice-daily diary surveys for 14 days. RESULTS: Findings indicated that adolescents co-ruminate across all modes of communication, particularly in person. There also was evidence of co-rumination stability and generalization over time for some modes of communication (within phone and from social media to in-person interactions), but not for others. Co-rumination through text and over the phone had affective and/or social benefits, whereas co-rumination through social media predicted diminished positive affect. We also identified ways these findings differed by gender. CONCLUSIONS: Implications for adolescents' emotional and social development and the field of co-rumination are discussed.

The effect of self-referential processing on anxiety in response to naturalistic and laboratory stressors.

Although stressful life events increase risk for symptoms of Generalised Anxiety Disorder (GAD), we know little about mechanisms that increase GAD symptoms during times of stress. Despite evidence that self-referential processing contributes to other forms of psychopathology, namely depression, it is unknown whether self-referential processing also contributes to symptoms of GAD. Thus, we examined the association of self-referential processing with GAD symptoms in response to a naturalistic stressor (Study 1; n=135) and with anxiety-tension in response to a laboratory stressor (Study 2; n=56). In Study 1, participants completed the self-referential encoding task (SRET) in their initial weeks of university, and we assessed GAD symptoms four times across the semester. In Study 2, participants completed the SRET immediately before a laboratory stressor, and we assessed moment-to-moment changes in anxiety-tension. Greater negatively biased self-referential processing was associated with higher GAD symptoms at the start of university and greater reactivity to the laboratory stressor. In contrast, greater positively biased self-referential processing served as a protective factor associated with greater decline in symptoms over time. This study is the first to demonstrate that there are valence-specific effects of self-referential processing on anxiety, suggesting that self-referential processing may be relevant to GAD.

Patterns of respiratory sinus arrhythmia and trajectories of anxiety and depressive symptoms in early adolescence.

In children and adults, individual differences in patterns of respiratory sinus arrhythmia (RSA; i.e., interactions between resting RSA and RSA reactivity to stress) have emerged as a central predictor of internalizing symptoms. However, it is unclear whether individual differences in patterns of RSA also contribute to internalizing symptoms during the key developmental period of early adolescence, when rates of internalizing symptoms sharply increase. In the present multi-wave longitudinal study, we assessed whether patterns of RSA predicted trajectories of the two most common types of internalizing symptoms among adolescents: anxiety and depression. In the baseline session, we assessed RSA at rest and in response to a psychosocial stressor (Trier Social Stress Test [TSST]) in a sample of 75 early adolescents (Mage = 12.85). Youth then completed measures of anxiety and depressive symptoms at baseline and four times over approximately two years. Findings indicate that RSA patterns predicted trajectories of anxiety, but not depression. Specifically, region of significance analyses indicated that individuals with high resting RSA who demonstrated RSA augmentation to the lab stressor evinced decreasing anxiety over the follow-up period. In direct contrast, adolescents with high resting RSA in combination with RSA withdrawal to the stressor exhibited a trajectory of increasing anxiety. Findings provide preliminary evidence for understanding RSA as a developmentally salient risk or protective factor.

Osteocalcin: A novel biomarker of adolescent psychopathology.

Osteocalcin is a bone-derived hormone implicated in the acute stress response and recently linked to adult depression. Yet it is unclear whether osteocalcin is a biomarker of other forms of psychopathology and whether osteocalcin-psychopathology associations emerge during developmentally sensitive periods earlier in life. Thus, in the current pilot study we examined salivary osteocalcin and psychiatric symptoms and disorders among 48 early adolescents during a period of stress. A logistic regression indicated lower osteocalcin was associated with meeting criteria for a psychiatric disorder, OR = 0.43, 95 % CI [.002,.924], and showed moderate-to-large cross-sectional associations with a range of elevated psychopathology symptoms, Bs ≥ |-3.44|, ps ≤.034. Multilevel linear growth models indicated that low osteocalcin prospectively predicted an even greater range of psychopathology symptoms at one-year follow-up as well as increases in some symptoms over time, Bs ≥ |-1.83|, ps ≤.021. Findings introduce osteocalcin as a biomarker of diverse forms of psychopathology in youth. Osteocalcin is a potential transdiagnostic mechanism through which dysregulated responses to stress could cause or exacerbate various types of psychopathology, highlighting a promising target for clinical assessment and early intervention.

Attentional Biases and their Push and Pull with Rumination and Co-Rumination is Based on Depressive Symptoms: a Prospective Study of Adolescents.

Emotion regulation (ER) is central to adolescent mental health and wellbeing. However, the mechanisms underlying two common ER strategies - rumination and its interpersonal counterpart, co-rumination - are insufficiently understood in youth. Past research has documented that attentional disengagement biases are associated with rumination in adults, particularly among individuals with elevated depressive symptoms. Extending this line of research, the current study investigated whether attentional disengagement biases predicted rumination and co-rumination in adolescents based on their symptoms of depression. Using a multi-wave prospective design, 91 early adolescents (47% female, Mage = 12.87) completed a measure of depressive symptoms and the Affective Posner Task to assess early and late attentional processes at baseline. Adolescents also completed measures of rumination and co-rumination at baseline and every 3-months for one year. A multivariate means-as-outcomes multilevel model indicated that early disengagement biases for sad and happy faces interacted with depressive symptoms to predict later rumination and co-rumination. Critically, the direction of findings across rumination and co-rumination differed based on depressive symptoms. Results are the first to delineate a distinct pattern of attentional disengagement biases that predict rumination versus co-rumination in early adolescents. Findings extend theoretical conceptualizations of rumination to youth and provide the first account of cognitive mechanisms underlying co-rumination.

Interpersonal emotion regulation flexibility: Effects on affect in daily life.

Although the emotion regulation (ER) literature is vast, two emerging areas are particularly noteworthy. First, as opposed to the traditional blanket characterization of ER strategies as adaptive or maladaptive, theoretical models have highlighted the adaptability of greater ER flexibility (i.e., flexibly implementing ER strategies based on the context). Second, instead of focusing on how individuals independently regulate emotions, researchers are increasingly examining how ER can occur with the help of another person, a process known as interpersonal emotion regulation (IER). This study is the first to integrate these two emerging areas of research and to apply the two main theories of ER flexibility to investigate the effect of IER flexibility on negative and positive affect. A sample of 384 adults (Mage = 38.58 years, SD = 13.82) residing predominantly in North America completed this 14-day daily diary study. As expected, greater repertoire and greater responsivity to feedback were associated with more adaptive affective outcomes (i.e., less negative affect and/or more positive affect). However, unexpected findings also emerged: Greater context sensitivity did not significantly predict affect, and the covariation of within-strategy variability and environmental variability predicted higher negative affect. Findings provide initial evidence that IER adaptiveness is influenced by one's ability to flexibly implement IER strategies (i.e., IER flexibility). The results also highlight the components of IER flexibility (namely greater repertoire and responsivity to feedback) that predict daily adaptive affective consequences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Discordance Indices of Stress Sensitivity and Trajectories of Internalizing Symptoms in Adolescence.

Psychiatric illness in adolescence is associated with long-term impairments, making it critical to identify predictors of adolescent psychiatric distress. Individual differences in stress sensitivity could be associated with longitudinal trajectories of internalizing symptoms. Historically, researchers have operationalized stress sensitivity by assessing either objective or subjective responses to stress. However, we posit that the relative discordance between subjective and objective responses to stress is a critical metric of stress sensitivity. We examined whether two discordance-based indices of stress sensitivity were related to one another and to trajectories of internalizing psychopathology among a sample of 101 adolescent youths (Mage = 12.80 at baseline; 55% males) across two successive stressors: the high school transition and the COVID-19 pandemic. Using latent growth curve modeling, we found that greater discordance between subjective (i.e., affective) and objective (i.e., cortisol) responses to a social-evaluative stressor was associated with higher internalizing symptoms at baseline and an accelerated symptom growth trajectory across the first year of the pandemic. In contrast, early life stress sensitivity was not associated with internalizing symptoms. Findings suggest that the discordance between objective and subjective experiences of social-evaluative stress predicts a pernicious growth trajectory of internalizing symptoms during adolescence. This work advances current methodologies, contributes to theoretical models of internalizing psychopathology, and with replication could have implications for policy and practice by identifying a key vulnerability factor that increases adolescents' psychiatric distress over time.

Advances in stress and depression research.

PURPOSE OF REVIEW: Stress plays a central role in the onset and course of depression. However, only a subset of people who encounter stressful life events go on to experience a depressive episode. The current review highlights recent advances in understanding when, why, and for whom the stress-depression link occurs, and we identify avenues for future research. RECENT FINDINGS: In the last 18 months, researchers have taken a more nuanced perspective on the biopsychosocial mechanisms critical to the stress-depression link. For example, examination of specific facets of emotion regulation, including emotion regulation flexibility and interpersonal emotion regulation, has been critical to understanding its role in depression. Similarly, refined investigations of social support allowed researchers to identify distinct - and occasionally opposite - outcomes depending on the context or manner in which the support was provided. Researchers also documented that the stress-depression link was enhanced by dysregulation of several stress-sensitive biological systems, such as the immune system, microbiome, endocrine system, and neuroanatomical substrates. SUMMARY: Recent studies highlight the importance of adopting a nuanced understanding of mechanisms and moderators that explain the stress-depression link. We also encourage continued engagement in collaborative, open science that uses multiple methods to study the full breadth of human diversity.

Emotion regulation and diurnal cortisol: A longitudinal study of early adolescents.

Aberrant patterns of diurnal cortisol, a marker of stress reactivity, predict adverse physical and mental health among adolescents. However, the mechanisms underlying aberrant diurnal cortisol production are poorly understood. Thus, the objective of this study was to investigate, for the first time, whether the core emotion regulation (ER) strategies of rumination (brooding, reflection), reappraisal, and suppression were prospectively associated with individual differences in diurnal cortisol during the COVID-19 pandemic, a period of significant stress. A community sample of 48 early adolescents (Mage = 13.45; 60% males) was recruited from British Columbia, Canada. Participants completed ER measures before the pandemic, and diurnal cortisol was assessed by collecting eight saliva samples over two days during the first COVID-19-related lockdown in the region. As expected, brooding predicted elevated waking cortisol and a blunted cortisol awakening response (CAR), whereas reflection predicted lower waking cortisol and suppression predicted a steeper CAR. Unexpectedly, reappraisal was not associated with diurnal cortisol production. Results indicate that ER strategies may represent a mechanism underlying individual differences in biological markers of wellbeing during stress.

Influence of Gender and Self-Perceived Competence on Psychological Well-Being in Adolescent and Young Adult Cancer Survivors.

Elucidating factors associated with mental health and well-being among adolescent and young adult cancer survivors (AYAs) is increasingly important as this population continues to grow. Adolescence and young adulthood are critical times for developing self-perceived competencies (SPCs), which may be shaped by the cancer experience and may have different consequences based on the person's gender. We assessed whether gender moderated the association between perceived competencies and mental health in 61 AYAs (51% males; 11-20 years old; diagnosed between 0.33 and 17.33 years old). Gender moderated the association of SPC in close friendship, job, and scholastic domains with depression, anxiety, and optimism.

The Association of Emotion Regulation Flexibility and Negative and Positive Affect in Daily Life.

In contrast to traditional classifications of emotion regulation (ER) strategies as either uniformly maladaptive or adaptive, recent theoretical models emphasize that adaptability is determined by greater ER flexibility (i.e., the ability to flexibly implement and adjust ER strategies based on the context). This study is the first to empirically test the two central perspectives of ER flexibility on affect. A sample of 384 adults (M age=38.58 years, SD=13.82) residing predominantly in North America completed daily diaries for 14 days. We found evidence that theoretical components of ER flexibility, as defined by greater context sensitivity in the selection of ER strategies, greater ER strategy repertoire, enhanced responsivity to affective feedback, and ER-environmental covariation, were associated with adaptive affective outcomes (i.e., reduced negative affect and/or increased positive affect). This study highlights the importance of examining ER flexibility and its consequences as a critical component of ER. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00132-7.

Impact of loneliness on diurnal cortisol in youth.

Loneliness is associated with multiple forms of psychopathology in youth. However, we do not yet know how loneliness gets "under the skin" in ways that may impact the long-term health and development of early adolescents. In particular, loneliness may influence youths' patterns of diurnal cortisol, an index of hypothalamic-pituitary-adrenal (HPA) axis functioning and a central predictor of health across the lifespan. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, or COVID-19) pandemic represents a salient period in which to study the consequences of loneliness, as recent work has provided evidence that the physical-distancing measures put in place to contain the virus have resulted in greater loneliness, particularly among youth. Thus, the current study aimed to examine the prospective association between loneliness during the COVID-19 pandemic and diurnal cortisol in early adolescents. We found that greater loneliness was associated with higher levels of cortisol at waking and a blunted cortisol awakening response (CAR). These results held even when controlling for covariates that can influence diurnal trajectories of cortisol. Critically, this pattern of HPA-axis functioning increases risk for adverse mental and physical health outcomes across adolescence and into adulthood. This study is the first to examine the prospective association between loneliness and diurnal cortisol in early adolescence, and the first to identify mechanisms that contribute to biological markers of distress during the COVID-19 pandemic. Findings underscore the importance of developing and distributing strategies to mitigate feelings of loneliness among youth.

The effects of inducing self-compassion on affective and physiological recovery from a psychosocial stressor in depression.

The current study was designed to extend previous research by testing whether self-compassion acts as a protective factor that facilitates faster affective and physiological recovery from stress in people with elevated depressive symptoms. Specifically, we examined the effect of experimentally induced self-compassion on positive affect, negative affect, and respiratory sinus arrhythmia (RSA) recovery from stress. Participants (N = 59) experiencing elevated depressive symptoms completed the Trier Social Stress Test (TSST), a standardized psychosocial stressor, and then were randomly assigned to either a self-compassion induction or a no-strategy control induction before resting quietly during the 30-min recovery period. During the induction period, participants in the self-compassion condition exhibited a greater increase in positive affect and a trend towards a greater decrease in negative affect than did participants in the no-strategy control condition. However, the psychological benefits of self-compassion did not continue during the post-induction recovery period. Moreover, changes in RSA levels did not differ between participants in the self-compassion and no-strategy control condition. These results suggest that, among individuals with elevated depressive symptoms, brief self-compassion inductions have short-term beneficial psychological, but not physiological, effects. As such, our findings delineate the benefits and boundaries of single-session self-compassion inductions in depression, and in doing so, inform future experimental and applied research.

Cognitive disengagement and biological stress responses in early adolescence.

Individual differences in biological responses to stress increase risk for the onset and exacerbation of health and psychiatric conditions. Biases in cognitive disengagement are hypothesized to underlie these individual differences in biological responses to stress. However, no studies have examined which cognitive disengagement bias has the strongest relation with biological responses to stress, and no studies have examined this relation during early adolescence, despite evidence that this is a critical developmental window in which patterns of cognition and biological responses to stress influence trajectories of health throughout life. The current study is the first to test whether difficulty disengaging attention versus working memory from valenced stimuli is associated with biological responses to stress in early adolescence. Youth between 11 and 13 years of age completed two computer-based tasks to assess biases in attention and working memory disengagement to valenced stimuli, and then completed a standardized psychosocial stressor. Consistent with expectations, attention and working memory disengagement biases were associated with stress responses of both the neuroendocrine and autonomic nervous systems, but bias valence and cognitive system influenced the directionality of results. These findings inform our understanding of cognitive mechanisms that influence biological stress reactivity.

Childhood Maltreatment, Negative Self-Referential Processing, and Depressive Symptoms During Stress.

INTRODUCTION: Researchers have documented that the impact of childhood maltreatment on later symptoms of depression differs depending on the type(s) of maltreatment experienced, with emotional abuse and neglect being more likely than other forms of childhood maltreatment to increase the risk for depression. It is possible that emotional abuse and neglect are more likely to increase the risk for depression because they promote the development of negative self-referential processing (SRP), but this has not yet been tested empirically. The current study was designed to examine whether negative SRP mediated the association between different forms of childhood maltreatment and symptoms of depression during a time of stress. METHODS: We assessed the experience of different forms of childhood maltreatment (ie, emotional neglect, physical neglect, emotional abuse, physical abuse, and sexual abuse) and negatively biased self-schemas early on in the university semester, among a sample of undergraduate students. We then assessed levels of depressive symptoms 2 months later during a naturalistic stressor (ie, university students' first final exams). RESULTS: As expected, negative SRP mediated the relation between both neglect and emotional abuse, but not physical and sexual abuse, and later symptoms of depression. DISCUSSION: This is the first study to examine SRP as a mechanism underlying the association between forms of childhood maltreatment and symptoms of depression during a time of stress. Results suggest that the development of negative SRP biases may explain why some types of childhood maltreatment are more likely than others to increase an individual's risk for depression during stressful developmental periods.

Effects of working memory training on cognitive, affective, and biological responses to stress in major depression: A novel cognitive bias modification protocol.

BACKGROUND: Over 320 million individuals are living with Major Depressive Disorder (MDD), a leading cause of disability worldwide. Thus, there is a crucial need to identify processes that contribute to the maintenance of depressive episodes. Difficulty removing negative information from working memory (WM) is posited to exacerbate affective, cognitive, and biological dysregulation in Major Depressive Disorder (MDD), but this has not yet been tested empirically. METHODS: In this study we examined whether training depressed individuals to remove negative information from WM (RNI training) would reduce symptoms of depression and levels of rumination, and would be associated with attenuated biological responsivity to stress. Individuals diagnosed with MDD were randomly assigned to complete Real-RNI training or Sham-RNI training for six days. RESULTS: Across conditions, participants exhibited significant improvements from pre- to post-training in removing negative information from WM, symptoms of depression, and rumination. Furthermore, participants in the Real-RNI condition showed a more attenuated pattern of cortisol and respiratory sinus arrhythmia (RSA) responses to stress than did participants in the Sham-RNI training condition. LIMITATIONS: We did not assess the long-term effects of training. It will be important for future research to examine whether the documented training-related effects persist across time. CONCLUSIONS: This study is the first to examine the effects of RNI training on clinical symptoms and biological responses to stress in MDD, and it provides experimental evidence that training individuals with depression to remove negative information from WM can help to modulate the heightened biological responses to stress seen in depression.

A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls.

With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%-20% of the patients in mental health outpatient facilities and 15%-40% in mental health inpatient facilities. Further, while 75%-80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

Effectiveness of a modified dialectical behaviour therapy for adolescents within a stepped-care model.

OBJECTIVE: Early intervention with evidence-based treatment is important to halt the progression from early manifestations of personality disorder traits to adult personality disorders. The purpose of this study is to evaluate dialectical behaviour therapy (DBT) modified for an adolescent population with borderline personality disorder (BPD), offered within a stepped-care model. METHODS: Seven adolescents (M=1, F=6, Mage=16.86) diagnosed with either BPD or BPD traits participated in a modified 15-week DBT group. The group was offered within a stepped-care model, which required participants to have previously completed an 8-week distress-tolerance module. Pre/post scores on self-report measures of BPD symptomatology, including impulse control, emotional regulation and awareness, anxiety, depression, and substance use, were collected. RESULTS: Participants showed a post-treatment decrease in anxiety symptoms (large effect size) and disruptive behaviours (medium effect size). There was also an increase in emotional symptoms (medium effect size) and hyperactivity/inattention (medium effect size). CONCLUSION: The modified DBT group shows promise in alleviating symptoms of anxiety and some of the disruptive behaviours associated with BPD. The increase in emotional symptoms may be due to the expressive nature of DBT, and may contribute to their eventual therapeutic processing in the next step of the program.