Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial.

INTRODUCTION: Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55). METHODS: Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D). RESULTS: The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members. CONCLUSION: Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

Individual-Specific Animated Profiles of Mental Health.

How important is the timing of the pretreatment evaluation? If we consider mental health to be a relatively fixed condition, the specific timing (e.g., day, hour) of the evaluation is immaterial and often determined on the basis of technical considerations. Indeed, the fundamental assumption underlying the vast majority of psychotherapy research and practice is that mental health is a state that can be captured in a one-dimensional snapshot. If this fundamental assumption, underlying 80 years of empirical research and practice, is incorrect, it may help explain why for decades psychotherapy failed to rise above the 50% efficacy rate in the treatment of mental-health disorders, especially depression, a heterogeneous disorder and the leading cause of disability worldwide. Based on recent studies suggesting within-individual dynamics, this article proposes that mental health and its underlying therapeutic mechanisms have underlying intrinsic dynamics that manifest across dimensions. Computational psychotherapy is needed to develop individual-specific pretreatment animated profiles of mental health. Such individual-specific animated profiles are expected to improve the ability to select the optimal treatment for each patient, devise adequate treatment plans, and adjust them on the basis of ongoing evaluations of mental-health dynamics, creating a new understanding of therapeutic change as a transition toward a more adaptive animated profile.

Thinking Transtheoretically About Alliance and Rupture: Implications for Practice and Training.

Repairing alliance ruptures has the potential to serve as a powerful mechanism of change in psychotherapy. In this article, a transtheoretical individual-specific framework for repairing alliance ruptures is proposed. According to the proposed framework, at the intake session, the therapist evaluates the trait-like tendencies of individual patients to face ruptures in interpersonal relationships. We propose a typology based on which patients are assigned to one of the following therapeutic strategies: (a) a treatment where alliance rupture and repair is the main mechanism of change (Type A), (b) an added module that augments another treatment, focusing on rupture and repair (Type B), or (c) treatment where no rupture resolution work is carried out (Type C). The proposed framework is based on cumulative clinical knowledge, and its validity and utility need to be assessed in future research.

Is There an All-Embracing "Intolerance to Uncertainty" Construct? French Adaptation and Validation of the Intolerance to Uncertainty Scale-Revised.

Objective: Intolerance to uncertainty is a trait-like disposition largely studied in psychopathology and known to be involved in many psychological disorders. Yet, the very operationalization of this construct has prompted debate in the literature. Three different models have regularly been discussed: a correlated two-factor solution, a bifactorial solution, and a single-factor structure. A growing body of evidence suggests that the bifactorial model represents the adequate factorial solution; however, its validity has never been tested in a large French-speaking sample. Moreover, uncertainty remains regarding the associations between IUS-R and other psychological constructs, especially stress and depression. This project was designed to overcome these limitations. Method: To do so, we translated the scale into French and tested (n = 728) via confirmatory factor analyses (CFA) whether the French version would better fit with a bifactorial-, correlated, or single-factor structure, as implied by previous works. We also examined the internal reliability of the IUS-R, as well as its associations with concurrent measures of stress, depression, anxiety, and worry. Results: The results pointed to a bifactorial structure as the best-fitting model and provided evidence for a strong general intolerance of uncertainty factor that was more reliable and accounted for significantly more common variance than each subscale factor individually. Conclusions: We discuss how this bifactorial structure impacts the conceptualization of IU.

Psychometric Properties of the Chinese Version of the Brief State Rumination Inventory.

State rumination, unlike trait rumination which is described as a persistent and stable response style, is usually triggered by a specific stressful event and causes negative emotions within a short period of time. The measurement methods of trait rumination, such as the ruminative response scale (RRS), are therefore not fully applicable to state rumination. Recently, researchers have developed the brief state rumination inventory (BSRI) to characterize state rumination, addressing the gap in the field of accurate measurement of state rumination. To develop such an effective tool in the Chinese context, we developed a Chinese version of the BSRI and tested its psychometric properties. Two studies were conducted to address the research goal. In Study 1, we recruited 512 subjects, each of whom completed the Chinese version of the BSRI, RRS, emotional regulation questionnaire (ERQ), depression-anxiety-stress scale (DASS), and positive and negative affect scale (PANAS). Results showed that the scores of the BSRI were positively correlated with all other scale scores (ps < 0.001), and the correlation with the RRS was the highest, indicating that the BSRI showed good convergent validity. Additionally, the Cronbach's alpha coefficient for the Chinese version of the BSRI was 0.93. Study 2 aimed to examine the ecological validity of the Chinese version of the BSRI. We recruited another 54 subjects who were randomly divided into two groups, with 27 in the rumination induction group and 27 in the distraction group, and recorded the BSRI scores of the two groups before and after a specific experiment. We found there was a significant increase in BSRI scores after rumination induction (t = 3.91, p < 0.001), while there was no significant difference in the concrete distraction group before and after the experiment (t = 0.70, p = 0.48). In sum, the Chinese version of the BSRI showed good reliability and validity for assessing state rumination in the general Chinese population.

The Fingerprint-Like Pattern of Nocturnal Brain Activity Demonstrated in Young Individuals is Also Present in Senior Adulthood.

PURPOSE: The quantitative sleep EEG has been considered as electroencephalographic "fingerprint", ie, it is stable within but differs between individuals. So far, however, almost all studies addressing this aspect have been conducted in young men. It was therefore of interest to know whether the sleep EEG fingerprint concept holds true in older samples of both sexes. PATIENTS AND METHODS: Data from three different subsamples of 30 healthy individuals each were reused for the present secondary analysis (young men (YM) = 25.6 ± 2.4 years, elderly men (EM) = 69.1 ± 5.5 years, elderly women (EW) = 67.8 ± 5.7 years). Individuals slept ten times in the sleep laboratory, resulting in a total of 900 study nights. However, to avoid misinterpretation due to intervention-related changes in sleep EEG power spectra, only the 3 sham nights without any intervention were included, reducing the datasets to 270. To determine stability of NREM sleep EEG power spectra between sham night pairs, within- and between-subject Manhattan distance measures were computed separately by sample. RESULTS: Regardless of subsample and sham night pair, lowest distance measures, ie, largest similarity, were observed for within-subject power spectra comparisons (range of mean distance measures for EW from 3.82 to 4.06, for EM from 3.55 to 3.63, and for YM from 3.04 to 3.62). Moreover, intraindividual similarity did not differ substantially between samples. Between-subject power spectra distance measures were considerably larger (range of mean distance measures for EW from 12.95 to 13.15, for EM from 12.21 to 12.57, and for YM from 10.33 to 10.78) and varied significantly between young and elderly individuals. CONCLUSION: The present results support the view that the sleep EEG power spectrum is an individual trait-like characteristic that remains unique up until old age. This finding may help to increase the sensitivity in measuring intervention effects.

The Risk and Protective Factors for Pediatric Eye Injuries: A Case-Crossover Study.

Purpose: To investigate state- and trait-like risk factors leading to childhood eye injuries controlling for the between-subject difference. This study measured socioeconomic, environmental, behavioral, and injury event characteristics to identify eye injury protective and risk factors.Methods: A retrospective case-crossover study including patients aged 0-18 years old (y.o.) with severe eye trauma treated at the Canton Hospital Zenica between 2011 and 2017 was conducted. One case time point was at the time of injury, and two control time points 1 month before the injury and a month before the survey.Results: Of 36 patients meeting the criteria, four were excluded, resulting in 32 cases and 64 controls. The mean age was 10.79 in males (77.8%) and 11 y.o. in females (22.2%). In univariate GEE logistic regression unusual activity had odds of 17.25 (95%CI = 6.97, 42.70), working/chores vs.running activity odds of 6.60 (95%CI = 1.71, 25.46), very active level vs.an intermediate child activity level odds of 5.26 (1/0.19, 95%CI = 1.75, 16.67) no supervision odds of 2.63 (1/0.38, 95%CI = 1.45, 4.76) and less than 7 hours of sleep odds of 4.69 (95%CI = 1.06, 20.77) of sustaining an eye injury. Using the quasi-likelihood approach and QICu as an indicator, the best model yielded odds of getting eye injured = 0.59 + 19.35*engaging in unusual activity+0.21*supervised by an adult person+0.84*playing+3.04*working within the households+0.22*other activity.Conclusions: Giving the best model to predict injuries, the combined strategies of teaching, modifying the environment, and the watchful supervision present a preventive triad that needs to be further explored and encouraged in practice.

State-Dependent and Trait-Like Characteristics of Dysfunctional Attitudes in Patients With Major Depressive Disorder.

BACKGROUND: Studies have shown that patients with major depressive disorder (MDD) exhibit elevated dysfunctional attitudes (DAs). However, it remains controversial whether the DAs are state-dependent or trait-like features of MDD. METHODS: This study recruited 172 patients and 159 healthy controls (HCs) at baseline. DAs were respectively assessed by the 24-item Hamilton Depression Rating Scale (HAMD24) and the Chinese version of Dysfunctional Attitude Scale form A (C-DAS-A). After baseline, patients received a 6-month antidepressant treatment. General linear models were used to analyze the differences in the C-DAS-A total and factor scores between the acute and remitted MDD groups and the HC group. Paired t tests were used to assess the changes of C-DAS-A total and factor scores in the remitted MDD group before and after treatment. RESULTS: At baseline, patients with MDD showed significantly higher scores in C-DAS-A and its subscales than HCs (all P < 0.05). After treatment, the C-DAS-A total and factor scores decreased significantly in the remitted MDD group (all P < 0.05). However, the C-DAS-A total (P = 0.005) and five factors' scores (vulnerability, attraction and repulsion, perfectionism, compulsion, and dependence) remained elevated in the remitted MDD group as compared with HCs (all P < 0.05). There were moderate correlations between the baseline and remission phase C-DAS-A total and five factors' scores (all P < 0.05). CONCLUSION: DAs show a mixture of state-dependent and trait-like characteristics in MDD with partial improvement in the remission phase. Special attention should be paid to the residual DAs in the remitted MDD for the prevention of relapse.

Robust stability of trait-like vulnerability or resilience to common types of sleep deprivation in a large sample of adults.

STUDY OBJECTIVES: Sleep loss produces large individual differences in neurobehavioral responses, with marked vulnerability or resilience among individuals. Such differences are stable with repeated exposures to acute total sleep deprivation (TSD) or chronic sleep restriction (SR) within short (weeks) and long (years) intervals. Whether trait-like responses are observed to commonly experienced types of sleep loss and across various demographically defined groups remains unknown. METHODS: Eighty-three adults completed two baseline nights (10 h-12 h time-in-bed, TIB) followed by five 4 h TIB SR nights or 36 h TSD. Participants then received four 12-h TIB recovery nights followed by five SR nights or 36 h TSD, in counterbalanced order to the first sleep loss sequence. Neurobehavioral tests were completed every 2 h during wakefulness. RESULTS: Participants who displayed neurobehavioral vulnerability to TSD displayed vulnerability to SR, evidenced by substantial to near perfect intraclass correlation coefficients (ICCs; 78%-91% across measures). Sex, race, age, body mass index (BMI), season, and sleep loss order did not impact ICCs significantly. Individuals exhibited significant consistency of responses within, but not between, performance and self-reported domains. CONCLUSIONS: Using the largest, most diverse sample to date, we demonstrate for the first time the remarkable stability of phenotypic neurobehavioral responses to commonly experienced sleep loss types, across demographic variables and different performance and self-reported measures. Since sex, race, age, BMI, and season did not affect ICCs, these variables are not useful for determining stability of responses to sleep loss, underscoring the criticality of biological predictors. Our findings inform mathematical models and are relevant for the general population and military and health professions.

Disentangling Trait-Like Between-Individual vs. State-Like Within-Individual Effects in Studying the Mechanisms of Change in CBT.

Hofmann et al. argued that "[w]hile the clinical field has produced a dizzying number of treatment models and treatment protocols for virtually every psychiatric and psychological problem imaginable, increases in understanding of the processes of change in psychotherapy has been slow to arrive." We propose that one of the reasons for the slow progress is that prior psychotherapy research conflates trait-like and state-like components of mechanisms of change. Trait-like components can serve as prescriptive or prognostic variables, whereas state-like components reflect within-client processes of change, and may highlight active ingredients of successful treatment. Distinguishing between the two is essential for clarifying the underlying processes of change in psychotherapy, and ultimately identifying empirically-derived individualized treatment targets. We review studies that implement methodological and statistical approaches for disentangling the two. These studies clarified particular mechanisms of change that may operate in a given treatment, highlighted differences in the processes of change between different treatments, and explored the within-individual interplay between different mechanisms of change during treatment. Examples include studies investigating the therapeutic role of behavioral, cognitive, and interpersonal skills, as well as emotional processing. We conclude with suggestions for future research, including attention to diversity, improved measurement to facilitate a reliable and valid estimation of trait-like and state-like components, the use of appropriate statistical approaches to adequately disentangle the two components, integration of theory-driven and data-driven methods of analysis, and the need to experimentally manipulate the state-like changes in a given mechanism of change to strengthen causal inferences.

Season-independent cognitive deficits in seasonal affective disorder and their relation to depressive symptoms.

Although cognitive impairments are common in depressed individuals, it is unclear which aspects of cognition are affected and whether they represent state or trait features of depression. We here exploited a naturalistic model, namely the seasonal fluctuations in depressed status in individuals with Seasonal Affective Disorder (SAD), to study depression-related cognition, longitudinally. Twenty-nine medication-free individuals diagnosed with winter-SAD and 30 demographically matched healthy controls with no seasonality symptoms completed the Letter-number Sequencing task (LNS), the Symbol Digit Modalities Test (SDMT) and the Simple Reaction Time (SRT) twice; in summer and in winter. Compared to controls, SAD individuals showed significant season-independent impairments in tasks measuring working memory (LNS), cognitive processing speed (SDMT) and motor speed (SRT). In SAD individuals, cognitive processing speed was significantly negatively associated with the seasonal change in SAD depressive symptoms. We present novel evidence that in SAD individuals, working memory, cognitive processing- and motor speed is not only impaired in the winter but also in the summer. This suggests that certain cognitive impairments are SAD traits. Furthermore, impairments in cognitive processing speed appear to be related to depressive symptoms in SAD. Reduced processing speed may thus constitute a SAD vulnerability trait marker.

Beyond the neuropsychology of dreaming: Insights into the neural basis of dreaming with new techniques of sleep recording and analysis.

Recent advances in electrophysiological [e.g., surface high-density electroencephalographic (hd-EEG) and intracranial recordings], video-polysomnography (video-PSG), transcranial stimulation and neuroimaging techniques allow more in-depth and more accurate investigation of the neural correlates of dreaming in healthy individuals and in patients with brain-damage, neurodegenerative diseases, sleep disorders or parasomnias. Convergent evidence provided by studies using these techniques in healthy subjects has led to a reformulation of several unresolved issues of dream generation and recall [such as the inter- and intra-individual differences in dream recall and the predictivity of specific EEG rhythms, such as theta in rapid eye movement (REM) sleep, for dream recall] within more comprehensive models of human consciousness and its variations across sleep/wake states than the traditional models, which were largely based on the neurophysiology of REM sleep in animals. These studies are casting new light on the neural bases (in particular, the activity of dorsal medial prefrontal cortex regions and hippocampus and amygdala areas) of the inter- and intra-individual differences in dream recall, the temporal location of specific contents or properties (e.g., lucidity) of dream experience and the processing of memories accessed during sleep and incorporated into dream content. Hd-EEG techniques, used on their own or in combination with neuroimaging, appear able to provide further important insights into how the brain generates not only dreaming during sleep but also some dreamlike experiences in waking.

Conductas sexuales de riesgo en una muestra de estudiantes universitarios argentinos: relación con consumo de sustancias, inicio sexual temprano e impulsividad rasgo / Risky sexual behaviors in a sample of Argentinean college students: Relationship with substance use, early sexual onset and trait-like impulsivity

Resumen Introducción: Los adultos emergentes universitarios son particularmente vulnerables a presentar consumo abusivo de sustancias y conductas sexuales de riesgo (CSR), lo que incrementa el riesgo de contraer infecciones de transmisión sexual (ITS) o embarazo no deseado. Objetivo: Examinar, en universitarios, si el tipo de consumo de sustancias (alcohol versus uso concurrente de alcohol y marihuana) y el nivel de impulsividad rasgo se asocian con la frecuencia de CSR con parejas ocasionales. Método: Una muestra de 467 estudiantes completó una encuesta online que medía frecuencia de CSR, ocurrencia de consumo de alcohol y de marihuana en el último año y nivel de impulsividad. Resultados: Los consumidores de alcohol y marihuana, comparados con los consumidores de alcohol, reportaron mayor promedio de parejas sexuales al año y mayor arrepentimiento por no cuidarse contra ITS/embarazo. Los participantes con uso concurrente de sustancias, y niveles medios y altos en las facetas de impulsividad, falta de perseverancia y de premeditación, mostraron mayor frecuencia de encuentros sexuales que los consumidores de alcohol o con baja impulsividad. Conclusiones: Los hallazgos sugieren que el uso concurrente de sustancias y ciertas facetas de impulsividad se asocian a una mayor frecuencia de determinadas CSR. Esta información podría ser útil para intervenir preventivamente en CSR en universitarios argentinos.

Abstract Introduction: College students, a subpopulation of emerging adults, are particularly vulnerable to exhibit substance abuse and risky sexual behaviors. These behaviors put people at risk for sexually transmitted infections and/or unwanted pregnancy. Aim: To examine, in college students, whether the pattern of substance use (i.e., alcohol versus co-use of alcohol and marijuana) and the level of impulsivity are associated with the frequency of risky sexual behaviors with occasional partners. Method: A sample of 467 college students completed an online survey that assessed the frequency of risky sexual behaviors, past-year alcohol and marijuana use and trait-like impulsivity. Results: Alcohol/marijuana co-users, compared with alcohol users, reported a higher average of sexual partners per year and greater feelings of regret following careless sexual encounters. Co-users with medium or high levels in lack of perseverance and lack of premeditation (i.e., two facets of impulsivity) reported higher frequency of sexual encounters than alcohol users and/or students with low impulsivity. Conclusions: Findings suggest substance co-use, alongside different facets of impulsivity, are associated with greater frequency of specific risky sexual behaviors. These findings could better inform interventions aimed at prevent risky sexual behaviors in Argentinean college students.

Impact of experimentally manipulated sleep on adolescent simulated driving.

OBJECTIVE/BACKGROUND: Sleep restriction (SR) impairs adolescents' attention, which could contribute to high rates of driving crashes. Here, we examine the impact of experimental SR on adolescent drivers, considering whether that impact is moderated by the nature of the drive (urban/suburban vs. rural) or how vulnerable each adolescent is to attentional decline after SR. PARTICIPANTS/METHODS: A total of 17 healthy 16-18-year-old licensed drivers completed two five-night sleep conditions: SR (6.5 h in bed) versus extended sleep (ES; 10 h in bed) in counterbalanced order. After each, participants completed rural and urban/suburban courses in a driving simulator, and parents rated participants' attention in day-to-day settings. Vulnerability to SR was computed as cross-condition change in parent ratings. Dependent variables included standard deviation (SD) of lateral lane position (SDLP), mean speed, SD of speed, and crashes. Multivariate models examined the main and interaction effects of sleep condition, driving environment, and vulnerability to SR, covarying for years licensed. RESULTS: Although the effects for the other outcomes were nonsignificant, there were three-way interactions (sleep × drive × vulnerability) for mean speed and SDLP (p <0.02). During the rural drive, adolescents had less consistent lateral vehicle control in SR than ES, despite slower driving among those reported to be vulnerable to SR. During the urban/suburban drive, SR worsened SDLP only among adolescents reported to be vulnerable to SR. CONCLUSIONS: These preliminary findings suggest that even a moderate degree of SR may be a modifiable contributor to adolescent driving problems for some. This impact is widely present during monotonous rural drives and in a subgroup during interesting urban/suburban drives.

The Multidimensional Aspects of Sleep Spindles and Their Relationship to Word-Pair Memory Consolidation.

STUDY OBJECTIVES: Several studies proposed a link between sleep spindles and sleep dependent memory consolidation in declarative learning tasks. In addition to these state-like aspects of sleep spindles, they have also trait-like characteristics, i.e., were related to general cognitive performance, an important distinction that has often been neglected in correlative studies. Furthermore, from the multitude of different sleep spindle measures, often just one specific aspect was analyzed. Thus, we aimed at taking multidimensional aspects of sleep spindles into account when exploring their relationship to word-pair memory consolidation. DESIGN: Each subject underwent 2 study nights with all-night high-density electroencephalographic (EEG) recordings. Sleep spindles were automatically detected in all EEG channels. Subjects were trained and tested on a word-pair learning task in the evening, and retested in the morning to assess sleep related memory consolidation (overnight retention). Trait-like aspects refer to the mean of both nights and state-like aspects were calculated as the difference between night 1 and night 2. SETTING: Sleep laboratory. PARTICIPANTS: Twenty healthy male subjects (age: 23.3 ± 2.1 y). MEASUREMENTS AND RESULTS: Overnight retention was negatively correlated with trait-like aspects of fast sleep spindle density and positively with slow spindle density on a global level. In contrast, state-like aspects were observed for integrated slow spindle activity, which was positively related to the differences in overnight retention in specific regions. CONCLUSION: Our results demonstrate the importance of a multidimensional approach when investigating the relationship between sleep spindles and memory consolidation and thereby provide a more complete picture explaining divergent findings in the literature.