Internet-based cognitive behavior therapy for major depressive disorder: A randomized controlled trial.

BACKGROUND: Prior research has shown that the Sadness Program, a technician-assisted Internet-based cognitive behavioral therapy (iCBT) intervention developed in Australia, is effective for treating major depressive disorder (MDD). The current study aimed to expand this work by adapting the protocol for an American population and testing the Sadness Program with an attention control group. METHODS: In this parallel-group, randomized controlled trial, adult MDD participants (18-45 years) were randomized to a 10-week period of iCBT (n = 37) or monitored attention control (MAC; n = 40). Participants in the iCBT group completed six online therapy lessons, which included access to content summaries and homework assignments. During the 10-week trial, iCBT and MAC participants logged into the web-based system six times to complete self-report symptom scales, and a nonclinician technician contacted participants weekly to provide encouragement and support. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), and the secondary outcomes were the Patient Health Questionnaire-9 and Kessler-10. RESULTS: Intent-to-treat analyses revealed significantly greater reductions in depressive symptoms in iCBT compared with MAC participants, using both the self-report measures and the clinician-rated HRSD (d = -0.80). Importantly, iCBT participants also showed significantly higher rates of clinical response and remission. Exploratory analyses did not support illness severity as a moderator of treatment outcome. CONCLUSIONS: The Sadness Program led to significant reductions in depression and distress symptoms. With its potential to be delivered in a scalable, cost-efficient manner, iCBT is a promising strategy to enhance access to effective care.

Microstructure of frontoparietal connections predicts individual resistance to sleep deprivation.

Sleep deprivation (SD) can degrade cognitive functioning, but growing evidence suggests that there are large individual differences in the vulnerability to this effect. Some evidence suggests that baseline differences in the responsiveness of a fronto-parietal attention system that is activated during working memory (WM) tasks may be associated with the ability to sustain vigilance during sleep deprivation. However, the neurocircuitry underlying this network remains virtually unexplored. In this study, we employed diffusion tensor imaging (DTI) to investigate the association between the microstructure of the axonal pathway connecting the frontal and parietal regions--i.e., the superior longitudinal fasciculus (SLF)--and individual resistance to SD. Thirty healthy participants (15 males) aged 20-43 years underwent functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) at rested wakefulness prior to a 28-hour period of SD. Task-related fronto-parietal fMRI activation clusters during a Sternberg WM Task were localized and used as seed regions for probabilistic fiber tractography. DTI metrics, including fractional anisotropy, mean diffusivity, axial and radial diffusivity were measured in the SLF. The psychomotor vigilance test (PVT) was used to evaluate resistance to SD. We found that activation in the left inferior parietal lobule (IPL) and dorsolateral prefrontal cortex (DLPFC) positively correlated with resistance. Higher fractional anisotropy of the left SLF comprising the primary axons connecting IPL and DLPFC was also associated with better resistance. These findings suggest that individual differences in resistance to SD are associated with the functional responsiveness of a fronto-parietal attention system and the microstructural properties of the axonal interconnections.

Sleep difficulties are associated with increased symptoms of psychopathology.

Sleep problems often co-occur with psychopathological conditions and affective dysregulation. Individuals with mood disorders have significantly higher rates of sleep disturbances than healthy individuals, and among those with mood disorders, sleep problems are associated with lower rates of remission and response to treatment. Sleep disruption may itself be a risk factor for various forms of psychopathology, as experimental sleep deprivation has been found to lead to increased affective, cognitive, and somatic symptoms within healthy volunteers. However, little is known about the relationship between recurring sleep complaints in a naturalistic environment and symptoms of psychopathology among healthy individuals. In the present study, 49 healthy adults (21 males and 28 females) reported sleep quality and completed the Personality Assessment Inventory, a standardized self-report assessment of symptoms of psychopathology. Consistent with prior published findings during total sleep deprivation, individuals endorsing self-reported naturally occurring sleep problems showed higher scores on scales measuring somatic complaints, anxiety, and depression. Furthermore, the reported frequency of sleep disturbance was closely linked with the severity of self-reported symptoms. While causal directionality cannot be inferred, these findings support the notion that sleep and emotional functioning are closely linked.

The design organization test: further demonstration of reliability and validity as a brief measure of visuospatial ability.

Neuropsychological assessments are frequently time-consuming and fatiguing for patients. Brief screening evaluations may reduce test duration and allow more efficient use of time by permitting greater attention toward neuropsychological domains showing probable deficits. The Design Organization Test (DOT) was initially developed as a 2-min paper-and-pencil alternative for the Block Design (BD) subtest of the Wechsler scales. Although initially validated for clinical neurologic patients, we sought to further establish the reliability and validity of this test in a healthy, more diverse population. Two alternate versions of the DOT and the Wechsler Abbreviated Scale of Intelligence (WASI) were administered to 61 healthy adult participants. The DOT showed high alternate forms reliability (r = .90-.92), and the two versions yielded equivalent levels of performance. The DOT was highly correlated with BD (r = .76-.79) and was significantly correlated with all subscales of the WASI. The DOT proved useful when used in lieu of BD in the calculation of WASI IQ scores. Findings support the reliability and validity of the DOT as a measure of visuospatial ability and suggest its potential worth as an efficient estimate of intellectual functioning in situations where lengthier tests may be inappropriate or unfeasible.

Physical exercise and brain responses to images of high-calorie food.

Physical exercise has many health benefits, including improved cardiovascular fitness, lean muscle development, increased metabolism, and weight loss, as well as positive effects on brain functioning and cognition. Recent evidence suggests that regular physical exercise may also affect the responsiveness of reward regions of the brain to food stimuli. We examined whether the total number of minutes of self-reported weekly physical exercise was related to the responsiveness of appetite and food reward-related brain regions to visual presentations of high-calorie and low-calorie food images during functional MRI. Second, we examined whether such responses would correlate with self-reported food preferences. While undergoing scanning, 37 healthy adults (22 men) viewed images of high-calorie and low-calorie foods and provided desirability ratings for each food image. The correlation between exercise minutes per week and brain responses to the primary condition contrast (high-calorie>low-calorie) was evaluated within the amygdala, insula, and medial orbitofrontal cortex, brain regions previously implicated in responses to food images. Higher levels of exercise were significantly correlated with lower responsiveness within the medial orbitofrontal cortex and left insula to high-calorie foods. Furthermore, activation of these regions was positively correlated with preference ratings for high-calorie foods, particularly those with a savory flavor. These findings suggest that physical exercise may be associated with reduced activation in food-responsive reward regions, which are in turn associated with reduced preferences for unhealthy high-calorie foods. Physical exercise may confer secondary health benefits beyond its primary effects on cardiovascular fitness and energy expenditure.