Amygdala response to self-critical stimuli and symptom improvement in psychotherapy for depression.

BACKGROUND: Cognitive-behavioural therapy is efficacious in the treatment of major depressive disorder but response rates are still far from satisfactory. AIMS: To better understand brain responses to individualised emotional stimuli and their association with outcome, to enhance treatment. METHOD: Functional magnetic resonance imaging data were collected prior to individual psychotherapy. Differences in brain activity during passive viewing of individualised self-critical material in 23 unmedicated out-patients with depression and 28 healthy controls were assessed. The associations between brain activity, cognitive and emotional change, and outcome were analysed in 21 patients. RESULTS: Patients showed enhanced activity in the amygdala and ventral striatum compared with the control group. Non-response to therapy was associated with enhanced activity in the right amygdala compared with those who responded, and activity in this region was negatively associated with outcome. Emotional but not cognitive changes mediated this association. CONCLUSIONS: Amygdala hyperactivity may lessen symptom improvement in psychotherapy for depression through attenuating emotional skill acquisition.

Preliminary Evidence for a Nexus between Rumination, Behavioural Avoidance, Motive Satisfaction and Depression.

UNLABELLED: The present study tested a theoretically derived link between rumination and depressive symptoms through behavioural avoidance and reduced motive satisfaction as a key aspect of positive reinforcement. Rumination, behavioural avoidance, motive satisfaction and levels of depression were assessed via self-report measures in a clinical sample of 160 patients with major depressive disorder. Path analysis-based mediation analysis was used to estimate the direct and indirect effects as proposed by the theoretical model. Operating in serial, behavioural avoidance and motive satisfaction partially mediated the association between rumination and depressive symptoms, irrespective of gender, medication and co-morbid anxiety disorders. This is the first study investigating the associations between behavioural avoidance, rumination and depression in a clinical sample of depressed patients. The findings are in line with an understanding of rumination in depression as also serving an avoidance function. KEY PRACTITIONER MESSAGE: Rumination, avoidance, motive satisfaction and levels of depressive symptoms were examined in a clinical sample of 160 outpatients with major depressive disorder. Path analysis-based mediation analysis revealed that, operating in serial, avoidance and motive satisfaction partially mediated the link between rumination and levels of depressive symptoms. Findings support an understanding of rumination in depression as serving an avoidance function.

Interpersonal differentiation within depression diagnosis: relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance.

We examined interpersonal problems in psychotherapy outpatients with a principal diagnosis of a depressive disorder in routine care (n=361). These patients were compared to a normative non-clinical sample and to outpatients with other principal diagnoses (n=959). Furthermore, these patients were statistically assigned to interpersonally defined subgroups that were compared regarding symptoms and the quality of the early alliance. The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression. Latent Class Analysis identified eight distinct interpersonal subgroups, which differed regarding self-reported symptom load and the quality of the early alliance. However, therapists' alliance ratings did not differentiate between the groups. This interpersonal differentiation within the group of patients with a principal diagnosis of depression may add to a personalized psychotherapy based on interpersonal profiles.

Interpersonal microprocesses predict cognitive-emotional processing and the therapeutic alliance in psychotherapy for depression.

Interpersonal theories of psychotherapy hypothesize that the success of therapy depends on the therapist's and patient's dominant and affiliative behaviors as well as their interplay (complementarity). This study sought to investigate (a) how in-session interpersonal microprocesses predict postsession evaluations of the therapeutic alliance as well as cognitive-emotional processing and (b) how complementarity develops over the course of a therapy session. Twenty depressed patients were treated at a university-based outpatient clinic with a variant of cognitive therapy. One session was analyzed from each therapy's middle phase using a novel real-time rating procedure (joystick method) to assess the patients' and therapists' affiliative and dominant behaviors as well as their resulting complementarity over the course of the session. The therapeutic alliance and cognitive-emotional processing were assessed by self-reports directly after the respective session. As predicted, more emotional arousal was associated with deviations from complementarity, whereas a positive alliance was related to affiliative patient behavior. Moreover, marginally significant trends suggest that refraining from answering to the pull of patient hostility might benefit both the alliance as well as cognitive-emotional processing. Overall, multilevel growth modeling revealed a significant cubic trend of complementarity over the course of the session. Implications for future research and practice are discussed.

Impact messages of depressed outpatients as perceived by their significant others: profiles, therapeutic change, and relationship to outcome.

Whereas previous interpersonal research in depression has frequently used self-reports, patients' impact on others is rarely analyzed. We analyzed impacts of 180 depressed psychotherapy outpatients out of 832 diagnostically heterogeneous patients as rated by their significant others. Depressed patients were perceived as more submissive, hostile-submissive, and friendly-submissive, and as less dominant and friendly-dominant than patients with other principle disorders. After therapy, the 59 depressed patients whose significant others also provided data after treatment were perceived as less submissive (friendly-submissive, submissive, hostile-submissive) and more dominant and friendly-dominant. Whereas a decrease in submissiveness and hostile-submissiveness was associated with positive outcomes, decrease in friendly-submissiveness was unrelated. Cluster analyses suggested four distinct interpersonal subgroups. We discuss these results in terms of interpersonal theory and interpersonal assessment in depression therapy.

The structure and correlates of self-reported DSM-5 maladaptive personality traits: findings from two German-speaking samples.

The authors investigated the structure and correlates of DSM-5 maladaptive personality traits in two samples of 577 students and 212 inpatients using the German self-report form of the Personality Inventory for DSM-5. They found that (a) the factor structure of DSM-5 trait facets is largely in line with the proposed trait domains of Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism; (b) all DSM-5 trait domains except Psychoticism are highly related to the respective domains of the Five-Factor Model of personality; (c) the trait facets are positively associated with a self-report measure of general personality dysfunction; and (d) the DSM-5 trait facets show differential associations with a range of self-reported DSM-IV Axis I disorders. These findings give further support to the new DSM-5 trait model and suggest that it may generalize to other languages and cultures.

Self-compassion in depression: associations with depressive symptoms, rumination, and avoidance in depressed outpatients.

Self-compassion involves being kind to oneself when challenged with personal weaknesses or hardship and has been claimed to be associated with resilience in various areas. So far, there are only a handful of studies that investigate self-compassion and its relation to clinical depression. Therefore, the principal goals of the present study were (a) to compare self-compassion in clinically depressed patients and never-depressed subjects, (b) to investigate self-compassion and its relation to cognitive-behavioral avoidance and rumination in depressed outpatients, and (c) to investigate rumination and avoidance as mediators of the relationship between self-compassion and depressive symptoms. One hundred and forty-two depressed outpatients and 120 never-depressed individuals from a community sample completed a self-report measure of self-compassion along with other measures. Results indicate that depressed patients showed lower levels of self-compassion than never-depressed individuals, even when controlled for depressive symptoms. In depressed outpatients, self-compassion was negatively related to depressive symptoms, symptom-focused rumination, as well as cognitive and behavioral avoidance. Additionally, symptom-focused rumination and cognitive and behavioral avoidance mediated the relationship between self-compassion and depressive symptoms. These findings extend previous research on self-compassion, its relation to depression, as well as processes mediating this relationship, and highlight the importance of self-compassion in clinically depressed patients. Since depressed patients seem to have difficulties adopting a self-compassionate attitude, psychotherapists are well advised to explore and address how depressed patients treat themselves.