Neural response to rewards moderates the within-person association between daily positive events and positive affect during a period of stress exposure.

Stress and neural responses to reward can interact to predict psychopathology, but the mechanisms of this interaction are unclear. One possibility is that the strength of neural responses to reward can affect the ability to maintain positive affect during stress. In this study, 105 participants completed a monetary reward task to elicit the reward positivity (RewP), an event-related potential sensitive to rewards. Subsequently, during a stressful period, participants reported on their affect nine times a day and on daily positive and negative events for 10 days. Even during heightened stress, experiencing more positive events was associated with increased positive affect. The RewP significantly moderated this association: Individuals with a larger RewP reported greater increases in positive affect when they experienced more positive events, relative to individuals with a smaller RewP. A blunted RewP might contribute to stress susceptibility by affecting how much individuals engage in positive emotion regulation during stress.

Chronic stress in peer relationships moderates the association between pubertal development and neural response to emotional faces in adolescence.

Adolescence is a period of heightened risk for multiple forms of psychopathology, partly due to greater exposure to interpersonal stress. One way that interpersonal stress may increase risk for psychopathology is by altering the normative development of neural systems that support socio-affective processing. The late positive potential (LPP) is an event-related potential component that reflects sustained attention to motivationally-salient information and is a promising marker of risk for stress-related psychopathology. However, it is not clear how the LPP to socio-affective information changes across adolescence, nor whether exposure to stress with peers interferes with normative developmental differences in the LPP to socio-affective content during this period. In 92 adolescent girls (10-19 years old), we assessed the LPP to task-irrelevant emotional and neutral faces, as well as behavioural measures of interference following the presentation of these faces. Adolescents at more advanced stages of puberty showed a smaller LPP to emotional faces, but adolescents exposed to greater peer stress exhibited a larger LPP to these stimuli. Additionally, for girls exposed to lower levels of peer stress, more advanced pubertal development was associated with a smaller LPP to emotional faces, whereas for girls exposed to higher levels of peer stress, the association between pubertal development and the LPP to emotional faces was not significant. Neither stress nor pubertal stage was significantly associated with behavioural measures. Combined, these data suggest that one pathway through which stress exposure increases risk for psychopathology during adolescence is by interfering with the normative development of socio-affective processing.

Risk factors for the intergenerational transmission of depression in women and girls: Understanding neural correlates of major depressive disorder and the role of early-onset maternal depression.

Deficits in neural reward processing have been implicated in the etiology of depression and have been observed in high-risk individuals. However, depression is a heterogeneous disorder, and not all depressed individuals exhibit blunted neural reward response, suggesting the need to examine more specific depression phenotypes. Early-onset depression, a well-defined phenotype, has been associated with greater intergenerational transmission of depression and appears more closely linked to neural reward processing deficits. The present study examined whether a maternal history of early-onset depression was associated with neural reward response among mothers and their daughters. Mothers with and without a history of depression, as well as their biological, adolescent daughters (N = 109 dyads), completed a monetary reward guessing task while electroencephalogram was collected. Analyses focused on the Reward Positivity (RewP), an event-related potential following reward receipt. Adjusting for current depressive symptoms, maternal early-onset depression was associated with a blunted RewP in the mothers and a numerically smaller RewP in their never-depressed, adolescent daughters. Maternal adult-onset depression was not statistically associated with a blunted RewP in mothers or daughters. Thus, a blunted RewP appears to be a trait-like vulnerability marker for depression that emerges before depression onset and relates to more specific depression phenotypes (e.g., early-onset depression). These findings have implications for early identification of individuals at risk of depression and for developing more targeted interventions.

Associations between peer stress in early adolescence and multiple event-related potentials elicited during social feedback processing.

Interpersonal stress in adolescence has been associated with alterations in neural responses to peer feedback, and increased vulnerability to psychopathology. However, it is unclear whether the associations of interpersonal problems with neural responses are global across event-related potentials (ERPs) or might result in alterations only in specific ERPs. We examined associations between multiple informants of peer stress (self-reported, parent-reported, and peer-reported) and multiple ERPs (N1, P2, RewP, and LPP) to social feedback in a sample of 46 early adolescents (aged 12-13 years). Reports of peer stress were only moderately correlated with one another, indicating different informants capture different aspects of peer stress. Regressions using informant reports to predict ERPs revealed greater parent-reported peer stress was associated with a smaller RewP, whereas self-reported stress was associated with a smaller P2, to acceptance. In contrast, greater peer-reported stress was associated with larger P2, RewP, and LPP to acceptance. Findings suggest that different sources of stress measurement are differentially associated with ERPs. Future research using social feedback-related ERPs should consider multiple sources of information as well as multiple ERP components across the time-course of feedback processing, to gain a clearer understanding of the effects of peer stress on neural responses to feedback.

Clinicians' Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. OBJECTIVE: This study (1) explored clinicians' experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians' intentions to offer telepsychology after the COVID-19 pandemic. METHODS: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (ß=0.46; P<.001) and telephone services (ß=0.35; P<.001) after the pandemic. Social influence (ß=0.24; P=.004) and facilitating conditions (ß=0.19; P=.03) additionally predicted the intention to use telephone services. CONCLUSIONS: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.

Neural response to rewarding social feedback in never-depressed adolescent girls and their mothers with remitted depression: Associations with multiple risk indices.

Prevention of depression requires a clear understanding of etiology. Previous studies have identified reduced neural responses to monetary reward as a risk factor for depression, but social reward processing may be particularly relevant to depression. This study investigated associations between neural responses to social reward and three well-established risk factors for depression: personal history, family history, and interpersonal stress. We examined the reward positivity (RewP), an event-related potential sensitive to rewarding feedback, in a sample of 85 women with and without remitted depression and their never-depressed adolescent daughters. In never-depressed daughters, maternal history of depression predicted a blunted social RewP, but interpersonal stress did not. In the mothers, greater interpersonal stress predicted a blunted RewP, but personal depression history was not significant. Combined, these data suggest that personal history, family history, and interpersonal stress may converge on social reward sensitivity, which may advance future research to understand the development of depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Intergenerational transmission of depression risk: Mothers' neural response to reward and history of depression are associated with daughters' neural response to reward across adolescence.

Impaired reward responsiveness, a construct of the RDoC positive valence systems (PVS), prospectively predicts depression onset and may therefore represent an important marker of risk. Neural structures implicated in reward processing undergo substantial change during adolescence, a period of heightened risk for depression, particularly for those with a family history of the disorder. However, it is not clear whether familial transmission of PVS functioning also changes across adolescence, nor whether a family history of depression influences normative development of the PVS. To address these questions, mothers and their adolescent daughters each completed a monetary reward guessing task while an electroencephalogram was recorded (N = 109 dyads). Daughters' pubertal status significantly moderated the association between mothers' and daughters' reward processing in the delta frequency, such that there was a negative association for daughters in early puberty that shifted toward a positive association in later puberty. Furthermore, for never-depressed daughters without a maternal history of depression, more advanced pubertal development was associated with increased reward-related power in the delta frequency, whereas, for daughters with a maternal history of depression, more advanced pubertal development was associated with reduced power in the delta frequency. These data indicate that biomarkers of risk for psychopathology may differ as a function of both familial risk and developmental status. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neural responses to social acceptance predict behavioral adjustments following peer feedback in the context of a real-time social interaction task.

Strong social connections are important predictors of both mental and physical health. The ability to effectively process social feedback from other people and adjust behavior accordingly is a critical part of skillfully navigating the social landscape. However, relatively few studies have considered neural systems driving these behavioral adjustments. In this study, 254 participants engaged in a peer interaction game while electroencephalogram (EEG) was recorded. In this game, participants repeatedly "interact" with a small set of virtual peers over a series of rounds, in which they provide feedback to their peers, and receive feedback from them in turn. A reward-sensitive event-related potential called the Reward Positivity (RewP) was extracted from the EEG following positive feedback from peers, and multilevel modeling was used to examine whether the RewP moderated associations between the feedback participants received during the task and their subsequent behavior. Participants were more likely to accept coplayers who had previously voted to accept them, and to like coplayers who had voted to accept them on the same round. A larger RewP was associated with a stronger tendency to modify behavior following feedback from peers, both in terms of voting behavior and expressions of liking. These data suggest that initial neural responsiveness to reward within 300 ms of positive social feedback may guide social behaviors. Thus, this line of research represents an important step toward a more complete understanding of the ways in which neural responses to feedback are involved in human social behaviors.

Blunted Social Reward Responsiveness Moderates the Effect of Lifetime Social Stress Exposure on Depressive Symptoms.

Exposure to social stress is a well-established risk factor for the development and recurrence of depression. Reduced neural responsiveness to monetary reward has been associated with greater symptoms following stress exposure. However, it remains unclear whether reduced reward responsiveness serves as a mediator or moderator of the effects of stress on internalizing symptoms or whether similar patterns emerge with responses to social reward. We addressed this issue by measuring lifetime stress exposure and event-related potentials (ERPs) to social reward in 231 emerging adults (M = 18.16, SD = 0.41 years old). Participants completed the Stress and Adversity Inventory (STRAIN) to assess severity of lifetime stressors and self-report measures of current internalizing symptoms. In addition, participants completed the Island Getaway task in which the reward positivity (RewP) ERP was recorded in response to social acceptance, adjusting for responses to rejection (RewP residual). In this task, participants vote to accept or reject peers and receive reward/acceptance and rejection feedback. Stressors were divided into social and non-social stress severity scores. Analyses were conducted to test social reward responsiveness as a mediator or moderator of the effects of social and non-social stress on internalizing symptoms. Both social and non-social stress exposure over the life course predicted symptoms of depression (ps < 0.001) and social anxiety (ps < 0.002). The effect of social stress on depression was moderated by the residual RewP to social reward, adjusting for responses to social rejection (p =0.024), such that greater lifetime social stress exposure and a relatively blunted RewP to social reward were associated with greater depressive symptoms. Social reward responsiveness did not mediate effects of stress on internalizing symptoms. Reduced processing of social reward may be a vulnerability for depression that increases risk for symptoms following exposure to social stress. Blunted social reward responsiveness appears to be a relatively unique vulnerability for depression, rather than social anxiety. Results support the utility of ERP measures in measuring individual differences in social reward processing that can be applied to better understand neural processes involved in the development of depression, and highlight the importance of considering specific dimensions of stressful life experiences.

Past-year relational victimization is associated with a blunted neural response to rewards in emerging adults.

Anhedonia is associated with multiple forms of psychopathology, yet relatively, little is known about how anhedonia develops. Emerging evidence suggests that anhedonia is the result of interactions between life stress and the brain's reward systems, and that social stress, in particular, may drive these processes. One potent form of social stress is peer victimization, but very little research has focused on peer victimization beyond adolescence, and even less has examined the associations between peer victimization and neural response to rewards. The present study sought to identify associations between past-year history of peer victimization and neural response to rewards in emerging adults (N = 61). Relational and physical forms of victimization were assessed separately since these distinct types of social stress have different trajectories across development and different associations with psychopathology. Reward sensitivity was indexed with the event-related potential component known as the reward positivity, which was elicited using a forced-choice monetary reward guessing task. Results demonstrated that past-year relational, but not physical, victimization was associated with a blunted neural response to rewards. These findings provide insight into one potential mechanism in the etiology of anhedonia, which may, in turn, help us to better identify pathways to multiple psychopathologies.

Psychometric properties of neural responses to monetary and social rewards across development.

Reward-related event-related potentials (ERPs) are often used to index individual differences that signal the presence or predict the onset of psychopathology. However, relatively little research has explored the psychometric properties of reward-related ERPs. Without understanding their psychometric properties, the value of using ERPs as biomarkers for psychopathology is limited. The present study, therefore, sought to establish the internal consistency reliability and convergent validity of the reward positivity (RewP) and feedback negativity (FN) elicited by two types of incentives commonly used in individual differences research - monetary and social rewards. A large, developmentally-diverse sample completed a forced-choice guessing task in which they won or lost money, as well as a social interaction task in which they received acceptance and rejection feedback. Data were analyzed at both Cz and at a frontocentral region of interest (ROI) using techniques derived from classical test theory and generalizability theory. Results demonstrated good to excellent internal consistency of the RewP and FN within 20 trials in both tasks, in addition to convergent validity between the two tasks. Results from a regression-based approach to isolating activity specific to a single response demonstrated acceptable to good internal consistency within 20 trials in both tasks, while a subtraction-based approach (∆RewP) did not achieve acceptable internal consistency in either task. Internal consistency was not moderated by age and did not differ between Cz and the frontocentral ROI; however, the magnitudes of the RewP and FN were significantly associated with age at Cz but not at the ROI. This work replicates previous studies demonstrating good psychometric properties of the monetary RewP/FN and provides novel information about the psychometric properties of the social RewP/FN. These data support the use of reward-related ERPs elicited by multiple reward types in studies of biomarkers of psychopathology.

Childhood maltreatment is associated with increased neural response to ambiguous threatening facial expressions in adulthood: Evidence from the late positive potential.

Childhood maltreatment increases lifetime vulnerability for psychopathology. One proposed mechanism for this association is that early maltreatment increases vigilance for and attention to subtle threat cues, persisting outside of the environment in which maltreatment occurs. To test this possibility, the present study examined neural responses to ambiguous and nonambiguous threatening facial expressions in a sample of 25 adults reporting a history of low-to-moderate levels of abuse in childhood and 46 reporting no or low levels of childhood maltreatment. The measure of neural response used was the late positive potential (LPP), a neural marker of sustained attention to motivationally salient information that is sensitive to subtle variation in emotional content. Participants passively viewed angry-neutral and fearful-neutral face blends and rated emotional intensity for each face. In the maltreated group, as fearful faces increased in emotional intensity, the LPP similarly increased, suggesting increased sensitivity to subtle variation in threatening content. Moreover, the LPP at each level of emotional intensity was not related to current symptoms of anxiety and depression. However, contrary to our hypotheses, adults with a history of abuse did not rate angry or fearful faces as more threatening, nor did they exhibit a larger LPP to angry faces, compared to controls. These findings suggest that childhood maltreatment may be associated with increased sensitivity to ambiguous threatening information in adulthood.

Neural responses to social and monetary reward in early adolescence and emerging adulthood.

Reward processing is often considered to be a monolithic construct, with different incentive types eliciting equivalent neural and behavioral responses. The majority of the literature on reward processing has used monetary incentives to elicit reward-related activity, yet social incentives may be particularly important due to their powerful ability to shape behavior. Findings from studies comparing social and monetary rewards have identified both overlapping and distinct responses. In order to explore whether reward processing is domain general or category specific (i.e., the same or different across reward types), the present study recorded ERPs from early adolescents (ages 12-13) and emerging adults (ages 18-25) while they completed social and monetary reward tasks. Temporospatial principal components analysis revealed morphologically similar reward positivities (RewPs) in the social and monetary reward tasks in each age group. In early adolescents, no significant difference was found between the magnitude of the RewP to social and monetary rewards. In emerging adults, however, the RewP to monetary rewards was significantly larger than the RewP to social rewards. Additionally, responses to feedback between the two tasks were not significantly correlated in either age group. These results suggest that both domain-general and category-specific processes underlie neural responses to rewards and that the relative incentive value of different types of rewards may change across development. Findings from this study have important implications for understanding the role that neural response to rewards plays in the development of psychopathology during adolescence.

Client Perceptions of the Mental Health Engagement Network: A Secondary Analysis of an Intervention Using Smartphones and Desktop Devices for Individuals Experiencing Mood or Psychotic Disorders in Canada.

BACKGROUND: The use of innovative technologies in mental health care has the potential to improve system efficiency, enhance quality of care, and increase patient engagement. The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients' perceptions of technology and the use of these technologies in their care. OBJECTIVE: We aimed to answer six questions: (1) What is the level of comfort with technology within a sample of individuals experiencing mood or psychotic disorders? (2) How easy to use and helpful are the MHEN technologies from the perspective of individuals experiencing a mental illness? (3) Are there differences in how helpful or useful individuals find the smartphone compared to the LSR? (4) Are there specific functions of MHEN technologies (eg, reminders for medications or appointments) that are more valued than others? (5) What are the other ways that individuals are using MHEN technologies in their daily lives? (6) How likely are individuals to be able to retain and maintain their smartphone? METHODS: Mental health clients aged 18-80 (N=400) and diagnosed with a mood or psychotic disorder were provided with a smartphone (iPhone 4S) and participating care providers (n=52) were provided with a tablet (iPad) in order to access and engage with the LSR. A delayed implementation design with mixed methods was used. Survey and interview data were collected over the course of 18 months through semistructured interviews conducted by experienced research assistants every 6 months post-implementation of the intervention. Paired t tests were used to determine differences between 6 and 12-month data for perceptions of the MHEN technologies. A paired t test was used to examine whether differences existed between perceptions of the smartphone and the LSR at 12 months post-implementation. RESULTS: Due to dropout or loss of contact, 394 out of 400 individuals completed the study. At the end of the study, 52 devices were lost or unusable. Prior to the intervention, participants reported being comfortable using technology. Perceptions of the MHEN technologies and their functions were generally positive. Positive perceptions of the smartphone increased over time (P=.002), while positive perceptions of the LSR decreased over time (P<.001). CONCLUSIONS: Quantitative and qualitative findings from this analysis demonstrated that these technologies positively impacted the lives of individuals experiencing severe mental illnesses and dispeled some of the myths regarding retention of technology among marginalized populations. This secondary analysis supported the acceptability of using mental health technologies within this population and provided considerations for future development. TRIAL REGISTRATION: ClinicalTrials.gov NCT01473550; http://clinicaltrials.gov/show/NCT01473550 (Archived by WebCite at http://www.webcitation.org/6SLNcoKb8).

Client perceptions of the mental health engagement network: a qualitative analysis of an electronic personal health record.

BACKGROUND: Information technologies such as websites, mobile phone applications, and virtual reality programs have been shown to deliver innovative and effective treatments for mental illness. Much of the research studying electronic mental health interventions focuses on symptom reduction; however, to facilitate the implementation of electronic interventions in usual mental health care, it is also important to investigate the perceptions of clients who will be using the technologies. To this end, a qualitative analysis of focus group discussions regarding the Mental Health Engagement Network, a web-based personal health record and smartphone intervention, is presented here. METHODS: Individuals living in the community with a mood or psychotic disorder (n = 394) were provided with a smartphone and access to an electronic personal health record, the Lawson SMART Record, for 12 to 18 months to manage their mental health. This study employed a delayed-implementation design and obtained both quantitative and qualitative data through individual interviews and focus group sessions. Participants had the opportunity to participate in voluntary focus group sessions at three points throughout the study to discuss their perceptions of the technologies. Qualitative data from 95 focus group participants were analysed using a thematic analysis. RESULTS: Four overarching themes emerged from focus group discussions: 1) Versatile functionality of the Lawson SMART Record and smartphone facilitated use; 2) Aspects of the technologies as barriers to use; 3) Use of the Mental health Engagement Network technologies resulted in perceived positive outcomes; 4) Future enhancement of the Lawson SMART Record and intervention is recommended. DISCUSSION: These qualitative data provide a valuable contribution to the understanding of how smarttechnologies can be integrated into usual mental health care. Smartphones are extremely portable andcommonplace in society. Therefore, clients can use these devices to manage and track mental health issuesin any place at almost any time without feeling stigmatized. CONCLUSIONS: Assessing clients' perspectives regarding the use of smart technologies in mental health care provides an invaluable addition to the current literature. Qualitative findings support the feasibility of implementing a smartphone and electronic personal health record intervention with individuals who are living in the community and experiencing a mental illness, and provide considerations for future development and implementation.

Persistent psychogenic déjà vu: a case report.

INTRODUCTION: Déjà vu is typically a transient mental state in which a novel experience feels highly familiar. Although extensively studied in relation to temporal lobe epilepsy as part of simple partial seizures, déjà vu has been less studied in other clinical populations. A recent review of temporal lobe epilepsy suggested a possible link between clinical levels of anxiety and debilitating déjà vu, indicating further research is required. Here, for the first time in the literature, we present a case study of a young man with anxiety and depersonalisation who reported experiencing persistent and debilitating déjà vu. This report therefore adds to the limited literature on the relationship between anxiety and déjà vu. CASE PRESENTATION: A 23-year-old White British man presented with a form of persistent déjà vu in 2010, approximately 3 years since symptom onset. He reported a history of anxiety and experiencing feelings of depersonalisation. Neurological assessment (electroencephalogram and magnetic resonance imaging) did not indicate any abnormalities. We assessed his recognition memory with a task used in patients with dementia who report similar experiences but lack awareness of their falseness. CONCLUSIONS: Our case's memory performance was more conservative than controls but did not indicate a memory deficit. Unlike other patients with chronic déjà vu (for example, in dementia), he is fully aware of the false nature of his déjà vu and this presumably leads to his intact recognition memory performance. We suggest that his persistent déjà vu is psychogenic and conclude that déjà vu should be further studied in psychiatric disorders.