Performance-based attentional control, but not self-reported attentional control, predicts changes in depressive symptoms in short-term psychotherapy.

OBJECTIVE: Although impairments in attentional control are pervasive across psychopathology, there is substantial individual differences. In the current study, we examined whether individual differences in self-reported and performance-based measures of attentional control predict changes in depressive symptoms and well-being in a diagnostically diverse sample of patients attending a CBT-based partial hospital program. METHOD: Participants were 89 patients (56.2% men, 75.3% non-Hispanic White). At baseline, patients completed the self-reported Attentional Control Scale and the Rapid Serial Visual Presentation task (RSVP), a behavioral measure of attentional control. Depressive symptoms were assessed daily using the Patient Health Questionnaire and well-being was assessed using the Mental Health Continuum Short Form. RESULTS: On average, greater self-reported attentional control was significantly associated with lower depressive symptoms, ß = -0.49, t(52) = 4.84, p < .001, 95% CIs [-0.69, -0.29], and greater well-being, ß = 0.45, t(53) = 3.90, p < .001, 95% CIs [0.22, 0.67]. More accurate task-based performance was associated with a decline in depressive symptoms over time, ß = -0.02, t(32) = 2.50, p = .02, 95% CIs [-0.04, -0.01]. Neither self-reported nor performance-based measures of attentional control predicted changes in well-being. Finally, exploratory analyses suggest that depressive symptoms also improved over time for individuals who underestimated self-reported attentional control abilities relative to task-based performance, ß = -0.19, t(32) = 2.23, p = .03, 95% CIs [-0.36, -0.02]. CONCLUSIONS: Results suggest that performance-based attentional control may be an important target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.

Conversational assessment using artificial intelligence is as clinically useful as depression scales and preferred by users.

BACKGROUND: Depression is prevalent, chronic, and burdensome. Due to limited screening access, depression often remains undiagnosed. Artificial intelligence (AI) models based on spoken responses to interview questions may offer an effective, efficient alternative to other screening methods. OBJECTIVE: The primary aim was to use a demographically diverse sample to validate an AI model, previously trained on human-administered interviews, on novel bot-administered interviews, and to check for algorithmic biases related to age, sex, race, and ethnicity. METHODS: Using the Aiberry app, adults recruited via social media (N = 393) completed a brief bot-administered interview and a depression self-report form. An AI model was used to predict form scores based on interview responses alone. For all meaningful discrepancies between model inference and form score, clinicians performed a masked review to determine which one they preferred. RESULTS: There was strong concurrent validity between the model predictions and raw self-report scores (r = 0.73, MAE = 3.3). 90 % of AI predictions either agreed with self-report or with clinical expert opinion when AI contradicted self-report. There was no differential model performance across age, sex, race, or ethnicity. LIMITATIONS: Limitations include access restrictions (English-speaking ability and access to smartphone or computer with broadband internet) and potential self-selection of participants more favorably predisposed toward AI technology. CONCLUSION: The Aiberry model made accurate predictions of depression severity based on remotely collected spoken responses to a bot-administered interview. This study shows promising results for the use of AI as a mental health screening tool on par with self-report measures.

Measuring attentional blink magnitude: Reliability and validity of a novel single-target rapid serial visual presentation task index in a psychiatric sample.

Rapid serial visual presentation (RSVP) tasks have been frequently used to assess attentional control in psychiatric samples; however, it is unclear whether RSVP tasks exhibits the psychometric properties necessary to assess these individual differences. In the current study, we examined the reliability and validity of single-target computerized RSVP task outcomes in a sample of 63 participants with moderate to severe psychiatric illness. At the group level, we observed the classical attentional blink phenomenon. At the individual level, conventional indices of attentional blink magnitude exhibited poor internal consistency. We empirically evaluated a novel index for assessing attentional blink magnitude using a single-target RSVP task that involves collapsing across experimental trials in which the attentional blink phenomenon occurs and disregarding performance on control trials, which suffer from ceiling effects. We found that this new index resulted in much improved reliability estimates. Both novel and conventional indices provided evidence of convergent validity. Consequently, this novel index may be worth examining and adopting for researchers interested in assessing individual differences in attentional blink magnitude.

Change in negative attention bias mediates the association between attention bias modification training and depression symptom improvement.

OBJECTIVE: Attention bias modification training (ABMT) is purported to reduce depression by targeting and modifying an attentional bias for sadness-related stimuli. However, few tests of this hypothesis have been completed. METHOD: The present study examined whether change in attentional bias mediated a previously reported association between ABMT condition (active ABMT, sham ABMT, assessments only; N = 145) and depression symptom change among depressed adults. The preregistered, primary measure of attention bias was a discretized eye-tracking metric that quantified the proportion of trials where gaze time was greater for sad stimuli than neutral stimuli. RESULTS: Contemporaneous longitudinal simplex mediation indicated that change in attentional bias early in treatment partially mediated the effect of ABMT on depression symptoms. Specificity analyses indicated that in contrast to the eye-tracking mediator, reaction time assessments of attentional bias for sad stimuli (mean bias and trial level variability) and lapses in sustained attention did not mediate the association between ABMT and depression change. Results also suggested that mediation effects were limited to a degree by suboptimal measurement of attentional bias for sad stimuli. CONCLUSION: When effective, ABMT may improve depression in part by reducing an attentional bias for sad stimuli, particularly early on during ABMT. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Rising to the Occasion of This COVID-19-Impacted Nation: Development, Implementation, and Feasibility of the Brief Assessment-Informed Skills Intervention for COVID-19 (BASIC).

The COVID-19 pandemic has had a profound impact on the global economy, physical health, and mental health. This pandemic, like previous viral outbreaks, has resulted in spikes in anxiety, depression, and stress. Even though millions of individuals face the physical health consequences of infection by COVID-19, even more individuals are confronted with the mental health consequences of this pandemic. This significantly increased demand for mental health services cannot be easily met by existing mental health systems, which often rely on courses of therapy to be delivered over months. Single session interventions (SSIs) may be one important approach to meeting this increased demand, as they are treatments designed to be delivered over the course of a single meeting. SSIs have been found to be effective for a range of mental health challenges, with durable effects lasting months to years later. Here, we describe an SSI designed for the COVID-19 pandemic. This Brief Assessment-informed Skills Intervention for COVID-19 (BASIC) program draws upon therapeutic skills from existing empirically supported treatments to target common presenting complaints due to this pandemic. We discuss the process of developing and implementing this intervention, as well as explore feasibility and initial clinical insights. In short, BASIC is an easy-to-adopt intervention that is designed to be effective in a single session, making it well-suited for handling the increased demand for mental health services due to COVID-19.

Efficacy of attention bias modification training for depressed adults: a randomized clinical trial.

BACKGROUND: This study examined the efficacy of attention bias modification training (ABMT) for the treatment of depression. METHODS: In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity [i.e. self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ⩾13] and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. The training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for 4 weeks (2224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. RESULTS: Intent-to-treat analyses indicated that, relative to assessment-only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = 0.008, d = -0.57) and 0.74 ± 0.31 (p = 0.021, d = -0.49) points per week. Similar results were observed for active v. sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = 0.067, d = -0.41) and 0.69 ± 0.32 HRSD (p = 0.033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales. CONCLUSION: Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

Neurocognitive predictors of self-reported reward responsivity and approach motivation in depression: A data-driven approach.

BACKGROUND: Individual differences in reward-related processes, such as reward responsivity and approach motivation, appear to play a role in the nature and course of depression. Prior work suggests that cognitive biases for valenced information may contribute to these reward processes. Yet there is little work examining how biased attention, processing, and memory for positively and negatively valenced information may be associated with reward-related processes in samples with depression symptoms. METHODS: We used a data-driven, machine learning (elastic net) approach to identify the best predictors of self-reported reward-related processes using multiple tasks of attention, processing, and memory for valenced information measured across behavioral, eye tracking, psychophysiological, and computational modeling approaches (n = 202). Participants were adults (ages 18-35) who ranged in depression symptom severity from mild to severe. RESULTS: Models predicted between 5.0-12.2% and 9.7-28.0% of held-out test sample variance in approach motivation and reward responsivity, respectively. Low self-referential processing of positively valenced information was the most robust, albeit modest, predictor of low approach motivation and reward responsivity. CONCLUSIONS: Self-referential processing of positive information is the strongest predictor of reward responsivity and approach motivation in a sample ranging from mild to severe depression symptom severity. Experiments are now needed to clarify the causal relationship between self-referential processing of positively valenced information and reward processes in depression.

Examining differential relationships among self-reported attentional control, depression, and anxiety in a transdiagnostic clinical sample.

BACKGROUND: Poor attentional control, defined as difficulty focusing attention on a task or shifting attention flexibly between tasks, is a transdiagnostic construct theorized to confer risk for, and maintain, depression and anxiety. Research to date in non-clinical samples has suggested a dissociable relationship between the two factors of self-reported attentional control and psychopathology, with depression being associated with difficulties shifting and anxiety being associated with focusing. However, to our knowledge no study has tested this differential set of relationships in a clinical sample. METHODS: Adults (N = 493) presenting for psychiatric treatment completed measures of depressive and anxiety symptom severity and self-reported attentional control. Hierarchical linear regression and Zou's (2007) confidence interval method were used to examine the relationship between clinical symptoms and attentional control. RESULTS: Both shifting and focusing were significantly correlated with anxiety and depressive symptoms in this sample. However, focusing was more strongly associated with clinical symptomatology than shifting, which showed a weak correlation. LIMITATIONS: All constructs were measured cross-sectionally by self-report questionnaires. CONCLUSIONS: In contrast to studies conducted in non-clinical samples, attentional focusing appears to be more relevant than attentional shifting in a clinical sample for both depression and anxiety symptoms. These findings lend support to efforts to develop neurocognitive interventions that improve focusing. Replication of these findings, particularly in longitudinal studies, is warranted.

Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder.

BACKGROUND: Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment. Identifying factors associated with improved outcomes can facilitate individualized treatment choices. We investigated whether patterns of neural connectivity predicted treatment responses and whether treatment type, cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), moderated this effect. METHODS: Participants with SAD (n = 34) underwent fMRI prior to treatment and completed implicit and explicit emotion regulation tasks. Neural connectivity measures were estimates of amygdala-prefrontal cortex connectivity. Treatment responder status was defined using the 'clinically significant change index' (Loerinc et al., 2015). RESULTS: Right amygdala-right ventrolateral prefrontal cortex connectivity during implicit emotion regulation was a significant predictor of treatment response (OR = 9.01, 95% CI = 1.77, 46.0, p = .008). Stronger inverse connectivity was associated with greater likelihood of treatment response. There were no significant neural moderators of treatment response to CBT versus ACT. LIMITATIONS: The primary limitation of this work was the small sample size which restricted the power to detect significant moderation effects, and results should be interpreted as preliminary. CONCLUSIONS: Amygdala-vlPFC connectivity during affect labeling predicted treatment responder status following CBT or ACT for social anxiety disorder. This suggests that the functioning of neural circuitry supporting emotion regulation capacities may be a 'gateway' to receiving benefit from psychological treatments. Future work should aim to replicate this effect in a larger sample and consider methods for enhancing functional connectivity within this circuitry as a potential treatment adjunct.

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program.

BACKGROUND: Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. METHOD: Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. RESULTS: Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen's dz = 0.61) and positive urgency (p < .001, Cohen's dz = 0.39) significantly decreased during treatment. DISCUSSION: Findings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.

Attentional bias modification treatment for depression: Study protocol for a randomized controlled trial.

Theoretical models and empirical research point to negatively biased attention as a maintaining factor in depression. Although preliminary studies suggest experimentally modifying attentional biases (i.e., attentional bias modification; ABM) reduces depression symptoms and depression risk, relatively few rigorous studies with clinical samples have been completed. This clinical trial examines the impact of ABM on a sample of adults (N = 123) with elevated depression severity who also exhibit at least modest levels of negatively biased attention prior to treatment. Participants will be randomly assigned to either active ABM, placebo ABM, or an assessment-only control condition. Individuals assigned to ABM will complete 5 trainings per week (2 in-clinic, 3 brief trainings at-home) during a four-week period. Throughout this four-week period, participants will complete weekly assessments of symptom severity and putative treatment mediators measured across different levels of analysis (e.g., eye tracking, behavioral measures, and functional Magnetic Resonance Imaging). This article details the rationale and design of the clinical trial, including methodological issues that required more extensive consideration. Our findings may not only point to an easily-accessible, efficacious treatment for depression but may also provide a meaningful test of whether a theoretically important construct, negatively biased attention, maintains depression.

Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement.

OBJECTIVE: Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings. METHOD: Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms. RESULTS: Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement. CONCLUSIONS: Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.

Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital.

OBJECTIVE: Despite the effectiveness of cognitive behavioral therapy (CBT) for depression, a significant number of patients do not respond. Data examining predictors of treatment response in settings in which CBT is delivered naturalistically are lacking. METHOD: Treatment outcome data collected at a CBT-based partial hospital (n = 956) were used to examine predictors of two types of treatment response: (a) a reliable and clinically significant change in depressive symptoms and (b) a self-rating of "very much" or "much" improved. In multiple logistic regression models, we examined predictors of response in the total sample and separately for patients with a primary diagnosis of major depressive disorder (MDD) versus patients with other primary diagnoses. RESULTS: In the total sample, higher treatment outcome expectations and fewer past hospitalizations predicted clinically significant improvement in depression symptoms, and higher treatment expectations and ethnoracial minority background predicted global improvement. In patients with primary MDD, higher treatment outcome expectations and being referred from the community (vs. inpatient hospitalization) predicted better depression response, and higher treatment outcome expectations predicted global improvement. In patients with other primary diagnoses, higher treatment outcome expectations and fewer borderline personality disorder traits predicted depression reduction, and higher treatment outcome expectations, less relationship difficulty, and female gender predicted global improvement. CONCLUSIONS: Results are generally consistent with data from randomized controlled trials on longer term outpatient CBT. Interventions that increase treatment expectancy and modifications to better target men may enhance treatment outcome. Future research should include objective outcome measures and examine mechanisms underlying treatment response.

Properties of the Dialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse Partial Hospital Sample.

OBJECTIVE: Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. METHOD: We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. RESULTS: Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. CONCLUSIONS: Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.

Psychometric properties of the anxiety sensitivity index-3 in an acute and heterogeneous treatment sample.

Anxiety sensitivity (AS) is associated with various forms of psychopathology. The most common measure of AS is the anxiety sensitivity index-3 (ASI-3). The current study examined the psychometric properties and factor structure of the ASI-3 in an acute and comorbid population seeking treatment for a broad range of psychopathology (N=382). Results confirmed a bi-factor structure and suggested that the ASI-3 demonstrates adequate psychometric properties in a transdiagnostic sample. The ASI-3 also showed adequate sensitivity to change over the course of partial hospital treatment. Findings regarding associations between specific anxiety disorders and subscales of the ASI-3 are discussed. Overall, the current results support the use of the ASI-3 to assess AS in heterogeneous treatment-seeking samples. This work is of particular utility for researchers examining the concept of AS transdiagnostically.

Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control.

BACKGROUND: Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model. METHODS: Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator. RESULTS: The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant. LIMITATIONS: Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report. CONCLUSIONS: Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions).

Experimentally induced distraction impacts cognitive but not emotional processes in think-aloud cognitive assessment.

Studies have examined the impact of distraction on basic task performance (e.g., working memory, motor responses), yet research is lacking regarding its impact in the domain of think-aloud cognitive assessment, where the threat to assessment validity is high. The Articulated Thoughts in Simulated Situations think-aloud cognitive assessment paradigm was employed to address this issue. Participants listened to scenarios under three conditions (i.e., while answering trivia questions, playing a visual puzzle game, or with no experimental distractor). Their articulated thoughts were then content-analyzed both by the Linguistic Inquiry and Word Count (LIWC) program and by content analysis of emotion and cognitive processes conducted by trained coders. Distraction did not impact indices of emotion but did affect cognitive processes. Specifically, with the LIWC system, the trivia questions distraction condition resulted in significantly higher proportions of insight and causal words, and higher frequencies of non-fluencies (e.g., "uh" or "umm") and filler words (e.g., "like" or "you know"). Coder-rated content analysis found more disengagement and more misunderstanding particularly in the trivia questions distraction condition. A better understanding of how distraction disrupts the amount and type of cognitive engagement holds important implications for future studies employing cognitive assessment methods.

Neuropsychological deficits in major depression reflect genetic/familial risk more than clinical history: a monozygotic discordant twin-pair study.

Neuropsychological deficits have been associated with major depression (MD) and persist in some individuals even after symptom remission. However, it is unclear if the deficits are a consequence of MD or are pre-existing and reflect MD vulnerability. We addressed this issue by studying 117 twins from monozygotic (MZ) pairs discordant for lifetime history of DSM-III-R defined MD and 41 twins from MZ pairs in which neither twin had experienced MD. Our assessment included a structured clinical interview and measures from the WMS-III and WAIS-III. The "unaffected" twins from discordant pairs showed the same pattern of performance as their affected cotwins on measures of attention, working memory, verbal memory, and visuo-spatial processing. Compared to twins from pairs with no MD history, twins in discordant pairs had lower performance in the domains of attention, memory, visuo-spatial processing, and general knowledge. However, after adjusting for sex and age, the groups differed only on attention and general knowledge. The similar performance of twins in pairs discordant for MD suggests that familial risk for MD has a greater influence on neuropsychological functioning than individual MD history. Findings of impairment in individuals euthymic for MD are more consistent with pre-existing deficits than scarring effects of MD.