Depressive symptomatology in older adults treated with behavioral activation: A network perspective.

BACKGROUND: Late-life depression is a serious mental health problem. Behavioral Activation (BA) is an effective, accessible psychotherapeutic treatment for older adults. However, little is known about which symptoms decrease and how associations between depressive symptoms change during BA treatment. METHODS: Using data from a cluster-randomized trial for older adults with late-life depression, we estimated a partial correlation network and a relative importance network of depressive symptoms before and after 8 weeks of BA treatment in primary care (n = 96). Networks were examined with measures of network structure, connectivity, centrality as well as stability. RESULTS: The most central symptoms at baseline and post-treatment were anhedonia, fatigue, and feeling depressed. In contrast, sleeping problems had the lowest centrality. The post-treatment network was significantly more interconnected than at baseline. Moreover, all symptoms were significantly more central at post-treatment. CONCLUSION: Our findings highlight the utility of the network approach to better understand symptom networks of depressed older adults before and after BA treatment. Results show that network connectivity and centrality of all symptoms increased after treatment. Future studies should investigate longitudinal idiographic networks to explore symptom dynamics within individuals over time.

From smartphone data to clinically relevant predictions: A systematic review of digital phenotyping methods in depression.

BACKGROUND: Smartphone-based digital phenotyping enables potentially clinically relevant information to be collected as individuals go about their day. This could improve monitoring and interventions for people with Major Depressive Disorder (MDD). The aim of this systematic review was to investigate current digital phenotyping features and methods used in MDD. METHODS: We searched PubMed, PsycINFO, Embase, Scopus and Web of Science (10/11/2023) for articles including: (1) MDD population, (2) smartphone-based features, (3) validated ratings. Risk of bias was assessed using several sources. Studies were compared within analysis goals (correlating features with depression, predicting symptom severity, diagnosis, mood state/episode, other). Twenty-four studies (9801 participants) were included. RESULTS: Studies achieved moderate performance. Common themes included challenges from complex and missing data (leading to a risk of bias), and a lack of external validation. DISCUSSION: Studies made progress towards relating digital phenotypes to clinical variables, often focusing on time-averaged features. Methods investigating temporal dynamics more directly may be beneficial for patient monitoring. European Research Council consolidator grant: 101001118, Prospero: CRD42022346264, Open Science Framework: https://osf.io/s7ay4.

Age related differences in symptom networks of overall psychological functioning in a sample of patients diagnosed with anxiety, obsessive compulsive disorder, or posttraumatic stress disorder.

Anxiety disorders, obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) are among the most prevalent mental disorders across the lifespan. Yet, it has been suggested that there are phenomenological differences and differences in treatment outcomes between younger and older adults. There is, however, no consensus about the age that differentiates younger adults from older adults. As such, studies use different cut-off ages that are not well founded theoretically nor empirically. Network tree analysis was used to identify at what age adults differed in their symptom network of psychological functioning in a sample of Dutch patients diagnosed with anxiety disorders, OCD, or PTSD (N = 27,386). The networktree algorithm found a first optimal split at age 30 and a second split at age 50. Results suggest that differences in symptom networks emerge around 30 and 50 years of age, but that the core symptoms related to anxiety remain stable across age. If our results will be replicated in future studies, our study may suggest using the age split of 30 or 50 years in studies that aim to investigate differences across the lifespan. In addition, our study may suggest that age-related central symptoms are an important focus during treatment monitoring.

Depression recurrence is accompanied by longer periods in default mode and more frequent attentional and reward processing dynamic brain-states during resting-state activity.

Recurrence in major depressive disorder (MDD) is common, but neurobiological models capturing vulnerability for recurrences are scarce. Disturbances in multiple resting-state networks have been linked to MDD, but most approaches focus on stable (vs. dynamic) network characteristics. We investigated how the brain's dynamical repertoire changes after patients transition from remission to recurrence of a new depressive episode. Sixty two drug-free, MDD-patients with ≥2 episodes underwent a baseline resting-state fMRI scan when in remission. Over 30-months follow-up, 11 patients with a recurrence and 17 matched-remitted MDD-patients without a recurrence underwent a second fMRI scan. Recurrent patterns of functional connectivity were characterized by applying Leading Eigenvector Dynamics Analysis (LEiDA). Differences between baseline and follow-up were identified for the 11 non-remitted patients, while data from the 17 matched-remitted patients was used as a validation dataset. After the transition into a depressive state, basal ganglia-anterior cingulate cortex (ACC) and visuo-attentional networks were detected significantly more often, whereas default mode network activity was found to have a longer duration. Additionally, the fMRI signal in the basal ganglia-ACC areas underlying the reward network, were significantly less synchronized with the rest of the brain after recurrence (compared to a state of remission). No significant changes were observed in the matched-remitted patients who were scanned twice while in remission. These findings characterize changes that may be associated with the transition from remission to recurrence and provide initial evidence of altered dynamical exploration of the brain's repertoire of functional networks when a recurrent depressive episode occurs.

How context, mood, and emotional memory interact in depression: A study in everyday life.

Cognitive theories of depression hold that negative contextual triggers (e.g., stressful events) induce more negative and less positive mood, in turn instigating negatively biased memories. However, context-related variability in mood and emotional memory has received insufficient attention, while the dynamic interaction between these factors plays a crucial role in the kindling of new depressive episodes. Experience Sampling Method (ESM) for repeated, daily life measures of context, mood, and autobiographic emotional memory was used in 46 currently depressed, 90 remitted-depressed, and 55 never-depressed individuals. Currently depressed individuals showed strongest negative processing style and never-depressed most positive, with remitted-depressed patients scoring intermediate. The moderated mediation model indicated that context appraisal had a direct effect on the appraisal of the recalled event (i.e., our operationalization of emotional memory), which was mediated by positive (but hardly by negative) mood and was independent of depression status. This mediation strength was relatively similar to the strength of the direct effect of context on memory. Results are in line with cognitive theories of depression. Especially context seems important for emotional memory. The association between context, mood, and memory, however, may be independent of depression status. Yet, the "level" of mood, context, and event appraisal does depend on depression status. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effects of daily autobiographical memory training on memory bias, mood and stress resilience in dysphoric individuals.

Negative memory bias refers to the enhanced recall of negative memories and is a prominent cognitive factor causing and maintaining depression. Surprisingly few studies modify this negative recall. The current study used a smartphone-based autobiographical memory training to increase positive memory recall and thereby alter negative memory bias. A total of 96 dysphoric (≥ 13 BDI-II) participants were randomly allocated to a positive, sham or no-training condition, conducted over a period of 6 days. Positive memory bias (i.e., recalled event evaluation) significantly increased from pre- to post-training after positive and sham intervention, suggesting an unspecific training effect. No transfer to memory specificity, implicit memory bias or depressive symptoms was found, nor was the training effect modulated by pre-existing level of positive memory bias. A post-hoc follow-up measurement during the initial COVID-19 crisis revealed that subjects who benefitted most from either of the trainings maintained their stress levels better during a natural stressful period, compared to those who responded least to the training. Future studies should carefully consider the impact of sham training design. Moreover, it is important to examine transfer effects of bias training as practice in daily life.

Digital phenotyping and the COVID-19 pandemic: Capturing behavioral change in patients with psychiatric disorders.

The COVID-19 pandemic has led to unprecedented societal changes limiting us in our mobility and our ability to connect with others in person. These unusual but widespread changes provide a unique opportunity for studies using digital phenotyping tools. Digital phenotyping tools, such as mobile passive monitoring platforms (MPM), provide a new perspective on human behavior and hold promise to improve human behavioral research. However, there is currently little evidence that these tools can reliably detect changes in behavior. Considering the Considering the COVID-19 pandemic as a high impact common environmental factor we studied potential impact on behavior of participants using our mobile passive monitoring platform BEHAPP that was ambulatory tracking them during the COVID-19 pandemic. We pooled data from three MPM studies involving Schizophrenia (SZ), Major Depressive Disorder (MDD) and Bipolar Disorder (BD) patients (N = 12). We compared the data collected on weekdays during three weeks prior and three weeks subsequent to the start of the quarantine. We hypothesized an increase in communication and a decrease in mobility. We observed a significant increase in the total time spent on communication applications (median 179 and 243 min per week respectively, p = 0.005), and a significant decrease in the number of unique places visited (median 6 and 3 visits per week respectively, p = 0.007), while the total time spent at home did not change significantly (median 64 and 77 h per week, respectively, p = 0.594). The data provides a proof of principle that digital phenotyping tools can identify changes in human behavior incited by a common external environmental factor.

Spatio-temporal associations with memory cues are linked to analogue traumatic intrusions.

Trauma survivors with post-traumatic stress disorder (PTSD) frequently experience intrusive trauma memories associated with a feeling of "nowness". Information-processing models of PTSD ascribe these symptoms to an insufficient integration of memories with their spatio-temporal context in the past, turning them into powerful stressors. Here, we tested the idea that automatic associations of trauma reminders with the present or the past predict intrusive memories. We instructed 96 healthy participants to view two different traumatic films. Participants then underwent a computerized training that established implicit contingencies between film reminder pictures with the verbal responses "now" or "past" to increase and reduce intrusions, respectively. The training successfully altered implicit spatio-temporal associations for film reminder stimuli on a subsequent Implicit Association Test (IAT). There were no additional transfer effects for tense usage during a free recall task after one week and for the development of intrusion symptoms (one-week diary, retrospective questionnaire). However, participants who associated one film more strongly with the present and the other with the past consistently reported relatively more intrusive memories related to the former film. Thus, our results lend support to information processing models of PTSD and warrant further investigation of the causal role of implicit associations with spatio-temporal information.

Emotional Biases and Recurrence in Major Depressive Disorder. Results of 2.5 Years Follow-Up of Drug-Free Cohort Vulnerable for Recurrence.

An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of emotional stimuli/information. Negatively biased processing of emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation biases in recurrently depressed patients in remission and relate these biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35-65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent biases with an emotional categorization task, bias in emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed biases toward emotionally negative stimuli, faster responses to negative self-relevant characteristics in the emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < p < 0.05). Of these, the number of misclassifications as angry and the overall performance in the emotional memory task were significantly associated with the time to recurrence (p ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided p = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) emotional bias when patients with recurrent depression are in remission. Moreover, these persisting biases might be mechanistically important for recurrence and prevention thereof.

Attention bias modification in specific fears: Spiders versus snakes.

BACKGROUND AND OBJECTIVES: Attention Bias Modification (ABM) is used to manipulate attention biases in anxiety disorders. It has been successful in reducing attention biases and anxious symptoms in social anxiety and generalized anxiety, but not yet in specific fears and phobias. METHODS: We designed a new version of the dot-probe training task, aiming to train fearful participants' attention away from or towards pictures of threatening stimuli. Moreover, we studied whether the training also affected participants' avoidance behavior and their physical arousal upon being confronted with a real threat object. RESULTS: In Experiment 1, students with fear of spiders were trained. We found that the attention manipulation was successful, but the training failed to affect behavior or arousal. In Experiment 2, the same procedure was used on snake-fearful students. Again, attention was trained in the expected directions. Moreover, participants whose attention had been trained away from snakes showed lower physiological arousal upon being confronted with a real snake. LIMITATIONS: The study involved healthy students with normal distribution of the fear of spider/snake. Future research with clinical sample could help with determining the generalizability of the current findings. CONCLUSIONS: The effect of ABM on specific phobia is still in question. The finding in the present study suggested the possibility to alter attentional bias with a dot-probe task with general positive stimuli and this training could even affect the behavior while encountering a real threat.