Genetic predisposition for negative affect predicts mental health burden during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an increase in mental health challenges including depression, stress, loneliness, and anxiety. Common genetic variants can contribute to the risk for psychiatric disorders and may present a risk factor in times of crises. However, it is unclear to what extent polygenic risk played a role in the mental health response to the COVID-19 pandemic. In this study, we investigate whether polygenic scores (PGSs) for mental health-related traits can distinguish between four resilience-vulnerability trajectories identified during the COVID-19 pandemic and associated lockdowns in 2020/21. We used multinomial regression in a genotyped subsample (n = 1316) of the CovSocial project. The most resilient trajectory characterized by the lowest mental health burden and the highest recovery rates served as the reference group. Compared to this most resilient trajectory, a higher value on the PGS for the well-being spectrum decreased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.3%). Conversely, a higher value on the PGS for neuroticism increased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.2%). Latent change in mental health burden extracted from the resilience-vulnerability trajectories was not associated with any PGS. Although our findings support an influence of PGS on mental health during COVID-19, the small added explained variance suggests limited utility of such genetic markers for the identification of vulnerable individuals in the general population.

Training-related improvements in mental well-being through reduction in negative interpretation bias: A randomized trial of online socio-emotional dyadic and mindfulness interventions.

BACKGROUND: Effects of online contemplative practices, especially partner-based practices, on psychological well-being remain mixed, with sparse understanding of potential affective-cognitive mechanisms. The study aimed to assess the efficacy of two online contemplative interventions in improving depression, anxiety, emotion regulation (ER), and resilience, and to evaluate the mechanistic role of negative attention and interpretation biases. METHODS: Employing a randomized controlled design (n = 285), we compared the efficacy of 10-week online mindfulness-based and partner-based socio-emotional dyadic interventions, both supported by weekly coaching sessions. Mental health aspects were assessed using validated self-report measures and negative biases using the mouse-contingent Scrambled Sentences Task. RESULTS: Both interventions, compared to waitlist control, led to reductions in depression and ER difficulties, while trait anxiety decreased only after mindfulness training. Increases in multidimensional resilience were observed only after socio-emotional training and in stress recovery only after mindfulness-based training, both compared to waitlist control. Socio-emotional training led to significant reductions in negative interpretation bias and this mediated reductions in depression and trait anxiety. Neither training led to reductions in state anxiety or negative attention bias. LIMITATIONS: The subclinical nature and overrepresentation of females in the sample limits generalizability. CONCLUSIONS: Findings indicate that online mindfulness-based and socio-emotional partner-based interventions, supported by online coaching sessions, can reduce depression and ER difficulties. Though mindfulness practice reduced trait anxiety and enhanced stress recovery, socio-emotional training increased multidimensional resilience. Socio-emotional training reduced negative interpretation bias, which emerged as an intervention-specific mechanism. These findings highlight the potential benefits of online contemplative intervention approaches for psychological well-being.

Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice.

BACKGROUND: Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. METHODS: This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. RESULTS: Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LIMITATIONS: Given the subclinical study sample, findings are limited in their generalizability to clinical samples. CONCLUSIONS: Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.

A randomized trial on differential changes in thought and affect after mindfulness versus dyadic practice indicates phenomenological fingerprints of app-based interventions.

Contemplative practice has demonstrated benefits for mental health and well-being. Most previous studies, however, implemented in-person trainings containing a mix of different, mostly solitary, practices and focused on pre- to post-training outcomes. In this randomized trial, we explore the immediate differential efficacy of two daily app-delivered practices in shifting emotional (valence, arousal) and thinking patterns (thought content on future-past, self-other, positive-negative dimensions). For 10 weeks of daily training, 212 participants (18-65 years) performed either a novel 12-min partner-based socio-emotional practice (Affect Dyad) or a 12-min attention-focused solitary mindfulness-based practice. Using ordinal Bayesian multilevel modeling, we found that both practice types led to more positive affect and higher arousal. However, whereas mindfulness-based practice partly led to a decrease in active thoughts, particularly in future-, other-related and negative thoughts, the Dyad in contrast led to increases in other-related, and positive thoughts. This shift towards more social and positive thoughts may specifically support overcoming ruminative thinking patterns associated with self-related and negative thought content. Overall, these differential findings may help inform the adaptation of scalable app-based mental trainings in different segments of the population with the goal to improve mental health and well-being.

Boosting Empathy and Compassion Through Mindfulness-Based and Socioemotional Dyadic Practice: Randomized Controlled Trial With App-Delivered Trainings.

BACKGROUND: Contemplative trainings have been found to effectively improve social skills such as empathy and compassion. However, there is a lack of research on the efficacy of app-delivered mindfulness-based and dyadic practices in boosting socioaffective capacity. OBJECTIVE: The first aim of this study was to compare a novel app-delivered, partner-based socioemotional intervention (Affect Dyad) with mindfulness-based training to foster empathy and compassion for the self or others. The second aim of this study was to investigate the underlying mechanisms of these effects. METHODS: This randomized controlled trial included socioemotional and mindfulness-based interventions and a waitlist control group, which received socioemotional training after the postintervention assessment. We used linear mixed-effects models to test intervention effects on self-report measures and an ecologically valid computer task of empathy, compassion for the self and others, and theory of mind. Moderated mediation models were used to investigate whether changes in acceptance, empathic distress, empathic listening, interoceptive awareness, and mindfulness served as underlying psychological processes of intervention effects. RESULTS: In 218 participants (mean age 44.12, SD 11.71 years; 160/218, 73.4% female), we found all interventions to have positive effects on composite scores for compassion toward the self (ßsocioemotional=.44, P<.001; ßwaitlist socioemotional=.30, P=.002; ßmindfulness-based=.35, P<.001) and others (ßsocioemotional=.24, P=.003; ßwaitlist socioemotional=.35, P<.001; ßmindfulness-based=.29, P<.001). Compassion measured with the computer task did not change significantly but showed a trend toward increase only in socioemotional dyadic practice (ßsocioemotional=.08, P=.08; ßwaitlist socioemotional=.11, P=.06). Similarly, on the empathic concern subscale of the Interpersonal Reactivity Index, a nonsignificant trend toward increase was found in the socioemotional intervention group (ßsocioemotional=.17; P=.08). Empathy significantly increased in both socioemotional groups (ßsocioemotional=.16, P=.03; ßwaitlist socioemotional=.35, P<.001) and the mindfulness-based group (ßmindfulness-based=.15; P=.04). The measures of theory of mind did not change over time. In the mindfulness-based group, the increase in self-compassion was mediated by a decrease in empathic distress (indirect effect abmindfulness-based=0.07, 95% CI 0.02-0.14). In the socioemotional group, an increase in self-compassion could be predicted by an increase in acceptance (ßsocioemotional=6.63, 95% CI 0.52-12.38). CONCLUSIONS: Using a multimethod approach, this study shows that app-delivered socioemotional and mindfulness-based trainings are effective in fostering compassion for the self and others in self-report. Both low-dose trainings could boost behavioral empathy markers; however, the effects on behavioral and dispositional markers of compassion only trended after dyadic practice, yet these effects did not reach statistical significance. Training-related increases in self-compassion rely on differential psychological processes, that is, on improved empathic distress regulation through mindfulness-based training and the activation of a human care- and acceptance-based system through socioemotional dyadic training. TRIAL REGISTRATION: ClinicalTrials.gov NCT04889508; https://clinicaltrials.gov/ct2/show/NCT04889508.

The contextual goal dependent attentional flexibility (CoGoDAF) framework: A new approach to attention bias in depression.

Successful adaptation to the environment requires attentional prioritization of emotional information relevant to the current situational demands. Accordingly, the presence of an attention bias (AB) for both positive and negative information may allow preferential processing of stimuli in line with the current situational goals. However, AB for negative information sometimes becomes maladaptive, being antithetical to the current adaptive needs and goals of an individual, such as in the case of affective disorders such as depression. Although difficulties in flexible shifting between emotional stimuli in depression have increasingly become a topic of discussion in the field, an integrative approach towards biased versus flexible emotional attentional processes remains absent. In the present paper, we advance a novel and integrative view of conceptualizing potentially aberrant affective attention patterns in depression as a function of the current contextual features. We propose that flexible emotional attention takes place as a result of attention prioritization towards goal-relevant emotional stimuli depending upon the current context of the individual. Specifically, the roles of context, distal and proximal goals, and approach and avoidance motivation processes are considered in a unified manner. The empirical, clinical, and interventional implications of this integrative framework provide a roadmap for future psychological and neurobiological experimental and translational research.

Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study.

The COVID-19 pandemic has created a significant mental health burden on the global population. Studies during the pandemic have shown that risk factors such as intolerance of uncertainty and maladaptive emotion regulation are associated with increased psychopathology. Meanwhile, protective factors such as cognitive control and cognitive flexibility have been shown to protect mental health during the pandemic. However, the potential pathways through which these risk and protective factors function to impact mental health during the pandemic remain unclear. In the present multi-wave study, 304 individuals (18 years or older, 191 Males), residing in the USA during data collection, completed weekly online assessments of validated questionnaires across a period of five weeks (27th March 2020-1st May 2020). Mediation analyses revealed that longitudinal changes in emotion regulation difficulties mediated the effect of increases in intolerance of uncertainty on increases in stress, depression, and anxiety during the COVID-19 pandemic. Further, individual differences in cognitive control and flexibility moderated the relationship between intolerance of uncertainty and emotion regulation difficulties. While intolerance of uncertainty and emotion regulation difficulties emerged as risk factors for mental health, cognitive control and flexibility seems to protect against the negative effects of the pandemic and promote stress resilience. Interventions aimed at enhancing cognitive control and flexibility might promote the protection of mental health in similar global crises in the future.

Heterogeneous Mental Health Responses to the COVID-19 Pandemic in Germany: An Examination of Long-Term Trajectories, Risk Factors, and Vulnerable Groups.

Abundant studies have examined mental health in the early periods of the COVID-19 pandemic. However, empirical work examining the mental health impact of the pandemic's subsequent phases remains limited. In the present study, we investigated how mental vulnerability and resilience evolved over the various phases of the pandemic in 2020 and 2021 in Germany. Data were collected (n = 3522) across seven measurement occasions using validated and self-generated measures of vulnerability and resilience. We found evidence for an immediate increase in vulnerability during the first lockdown in Germany, a trend towards recovery when lockdown measures were eased, and an increase in vulnerability with each passing month of the second lockdown. Four different latent trajectories of resilience-vulnerability emerged, with the majority of participants displaying a rather resilient trajectory, but nearly 30% of the sample fell into the more vulnerable groups. Females, younger individuals, those with a history of psychiatric disorders, lower income groups, and those with high trait vulnerability and low trait social belonging were more likely to exhibit trajectories associated with poorer mental well-being. Our findings indicate that resilience-vulnerability responses in Germany during the COVID-19 pandemic may have been more complex than previously thought, identifying risk groups that could benefit from greater support.

The Wither or Thrive Model of Resilience: an Integrative Framework of Dynamic Vulnerability and Resilience in the Face of Repeated Stressors During the COVID-19 Pandemic.

During the first 2 years of the COVID-19 pandemic, empirical efforts in the psychological sciences have been unequivocally focused on understanding the psychosocial impact on resilience and vulnerability. While current empirical work is guided by different existing theoretical models of resilience and vulnerability, the emerging datasets have also pointed to a necessity for an update of these models. Due to the unique features and developments specific to the current pandemic such as the occurrence of repeated collective stressors of varying durations, in the current position paper, we introduce the Wither or Thrive model of Resilience (With:Resilience). It integrates key aspects of prevailing psychological resilience frameworks within the context of the COVID-19 pandemic, and extends them by (1) moving away from single scale approaches towards a higher-order latent expression of resilience and vulnerability incorporating also non-clinical mental health markers, (2) proposing different trajectories of resilience-vulnerability emerging across repeated stressors over long periods of time, and (3) by incorporating multiple influencing factors including aspects of the socio-economic concept of social cohesion as well as separate mediating processing mechanisms. We propose that With:Resilience will enable a more nuanced approach and appropriate analytical investigation of the vast incoming data on mental health and resilience during the COVID-19 pandemic, and we suggest some concrete methodological approaches. This framework will assist in the development of actionable public health guidelines for society in the present and future pandemic contexts as well as aid policy making and the interventional sciences aimed at protecting the most vulnerable amongst us.

Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol.

BACKGROUND: The SARS-CoV-2 pandemic has led to a mental health crisis on a global scale. Epidemiological studies have reported a drastic increase in mental health problems, such as depression and anxiety, increased loneliness and feelings of disconnectedness from others, while resilience levels have been negatively affected, indicating an urgent need for intervention. The current study is embedded within the larger CovSocial project which sought to evaluate longitudinal changes in vulnerability, resilience and social cohesion during the pandemic. The current second phase will investigate the efficacy of brief online mental training interventions in reducing mental health problems, and enhancing psychological resilience and social capacities. It further provides a unique opportunity for the prediction of intervention effects by individual biopsychosocial characteristics and preceding longitudinal change patterns during the pandemic in 2020/21. METHODS: We will examine the differential effects of a socio-emotional (including 'Affect Dyad') and a mindfulness-based (including 'Breathing Meditation') intervention, delivered through a web- and cellphone application. Participants will undergo 10 weeks of intervention, and will be compared to a retest control group. The effectiveness of the interventions will be evaluated in a community sample (N = 300), which is recruited from the original longitudinal CovSocial sample. The pre- to post-intervention changes, potential underlying mechanisms, and prediction thereof, will be assessed on a wide range of outcomes: levels of stress, loneliness, depression and anxiety, resilience, prosocial behavior, empathy, compassion, and the impact on neuroendocrine, immunological and epigenetic markers. The multi-method nature of the study will incorporate self-report questionnaires, behavioral tasks, ecological momentary assessment (EMA) approaches, and biological, hormonal and epigenetic markers assessed in saliva. DISCUSSION: Results will reveal the differential effectiveness of two brief online interventions in improving mental health outcomes, as well as enhancing social capacities and resilience. The present study will serve as a first step for future application of scalable, low-cost interventions at a broader level to reduce stress and loneliness, improve mental health and build resilience and social capacities in the face of global stressors. TRIAL REGISTRATION: This trial has been registered on May 17, 2020 with the ClinicalTrials.gov NCT04889508 registration number (clinicaltrials.gov/ct2/show/NCT04889508).

Manipulating avoidance motivation to modulate attention bias for negative information in dysphoria: An eye-tracking study.

BACKGROUND AND OBJECTIVES: Instrumentality plays a key role in guiding attention, such that stimuli associated with achieving current goals of an individual prioritize attention. However, in depression, attention is prioritized to negative stimuli even when they are not relevant to current goals. In the current study, we tested whether attention is prioritized to stimuli that are associated with avoidance of imminent negative consequences over negative affective stimuli. METHODS: Using an eye-tracking based attention engagement-disengagement task, we presented pairs of negative faces, and neutral faces associated with avoidance of punishment (white noise and lost money) to a group of dysphoric and non-dysphoric individuals. RESULTS: First, we replicated previous evidence on difficulties to disengage attention from negative stimuli, when prompted to direct eye-gaze towards simple neutral stimuli, in dysphoric compared to non-dysphoric individuals. Further, we found that both dysphoric and non-dysphoric individuals were faster to disengage their attention from negative pictures when prompted to direct eye-gaze towards punishment avoidance-related neutral stimuli, versus towards simple neutral stimuli. LIMITATIONS: Although we seek to clarify the attention processes underlying depression, the current study employed a sub-clinical sample in order to serve as proof-of-concept study. CONCLUSIONS: Our results indicate that stimuli instrumental to the goal of avoiding negative consequences receive preference in the attention system over simple negative affective stimuli. Our findings suggest that manipulating the instrumentality of avoidance motivation can effectively modulate the attention bias for negative information in dysphoria, and also possibly in depression, akin to the modulation patterns in non-dysphoric individuals.

Contextual goal-dependent attention flexibility or rule-based learning? An investigation of a new attention flexibility paradigm.

BACKGROUND & OBJECTIVES: Deficits in the ability to process contextual changes have been proposed to be crucial for emotion dysregulation. A recent study found evidence for the role of contextual changes in exacerbating attention switching towards valence-specific goals using a novel attention flexibility paradigm. Despite the task indicating good reliability, the role of rule-based learning has not been clarified in this paradigm. Therefore, we examined whether the novel attention flexibility task is an index of context-based attention switching or does it reflect impact of rule-based learning on attention. METHOD: We employed a neutral version of the attention flexibility task. A sample of dysphoric and non-dysphoric participants were introduced to neutral contexts which required them to shift between neutral categories of pictures depending upon the cueing shape. RESULTS: There was an existence of a switch cost for shifting between different rules owing to the features of the rules. Further, non-dysphorics were faster at set-shifting between different rules as compared to dysphoric individuals. However, unlike in the affective version of the attention flexibility task, we found no significant differences between dysphoric and non-dysphoric individuals in attention switching patterns owing to switching between different rules. LIMITATIONS: Although the current study aimed to replicate the design of the previous study, a depressed patient sample must be employed to further clarify the different aspects of the attention flexibility paradigm. CONCLUSION: Our findings were able to clarify the non-existent role of rule-based learning in the attention flexibility paradigm.

Looking for carrots, watching out for sticks: A gaze-contingent approach towards training contextual goal-dependent affective attention flexibility.

The ability to flexibly shift between changing goals is crucial to develop an adaptive response to life stressors. Accordingly, lower affective attention flexibility, i.e. the ability to shift attention flexibly between goals, is associated with low reappraisal ability, high levels of rumination, and lower levels of resilience. However, attempts to manipulate affective attention flexibility with current attention training procedures have seen limited success. In the current study, we tested a novel attention flexibility training paradigm using eye-tracking, wherein dysphoric participants had to switch between different context-dependent goals. Attention towards goal-relevant emotional stimuli was reinforced using music and harsh sound. We found that participants in the training condition became significantly faster in switching attention from negative to positive goal-related stimuli pre-to post-training on an attention flexibility task, compared to the control condition. On a transfer task where participants had to give a presentation to an audience, we found that participants in the training condition displayed a more flexible pattern of attending to emotional faces during their presentation, depending upon which goal was activated. Comparatively, participants in the control condition remained rigidly attentive towards negative faces despite the goal activated. Our findings provide preliminary evidence for the role of context-based attention flexibility in dysphoria, and support scope for future clinical applications.

Conflicting rewards: effects of task goals on attention for alcohol cues.

Research has shown that temporary task goals capture more attention than negative, threatening cues, even in anxious individuals. In the current study, we investigated whether temporary task goals would also capture more attention than alcohol-related cues. In Experiment 1, 59 hazardous drinkers performed both a modified dot-probe and a flanker task in which temporary goal- and alcohol-relevant stimuli were presented together. Results of the dot-probe task confirmed an attentional bias towards goal-relevant stimuli in the presence of alcohol cues. This effect was absent in a modified flanker task, although there was a general slowing when the targets appeared on top of goal-relevant stimuli, suggesting that goal-related backgrounds captured more attention than alcohol backgrounds. In Experiment 2, we replicated the dot-probe procedure in 29 hazardous drinkers who had been exposed to a prime dose of alcohol prior to performing the task. Our findings indicate that temporary goal stimuli are more salient than alcohol cues, which might lead the way to novel clinical applications.

Music to my ears, goal for my eyes? Music reward modulates gaze disengagement from negative stimuli in dysphoria.

Attentional bias for negative information, i.e. difficulties in disengagement from negative stimuli, is considered to be one of the core mechanisms involved in the onset and maintenance of depression. However, current attention training procedures aimed at reducing this bias have shown limited success. In addition to the reliability and validity concerns generated by the use of dot-probe paradigm in these procedures, an important factor is the limited consideration of motivational influences in the use of attention training. Therefore, in the current study we examined whether goal stimuli, reinforced with music reward, can modulate attention for negative information in dysphoric individuals. Using a novel attention task which measures gaze disengagement from negative faces, we found that dysphoric individuals displayed greater difficulties in disengaging eye-gaze from negative and directing it towards standard neutral stimuli, as compared to non-dysphorics. However, when using reward-reinforced goal stimuli, dysphoric individuals were as quick as non-dysphorics in disengaging attention from negative stimuli in order to engage with goal-related stimuli. These results provide preliminary evidence for the modulating role of music-reinforced goals in the attention system of depressed individuals, and highlight how music-reinforced goals can be incorporated in current attention training procedures to improve outcomes.