Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST).

OBJECTIVE: Extending on previous findings that computerized MeST (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. METHODS: Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. RESULTS: The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05). CONCLUSIONS: c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.

Corrigendum: Study protocol for a randomized controlled trial of the RASPERA project: recalling and anticipating specific positive events to boost resilience in adolescents.

[This corrects the article DOI: 10.3389/fpubh.2023.1216988.].

Corrigendum: Study protocol for a randomized controlled trial of the RASPERA project: recalling and anticipating specific positive events to boost resilience in adolescents.

[This corrects the article DOI: 10.3389/fpubh.2023.1216988.].

Study protocol for a randomized controlled trial of the RASPERA project: recalling and anticipating specific positive events to boost resilience in adolescents.

Background: Many stress-related mental health problems, like depression and anxiety, emerge during adolescence, with some recent studies suggesting numbers are increasing. One possible way to reduce adolescents' vulnerability to stress-related mental health problems is to increase their resilience by training them in recalling specific positive memories and anticipating specific positive future events. Therefore, an innovative combi-training (called Positive Events Training; PET) was developed, focusing on the enhancement of the specificity of both past and future positive autobiographical events in adolescents. Its effects on adolescents' resilience and mental wellbeing will be examined. Methods: A cluster randomized controlled trial with a 2 (condition) × 3 (time-point) factorial design was conducted. Classes of adolescents were randomized to either a PET program (intervention) or a CREAtive writing Training (CREAT) program (active control). Both trainings consisted of four sessions of 50 min (one session, weekly, for four consecutive weeks) and were delivered in schools. Before (pre-training, T1), immediately after (post-training, T2), and 2 months after the training (follow-up, T3), participants completed a series of self-report questionnaires. Primary outcomes are resilience and mental wellbeing. Secondary outcomes are positive affect, positive affect regulation and anhedonia. CONSORT criteria for conducting and reporting RCTs will be used. Ethics and dissemination: Ethical approval was obtained from the Social and Societal Ethics Committee (SMEC) and the study has been preregistered on Open Science Framework (OSF) and ClinicalTrials.gov (Trial registration number: NCT05757180). We plan to develop a free, online, web-based self-directed PET protocol for teachers if the study provides evidence for the effectiveness of the PET program in increasing adolescents' resilience and mental wellbeing, so teachers can deliver the program to future students without the need of professional external trainers.

A validation of the Dutch version of the Awareness of Narrative Identity Questionnaire (ANIQ-NL).

Individuals build a narrative identity through the construction of an internalised, unfolding life story based on significant autobiographical memories. The current study validated a Dutch version of the Awareness of Narrative Identity Questionnaire (ANIQ-NL), which assesses how aware individuals are of having a narrative identity as well as their perception of the global coherence within their autobiographical memories, specifically, in terms of temporal ordering, causal connections and thematic integration. The questionnaire was administered to 541 adults (65.1% female, Mage = 34.09, SDage = 15.04, age range = 18-75). The results of a confirmatory factor analysis provided evidence for a four-factor structure, consisting of awareness and the three coherence subscales. The factor loadings of the items varied between .67 and .96. Moreover, the ANIQ-NL subscales showed good to excellent internal consistency, with Cronbach's alphas ranging from .86 to .96. Furthermore, higher levels of perceived autobiographical memory coherence were found to be significantly correlated to lower levels of depression, anxiety, and stress symptoms. The ANIQ-NL was determined to be a valid and reliable tool to measure narrative identity awareness and perceived narrative coherence. Future research could utilise the ANIQ-NL to further investigate the role of narrative identity in psychological well-being.

Direct accessibility for overgeneral memory predicts a worse course of depression: re-analysis of the online computerised memory specificity training for major depression study.

Researchers have been interested in what retrieval process is responsible for overgeneral autobiographical memories (OGM) in depression. Previous cross-sectional studies demonstrated that, for negatively valenced cues, directly retrieved OGM, rather than generatively retrieved OGM, are associated with depression. However, longitudinal evidence of this relationship is still lacking and needs to be tested. We conducted a re-analysis of the online computerised memory specificity training (c-MeST) data to examine whether directly retrieved OGM for negative cues prospectively predicts high levels of depression 1 month later. Participants who met the criteria of current major depressive disorders (N = 116; n = 58 in the c-MeST group and n = 58 in the control group) recalled autobiographical memories for positive and negative cues and judged each retrieval process (i.e. direct or generative). The results supported our prediction, and directly retrieved OGM for negative cues predicted high levels of depressive symptoms 1 month later even after controlling for the group effect, baseline depressive symptoms, executive functioning and rumination. Exploratory analysis showed that direct retrieval of specific memories prospectively predicted low levels of depression. These results support the theory that elevated accessibility of negatively valenced general memory representations is a vulnerability factor for depressive symptoms.

Different retrieval mechanisms of overgeneral autobiographical memory for positive and negative cues in remitted major depressive disorder.

BACKGROUND AND OBJECTIVES: Overgeneral autobiographical memory (OGM) has been shown to occur in depressed and previously depressed populations regardless of the emotional valence of cues. However, recent research has pointed out that the retrieval process underlying OGM, generative retrieval (i.e., retrieval requiring effort or additional information) or direct retrieval (i.e., memory that comes to consciousness without effort or additional information), may differ depending on the emotional valence of cues. We examined the hypotheses that a remitted MDD (major depressive disorder), group compared with a control group, would show (a) more direct retrieval of categoric memories for negative cues, (b) more generative retrieval of categoric memories for positive cues, and (c) less direct retrieval of specific memories for positive cues. METHODS: A remitted clinical MDD group (n = 21) and control group (n = 21) completed the Autobiographical Memory Test with minimal instruction, and were required to subjectively judge generative retrieval and direct retrieval. RESULTS: As expected, results showed that the remitted MDD group reported more frequent direct retrieval of categoric memory for negative cues and more generative retrieval of categoric memory for positive cues than the control group. LIMITATIONS: Our paradigm for distinguishing between generative and direct retrieval relied on subjective judgements. CONCLUSIONS: This extends the findings from student sample in previous studies to a help-seeking population. Increased availability of negative categoric memories and the attenuation of positive specific recall represent vulnerabilities for MDD. We discuss how these findings provide further rationale for memory therapeutics for MDD and refinement of those techniques.

Reduced specificity and increased overgenerality of autobiographical memory persist as cognitive vulnerabilities in remitted major depression: A meta-analysis.

Difficulty in accessing specific memories, referred to as reduced memory specificity or overgeneral memory (OGM), has been established as a marker of clinical depression. However, it is not clear if this deficit persists following the remission of depressive episodes. The current study involved a systematic review and meta-analysis of empirical studies with the aim of establishing whether remitted depression was associated with retrieving fewer specific and more overgeneral autobiographical memories. Seventeen studies were identified as eligible. The results indicated that people with remitted depression recalled fewer specific memories (k = 15; g = -0.314, 95% CI [-0.543; -0.085], z = -2.69, p = .007) and more categoric memories (k = 9; g = 0.254, 95% CI [0.007; 0.501], z = 2.02, p = .043) compared to people who had never been depressed. Given these deficits have elsewhere been shown to be prognostic of future depressive symptoms, these findings suggest that reduced memory specificity/overgeneral memory persists following remission and may be a risk factor for future episodes of depression in those that are in remission. The findings are discussed in terms of how this knowledge might influence clinical understanding of relapse prevention and maintenance of remission in those with a history of depression.

Characteristics of episodic future thinking in anxiety: A systematic review and meta-analysis.

Deficits in episodic future thinking (EFT) characteristics such as detail/vividness, specificity and the use of mental imagery are associated with psychopathology. However, whether these characteristics are associated with anxiety is not well understood. This article reports a systematic review and meta-analysis of research examining associations between anxiety and these EFT characteristics. Peer-reviewed studies that are published in the English language and contain at least one measure of anxiety and one measure of EFT characteristics were screened for inclusion in APAPsychINFO, CINAHL Plus and MEDLINE. Twenty-nine studies met the inclusion criteria. Results indicated that anxiety was not significantly correlated with detail/vividness overall. However, this was qualified by a moderating effect of cue valence. This finding is consistent with the Attentional Control and Contrast Avoidance Theories of anxiety, whereby higher anxiety is related to high detail/vividness in future thinking in the context of negatively-valenced cues, and conversely lower detail/vividness for positively-valenced cues. Anxiety was not significantly associated with specificity or the use of mental imagery. While heterogeneity and the low number of studies examining particular associations limited the findings, the results provide insight into the current state of the field and have both theoretical and clinical implications.

Remembering for resilience: Brief cognitive-reminiscence therapy improves psychological resources and mental well-being in young adults.

Reminiscence-based interventions focus on the recall of autobiographical memories and reflective reasoning about these remembered experiences. This study assessed the effect of a three-session, positive-memory version of cognitive-reminiscence therapy (CRT) on the psychological resources and mental well-being of young adults. The participants (N = 62, Mage = 24.6 [SD = 3.1], 71% females) were randomised to CRT or wait-list. Psychological resources (self-esteem, self-efficacy, meaning in life and optimism), mental well-being (depression, anxiety and stress symptoms) and theorised change processes (automatic negative thoughts, awareness of narrative identity and cognitive reappraisal) were assessed. The results showed the CRT group was significantly higher on psychological resources at post-CRT (d = 0.75-0.80) and follow-up (d = 0.52-0.87) and mental well-being at post-intervention (d = 0.71-1.30) and follow-up (d = 0.64-0.98). The hypotheses regarding change processes were supported. Future research may use an active comparator and include a longer follow-up, given only short-term effects were assessed. Brief, positive-focused CRT is effective in increasing psychological resources and mental well-being in young adults.

Direct retrieval bias for general and specific memories for negatively valenced cues in major depression.

Major depressive disorder (MDD) is associated with reduced specificity in autobiographical memory. It has been argued that this tendency occurs through a failure of effortful generative retrieval, regardless of valence of cue word. However, we propose that in MDD general memories are likely to be recalled via direct retrieval, and direct retrieval is more likely for negatively valenced cues. To provide a preliminary test of this, a large sample with MDD (N = 298; M age = 47.2) completed the autobiographical memory test and indicated whether retrievals were generative or direct. Categoric and extended memories for negatively valenced cues were more often directly retrieved than generatively retrieved, and more often than direct retrieval for positively valenced cues. In contrast, categoric and extended memories for positively valenced cues were more often generatively retrieved relative to generative retrieval for negatively valenced cues. Relative to non-clinical samples, direct retrieval for negatively valenced cues was high. Retrieval method and valence may be moderating processes in the type of memories recalled. This preliminary work presents the possibility of an extension of theory on retrieval tendencies in MDD.

Increasing anticipated and anticipatory pleasure through episodic thinking.

Episodic future thinking for positive future events is known to evoke positive affect. We aimed to assess whether it specifically evokes anticipated and anticipatory pleasure for future events, and behavioral intention. As a secondary aim, we examined if this differed compared to a condition of thinking of positive past events. In two studies, participants nominated 5 upcoming positive events and 5 positive past events. They then completed guided episodic thinking of past events and guided episodic thinking of future events. After guided episodic thinking, they rated the nominated future events on detail/vividness, mental imagery, anticipated and anticipatory pleasure, and behavioral intention. In Study 1 (N = 32, M age = 37.0, SD = 19.7), increases on all variables were found relative to baseline, although expected pleasure was at trend level. There were no significant differences between future and past conditions. In Study 2 (N = 29, M age = 38.4, SD = 16.3), participants were asked to nominate future events that were not already planned, and perceived control was also assessed. Again, increases in detail/vividness, mental imagery, and anticipated and anticipatory pleasure were found, this time with stronger effects for the future condition. No change was found for perceived control or intention. In both studies, increases in detail/vividness, mental imagery, and anticipated and anticipatory pleasure were generally positively correlated with increases in behavioral intention. This study provides evidence that guided episodic thinking increases anticipated and anticipatory pleasure for positive future events. Clinical implications, particularly in depression and schizophrenia-spectrum disorders, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Wanting and Liking: Testing the Factor Structure of The Temporal Experience of Pleasure Scale in Major Depression and Community Samples.

The Temporal Experience of Pleasure Scale (TEPS) is a multidimensional self-report measure that has been used to improve understanding of anticipation ("wanting") and consummation ("liking") of reward. The TEPS has been used to assess anhedonia in clinical depression, but its factor structure has not yet been confirmed in this population. This seems important given mixed findings on the model fit and factor structure of the TEPS in other clinical and community samples. To remedy this, the current study used confirmatory factor analysis to test models of the TEPS items across three studies: (a) in adults with major depression (n = 334), (b) in youth with major depression (n = 305), and (c) in a community sample (n = 320). In summary, the model fit of the two-factor TEPS scales was adequate in depressed and community Australian samples. Nevertheless, some items may require removal or revision based on cultural preferences for pleasurable experiences.

Perceived Autobiographical Coherence Predicts Depressive Symptoms Over Time Through Positive Self-Concept.

The coherence of autobiographical memories plays an important role in psychological well-being, as borne out by recent studies. This study aimed to advance this understanding by assessing whether coherence predicted depressive symptoms over time in adults. Further, it aimed to specify mediators through which this association might occur, namely psychological resources of self-esteem self-efficacy, meaning in life, and optimism. A sample of 160 participants (M age = 26.4, SD = 3.2, 58.1% women) completed surveys at three time-points spaced 1 week apart. The surveys contained measures of the perceived coherence of life stories and autobiographical memories, psychological resources, and depressive symptoms. The results of a path analysis model, controlling for depressive symptoms at baseline, indicated that perceived causal coherence was the only unique predictor of later depressive symptoms, and that this occurred through positive self-concept, represented by self-esteem and self-efficacy. Limitations of the study include no examination of cultural background as a moderating factor and the short time-intervals. Overall, the findings provide further evidence that the perception of how events have unfolded and impacted on one's life and sense of self is particularly important in mitigating depressive symptoms. It extends on our understanding by showing this occurs through changes in self-concept.

Confirmatory factor analysis of the Depression, Anxiety, and Stress Scale among Indian adults.

BACKGROUND: The Depression, Anxiety, and Stress Scale (DASS) is a widely used measure of negative emotional states. While the DASS is increasingly used in mental health research in India, to date no study has examined the factor structure among Indian adults. METHODS: A large community sample of English-speaking Indian adults completed the DASS 21-item version, and confirmatory factor analyses were conducted. RESULTS: The results indicated a good fit for a three factor (depression, anxiety, and stress) and a one-factor model (general psychological distress). There was no substantial difference between the fit of the models, and the DASS subscales were very strongly correlated with one another (r ≥ .80). CONCLUSION: The findings from this sample suggest that the DASS-21 items appear to assess general psychological distress, with little evidence that the items assess three distinct subscales.

The Association Between Anxiety and Falls: A Meta-Analysis.

OBJECTIVES: Falls occur frequently among older adults and can lead to a range of adverse and debilitating outcomes. Although symptoms of clinical anxiety have been implicated as risk factors for falls, there is no current consensus on the empirical association between anxiety and falls. The current study aimed to address this gap in the literature by conducting a quantitative, meta-analytic review of findings from previous studies. METHOD: A systematic literature search of bibliographic databases was conducted, yielding 18 studies that fit the criteria for inclusion in the meta-analysis. RESULTS: A random-effects model of all 18 studies showed a significant overall odds ratio of 1.53 (95% CI 1.28-1.83, p < .001), indicating that elevated levels of anxiety were associated with a 53% increased likelihood of falls. A high amount of variance among effect sizes was observed. Only age was identified as a moderator of this relationship in a subgroup of the samples. CONCLUSIONS: Clinical anxiety is associated with falls, however, further research is required to elucidate the factors that might moderate or mediate this relationship, the casual pathways through which they are related, and the associations between different types of anxiety and falls.

Development and Validation of the Awareness of Narrative Identity Questionnaire (ANIQ).

The utility of a narrative approach to identity and its role in psychological functioning are becoming increasingly recognized across various fields of inquiry. The current study aimed to develop a quantitative, self-report measure of the awareness of narrative identity and how globally coherent one's autobiographical memories are perceived to be, specifically, in terms of temporal ordering, causal associations, and the perception of unifying themes. The construct validity and reliability of the Awareness of Narrative Identity Questionnaire (ANIQ) were assessed across three studies. In the first study, exploratory factor analysis of the responses of a large sample ( N = 441, M [age in years] = 33.1, SD = 15.2) to an initial item pool resulted in a 20-item four-factor structure congruent with the proposed subscales, and convergent and divergent validity were established. In the second study, and with a different sample ( N = 320, M [age in years] = 26.2, SD = 4.0), further evidence for the factor structure was provided through confirmatory factor analysis. Validity findings from Study 1 were replicated and extended on, and test-retest reliabilities were found to be high ( r = .72-.79). Importantly, in the third study ( N = 71, M [age in years] = 24.9, SD = 6.9), criterion validity was established, whereby the ANIQ subscales were demonstrated to be associated with dimensions of narrative coherence coded from written turning-point narratives. Across all studies, the internal reliabilities for the subscales were high (α = .86-.96). The ANIQ represents a valid, psychometrically sound, and novel method of assessing the awareness of narrative identity and autobiographical memory coherence.

Brief reminiscence activities improve state well-being and self-concept in young adults: a randomised controlled experiment.

Reminiscence-based psychotherapies have been demonstrated to have robust effects on a range of therapeutic outcomes. However, little research has been conducted on the immediate effects of guided activities they are composed of, or how these might differ dependent on the type of reminiscence. The current study utilised a controlled experimental design, whereby 321 young adults (mean age = 25.5 years, SD = 3.0) were randomised to one of four conditions of online reminiscence activity: problem-solving (successful coping experiences), identity (self-defining events contributing to a meaningful and continuous personal identity), bitterness revival (negative or adverse events), or a control condition (any memory from their past). Participants recalled autobiographical memories congruent with the condition, and answered questions to facilitate reflection on the memories. The results indicated that problem-solving and identity reminiscence activities caused significant improvements in self-esteem, meaning in life, self-efficacy and affect, whereas no effects were found in the bitterness revival and control conditions. Problem-solving reminiscence also caused a small effect in increasing perceptions of a life narrative/s. Differences between the conditions did not appear to be explained by the positive-valence of memories. These results provide evidence for the specific effects of adaptive types of problem-solving and identity reminiscence in young adults.