The association between the sense of control and depression during the COVID-19 pandemic: a systematic review and meta-analysis.

Introduction: High levels of depression and low sense of control have been reported during the COVID-19 pandemic. The removal of typical freedoms through public health restrictions may have played an important role. The aim of this review was to examine data collected during the pandemic and (1) estimate the strength of the association between sense of control and depression, (2) examine whether the different types of control measures affected the strength of the association, and (3) whether this changed as a function of pandemic indicators. Methods: We conducted a systematic review and meta-analysis of studies published in English between December 2019 and November 2022. A total of 993 articles were identified, of which 20 were included in the review and 16 in the meta-analysis after conducting a quality assessment using the standard NIH tool. Results: The control-depression association gave a bias-independent pooled effect size of r = .41, and grew stronger over the 130 weeks covered by this review but did not change as a function of local COVID incidence rates. Subgroup analyses showed that external and overall control were more strongly related to depression than internal control. Discussion: These findings emphasize that external factors are important to the sense of control and the importance of preserving the sense of control in situations where the removal of personal freedoms is necessary, such as public health emergencies.

Experiences of people with multiple sclerosis participating in a social cognitive behavior change physical activity intervention.

BACKGROUND: Understanding the experiences of people with MS taking part in physical activity interventions is critical to inform future interventions. AIM: The aim was to gain insight into the experiences of people with MS taking part in a behavior change group physical activity intervention with a novel social cognitive theory component. METHODS: A qualitative semi-structured interview format was utilized. Questions focussed on expectations, views and beliefs at being involved in the study, beliefs on physical activity, and subjective evaluation of the trial content and delivery. Seventeen people were interviewed and data were analyzed using thematic analysis. RESULTS: Three themes were generated: psychological and social factors, intervention processes, and MS identity. The acceptance of MS as an identity acted as an initial barrier to exercise, with a more positive, exercise-enabling identity post-intervention. Psychological factors such as self-efficacy and anxiety, as well as social factors such as social support, were found to play an important role in how participants experienced the program. Similarly, intervention processes included support for group-based activities and structure of exercise classes, and were also inter-linked to the other themes. CONCLUSION: It appears that group-based exercise interventions are acceptable and feasible for people with MS. The qualitative findings support previously reported quantitative findings that the Step it Up intervention is effective at promoting physical activity and improving psychological outcomes.

Depression symptoms and the perception of public health restrictions during the COVID-19 pandemic in Saudi Arabia: The protective effect of sense of control.

The psychological impact of public health restrictions may play a role in the increased depression levels reported since the COVID-19 pandemic began. Data further suggest that people's sense of personal control has been reduced during the pandemic also producing psychological distress. This study aimed to test whether perceptions of public health restrictions predict depression under pandemic conditions and if the sense of control can serve as a protective factor. For this cross-sectional study, 641 residents in Saudi Arabia over the age of 17 years were recruited between November and December of 2020 to complete an online survey. The survey assessed depression levels (Beck Depression Inventory, BDI), the sense of control and perceptions of public health restrictions. Demographic information was also collected. Depression levels were higher compared to previous samples (d = 0.12). The number of restrictions perceived as distressing strongly predicted the probability of high BDI scores, ß = 0.92 , with higher sense of control predicting lower levels of depression (constraints, ß = - 0.50 , mastery, ß = - 0.71 ). A strong sense of control significantly reduced the impact of the perception of restrictions on depression. These results suggest that the perception of public health restrictions is part of the reason for increased levels of depression during the pandemic. A strong sense control reduced the impact of restrictions on depression. It is therefore possible that simple interventions enhancing the sense of control, such as the availability of choice, could support mental health in restricted situations.

When and How Video Games Can Be Good: A Review of the Positive Effects of Video Games on Well-Being.

Video games are a source of entertainment for a wide population and have varied effects on well-being. The purpose of this article is to comprehensively examine game-play research to identify the factors that contribute to these disparate well-being outcomes and to highlight the potential positive effects. On the basis of existing literature, we argue that the effects of gaming on well-being are moderated by other variables, such as motivations for gaming and video-game characteristics. Specifically, the inclusion of social activity can benefit prosocial behaviors and affect the relationship between violent video games and aggression that some studies have demonstrated. Moreover, the research on the relationship between violent video games and aggression depends greatly on individual and sociocontextual variables outside of game play. The inclusion of physical activity in games can provide an improvement in physical health with high levels of enjoyment, potentially increasing adherence rates. Overall, following our review, we determined that the effects of gaming on well-being are moderated by and depend on the motivation for gaming, outside variables, the presence of violence, social interaction, and physical activity. Thus, we argue that there is potential for an "optimal gaming profile" that can be used in the future for both academic- and industry-related research.

The relationship between perception of control and mood: The intervening effect of cultural values in a Saudi Arabian sample.

The relationship between the constructs of perceived control and symptoms of mood disorders has been demonstrated. The current study evaluates cultural values both as an individual difference moderating variable and as one of the mechanisms through which the association between perceived control and mood disturbances may operate. The hypotheses were examined with a sample of 615 participants recruited in Saudi Arabia. Participants completed measures of perceived control, individualism and collectivism, and symptoms of depression and bipolar disorder. In general, the results supported a model in which higher levels of perceived control promote a less symptomatic mood state. In most cases, cultural values positively mediated the relationship between perceived control and mood disturbance with lower symptom levels predicted. However, when the components of perceived control were examined separately, high perceived mastery together with highly individualistic values predicted higher levels of bipolar symptoms. In this sample, there was less evidence of cultural values moderating the control-mood disturbance relationship. Only one moderator relationship was identified, which showed low control linking to higher symptom levels only in those who disagreed with individualistic values. Overall, our data are in agreement with the notion that pre-existing cultural values have an important effect on mood disorder symptoms.

The impact of community-based mental health service provision on stigma and attitudes towards professional help-seeking.

BACKGROUND: Stigma of mental ill-health and attitudes towards help-seeking are recognized barriers to seeking professional help, and have previously been linked to the type of support services available. AIMS: This study examined if the introduction of community-based mental health services to an area impacts mental health stigma and attitudes towards professional help-seeking amongst local residents. METHOD: A repeated cross-sectional study comprising of community surveys in two localities was carried out before and after community-based mental health services were introduced (N = 1074). Measures including perceived public and self-stigma of mental ill-health, and attitudes towards seeking professional help were compared across the two time points. RESULTS: Both public and self-stigma were significantly lower, and attitudes towards seeking professional help significantly more positive, after community-based mental health services had been introduced in each locality. CONCLUSIONS: The presence of local, accessible mental health services can positively impact help-seeking behaviour by reducing stigma and changing norms and attitudes around professional help-seeking.

Identification Reduces Stigma of Mental Ill-Health: A Community-Based Study.

The stigma surrounding mental ill-health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill-health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill-health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill-health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill-health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well-being.

The effects of cognitive load during intertrial intervals on judgements of control: The role of working memory and contextual learning.

When there is no contingency between actions and outcomes, but outcomes occur frequently, people tend to judge that they have control over those outcomes, a phenomenon known as the outcome density (OD) effect. Recent studies show that the OD effect depends on the duration of the temporal interval between action-outcome conjunctions, with longer intervals inducing stronger effects. However, under some circumstances OD effect is reduced, for example when participants are mildly depressed. We reasoned that working memory (WM) plays an important role in learning of context; with reduced WM capacity to process contextual information during intertrial intervals (ITIs) during contingency learning might lead to reduced OD effects (limited capacity hypothesis). To test this, we used a novel dual-task procedure that increases the WM load during the ITIs of an operant (e.g., action-outcome) contingency learning task to impact contextual learning. We tested our hypotheses in groups of students with zero (Experiments 1, N=34), and positive contingencies (Experiment 2, N=34). The findings indicated that WM load during the ITIs reduced the OD effects compared to no load conditions (Experiment 1 and 2). In Experiment 2, we observed reduced OD effects on action judgements under high load in zero and positive contingencies. However, the participants' judgements were still sensitive to the difference between zero and positive contingencies. We discuss the implications of our findings for the effects of depression and context in contingency learning.

SSRI enhances sensitivity to background outcomes and modulates response rates: A randomized double blind study of instrumental action and depression.

Serotonin reuptake inhibitors (SSRIs) have immediate effects on synaptic levels of serotonin but their therapeutic effects are often delayed. This delay has been suggested to reflect time required for new learning and therefore that SSRIs might be having effects on the learning process. We examined the effects of elevating serotonin levels, through short-term SSRI administration (escitalopram), on learning about perceptions of instrumental control. A randomised double blind procedure was used to allocate healthy people, categorised as mildly depressed (high BDI⩾10: n=76) or not depressed (low BDI⩽5: n=78) to either a drug (escitalopram, 10mg/7days) or placebo control group. Following treatment, participants were trained with a simple task that involved learning the effectiveness of an instrumental action (key press) and the background context at eliciting an outcome (auditory cue) where there was no programmed contingency. The effects of the drug were (i) to moderate response rates and (ii) to enhance sensitivity to the background or context rate of occurrence of the outcome. These findings suggest that serotonin modulates learning about the long-term rate of outcomes, which supports perception of instrumental control, and that this may provide a clue to the mechanism for supporting the development of the therapeutic effects of the drug.

The relationship between mood state and perceived control in contingency learning: effects of individualist and collectivist values.

Perceived control in contingency learning is linked to psychological wellbeing with low levels of perceived control thought to be a cause or consequence of depression and high levels of control considered to be the hallmark of mental healthiness. However, it is not clear whether this is a universal phenomenon or whether the value that people ascribe to control influences these relationships. Here we hypothesize that values affect learning about control contingencies and influence the relationship between perceived control and symptoms of mood disorders. We tested these hypotheses with European university samples who were categorized as endorsing (or not) values relevant to control-individualist and collectivist values. Three online experimental contingency learning studies (N 1 = 127, N 2 = 324, N 3 = 272) were carried out. Evidence suggested that individualist values influenced basic learning processes via an effect on learning about the context in which events took place. Participants who endorsed individualist values made control judgments that were more in line with an elemental associative learning model, whilst those who were ambivalent about individualist values made judgments that were more consistent with a configural process. High levels of perceived control and individualist values were directly associated with increased euphoric symptoms of bipolar disorder, and such values completely mediated the relation between perceived control and symptoms. The effect of low perceived control on depression was moderated by collectivist values. Anxiety created by dissonance between values and task may be a catalyst for developing mood symptoms. Conclusions are that values play a significant intermediary role in the relation between perceived control and symptoms of mood disturbance.

Understanding help-seeking amongst university students: the role of group identity, stigma, and exposure to suicide and help-seeking.

BACKGROUND: Despite a high prevalence of suicide ideation and mental health issues amongst university students, the stigma of help-seeking remains a barrier to those who are in real need of professional support. Social identity theory states that help received from an ingroup source is more welcome and less threatening to one's identity than that from a source perceived as outgroup. Therefore, we hypothesized that students' stigma toward seeking help from their university mental health service would differ based on the strength of their identification with the university. METHOD: An online survey including measures of stigma of suicide, group identification, experience with help-seeking and exposure to suicide was administered to Irish university students (N = 493). RESULTS: Group identification was a significant predictor of help-seeking attitudes after controlling for already known predictors. Contrary to our expectations, those who identified more strongly with their university demonstrated a higher stigma of seeking help from their university mental health service. CONCLUSIONS: RESULTS are discussed in relation to self-categorization theory and the concept of normative fit. Practical implications for mental health service provision in universities are also addressed, specifically the need for a range of different mental health services both on and off-campus.

Time perception and depressive realism: judgment type, psychophysical functions and bias.

The effect of mild depression on time estimation and production was investigated. Participants made both magnitude estimation and magnitude production judgments for five time intervals (specified in seconds) from 3 sec to 65 sec. The parameters of the best fitting psychophysical function (power law exponent, intercept, and threshold) were determined individually for each participant in every condition. There were no significant effects of mood (high BDI, low BDI) or judgment (estimation, production) on the mean exponent, n = .98, 95% confidence interval (.96-1.04) or on the threshold. However, the intercept showed a 'depressive realism' effect, where high BDI participants had a smaller deviation from accuracy and a smaller difference between estimation and judgment than low BDI participants. Accuracy bias was assessed using three measures of accuracy: difference, defined as psychological time minus physical time, ratio, defined as psychological time divided by physical time, and a new logarithmic accuracy measure defined as ln (ratio). The ln (ratio) measure was shown to have approximately normal residuals when subjected to a mixed ANOVA with mood as a between groups explanatory factor and judgment and time category as repeated measures explanatory factors. The residuals of the other two accuracy measures flagrantly violated normality. The mixed ANOVAs of accuracy also showed a strong depressive realism effect, just like the intercepts of the psychophysical functions. There was also a strong negative correlation between estimation and production judgments. Taken together these findings support a clock model of time estimation, combined with additional cognitive mechanisms to account for the depressive realism effect. The findings also suggest strong methodological recommendations.

Context and time in causal learning: contingency and mood dependent effects.

Defining cues for instrumental causality are the temporal, spatial and contingency relationships between actions and their effects. In this study, we carried out a series of causal learning experiments that systematically manipulated time and context in positive and negative contingency conditions. In addition, we tested participants categorized as non-dysphoric and mildly dysphoric because depressed mood has been shown to affect the processing of all these causal cues. Findings showed that causal judgements made by non-dysphoric participants were contextualized at baseline and were affected by the temporal spacing of actions and effects only with generative, but not preventative, contingency relationships. Participants categorized as dysphoric made less contextualized causal ratings at baseline but were more sensitive than others to temporal manipulations across the contingencies. These effects were consistent with depression affecting causal learning through the effects of slowed time experience on accrued exposure to the context in which causal events took place. Taken together, these findings are consistent with associative approaches to causal judgement.

Dysphoric Mood States are Related to Sensitivity to Temporal Changes in Contingency.

A controversial finding in the field of causal learning is that mood contributes to the accuracy of perceptions of uncorrelated relationships. When asked to report the degree of control between an action and its outcome, people with dysphoria or depression are claimed to be more realistic in reporting non-contingency (e.g., Alloy and Abramson, 1979). The strongest evidence for this depressive realism (DR) effect is derived from data collected with experimental procedures in which the dependent variables are verbal or written ratings of contingency or cause, and, perhaps more importantly, the independent variable in these procedures may be ambiguous and difficult to define. In order to address these possible confounds, we used a two-response free-operant causal learning task in which the dependent measures were performance based. Participants were required to respond to maximize the occurrence of a temporally contiguous outcome that was programmed with different probabilities, which also varied temporally across two responses. Dysphoric participants were more sensitive to the changing outcome contingencies than controls even though they responded at a similar rate. During probe trials, in which the outcome was masked, their performance recovered more quickly than that of the control group. These data provide unexpected support for the DR hypothesis suggesting that dysphoria is associated with heightened sensitivity to temporal shifts in contingency.

Parent perspectives of clinical psychology access when experiencing distress.

Around 20 to 30% of parents experience mental health difficulties within their child's first year, but only a small proportion go on to access specialist services. This is despite growing evidence around the positive benefits of psychosocial interventions for both parents and children. Previous research highlights facilitators and barriers to generic healthcare services for mothers with postnatal depression. The current study adopted a qualitative methodology to explore parents' own perceptions of the barriers and facilitators to clinical psychology specifically. Seven women took part in the study, most of whom had no previous involvement with specialist mental health services. A thematic analysis of interview data suggested six key themes in relation to the research question: 'The importance of connecting', 'Pressing the danger button', 'I'm not mad', 'More round care', 'Psychological distress as barrier' and 'Making space, making sense'. These are presented alongside a consideration of the clinical implications for community-based practitioners, including clinical psychologists.

The effect of mild depression on time discrimination.

Depressed mood states affect subjective perceptions of time but it is not clear whether this is due to changes in the underlying timing mechanisms, such as the speed of the internal clock. In order to study depression effects on time perception, two experiments using time discrimination methods with short (<300 ms) and long (>1,000 ms) durations were conducted. Student participants who were categorized as mildly depressed by their scores on the Beck Depression Inventory were less able than controls to discriminate between two longer durations but were equally able to discriminate shorter intervals. The results suggest that mildly depressed or dysphoric moods do not affect pacemaker speed. It is more likely that depression affects the ability to maintain attention to elapsing duration.

Vicarious exposure to trauma and growth in therapists: the moderating effects of sense of coherence, organizational support, and empathy.

Therapists who work with traumatized individuals can experience psychological growth following this vicarious exposure to trauma. The purpose of the present study is to examine the variables that may moderate such vicarious posttraumatic growth. Therapists (N = 118) completed measures of vicarious exposure to trauma and growth, as well as empathy, sense of coherence, and perceived organizational support. Results showed that having a strong sense of coherence negatively predicted growth (ß = -.28, p = .001), whereas empathy was a positive predictor (ß = .37, p < .001). Empathy also moderated the exposure to growth relationship when growth involved relating to others (ß = -.20; p = .018). Organizational support did not predict growth. The results have implications for the recruitment, training, and supervision of therapists working with individuals who have experienced trauma.

5-HT modulation by acute tryptophan depletion of human instrumental contingency judgements.

INTRODUCTION: The concept of 'depressive realism', that depression leads to more accurate perception of causal control, has been influential in the field of depression research, but remains controversial. Recent work testing contingency learning has suggested that contextual processing might determine realism-like effects. Serotonin (5-hydroxytryptamine, (5-HT)), which is implicated in the pathophysiology of depression, might also influence contextual processing. Using acute tryptophan depletion (ATD), we tested the hypothesis that dysfunctional serotoninergic neurotransmission influences contingency judgements in dysphoric subjects via an effect on contextual processing. MATERIALS AND METHODS: We employed a novel contingency learning task to obtain separate measures (ratings) of the causal effect of participants' responses and efficacy of the background context over an outcome. Participants, without a history of depression, completed this task on and off ATD in a double-blind, placebo-controlled, within-subjects design. RESULTS: As with other work on contingency learning, the effects of ATD were related to baseline mood levels. Although no overall effects of ATD were observed, the subgroup of participants with low Beck depression inventory (BDI) scores showed reduced ratings of contextual control and improved accuracy of contingency judgements under positive contingencies following ATD, compared to placebo. High BDI participants demonstrated low accuracy in contingency judgements, regardless of serotoninergic status. CONCLUSIONS: No effect of ATD on contingency judgements was observed in the group as a whole, but effects were observed in a subgroup of participants with low BDI scores. We discuss these data in light of the context processing hypothesis, and prior research on 5-HT and depressive realism.

Client self rated adult attachment patterns and the therapeutic alliance: a systematic review.

Attachment theory has been proposed as a suitable framework within which to understand and explore the therapeutic alliance. This review systematically explores research that has examined the relationship between clients' self reported attachment patterns and the therapeutic alliance. Methodological characteristics and study findings are reviewed and discussed with the aim of concluding whether assessing clients' attachment patterns would be beneficial to therapy. In spite of inconsistencies with regards to the measurement and conceptualisation of attachment and the alliance, the evidence suggests that clients who rate themselves as having a more secure attachment pattern are likely to rate the alliance as stronger. The implications of this for therapeutic practice are discussed.