Andrew D. Peckham

A META‐ANALYSIS OF THE MAGNITUDE OF BIASED ATTENTION IN DEPRESSION

In this quantitative review, we examined the magnitude of attentional biases to negative stimuli in depression. Results from 29 empirical studies examining emotional Stroop or dot probe results in depressed participants (clinical depression, nonclinical dysphoria, and subjects undergoing depressive mood induction) were examined. Studies using the emotional Stroop task yielded marginally significant evidence of a difference between depressed and nondepressed samples, whereas those using the dot probe task showed significant differences between groups (d = 0.52). We found no evidence for significant moderation of these effects by age, sex, type of depressed sample, year of publication, stimulus presentation duration, or type of stimuli (verbal or nonverbal), although statistical power for these tests was limited. These results support the existence of biased attention to negative information in depression. Depression and Anxiety, 2010.© 2010 Wiley‐Liss, Inc.

Patient Preference for Psychological vs Pharmacologic Treatment of Psychiatric Disorders: A Meta-Analytic Review

OBJECTIVE Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. DATA SOURCES A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search. STUDY SELECTION Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion. DATA EXTRACTION Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment. RESULTS The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples. CONCLUSIONS Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed.

Mindfulness‐Based Cognitive Therapy for Nonremitted Patients with Bipolar Disorder

Introduction: Bipolar disorder is characterized by recurrent episodes of depression and/or mania along with interepisodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, many individuals with bipolar disorder continue to experience substantial residual mood symptoms that often lead to the recurrence of mood episodes.

Mindfulness-Based Cognitive Therapy for Bipolar Disorder: Effects on Cognitive Functioning

Bipolar disorder is associated with impairments in cognition, including difficulties in executive functioning, even when patients are euthymic (neither depressed nor manic). The purpose of this study was to assess changes in self-reported cognitive functioning in patients with bipolar disorder who participated in an open pilot trial of mindfulness-based cognitive therapy (MBCT). Following MBCT, patients reported significant improvements in executive functioning, memory, and ability to initiate and complete tasks, as measured by the Behavior Rating Inventory of Executive Function (BRIEF) and the Frontal Systems Behavior Scale (FrSBe). Changes in cognitive functioning were correlated with increases in mindful, nonjudgmental observance and awareness of thoughts, feelings, and sensations, and were not associated with decreases in depression. Improvements tended to diminish after termination of treatment, but some improvements, particularly those in executive functioning, persisted after 3 months. These results provide preliminary evidence that MBCT may be a treatment option that can be used as an adjunct to medication to improve cognitive functioning in bipolar disorder. (Journal of Psychiatric Practice 2011;17:410–419)

Emotion perception and quality of life in bipolar I disorder.

BACKGROUND Across two studies we examined the role of emotion perception as a correlate of quality of life and occupational functioning in bipolar I disorder. METHOD In Study 1, we tested a multifactorial model of quality of life and occupational functioning, including the role of emotion perception and other established correlates of functional outcomes, among 42 participants diagnosed with bipolar I disorder. In Study 2, participants diagnosed with bipolar I disorder and age- and gender-matched controls completed an affect recognition task and a quality of life measure. RESULTS Across both studies, emotion perception related to functional outcomes. In Study 1, self-rated emotion perception explained unique variance in subjective well-being after controlling for illness characteristics, education, and executive function. In Study 2, a behavioral measure of facial affect recognition accuracy was related to quality of life, even after controlling for illness severity. LIMITATIONS Limitations include the use of a cross-sectional design, relatively small sample sizes, and the focus on only one aspect of social cognition. CONCLUSIONS Findings indicate that emotion perception may protect quality of life in bipolar disorder. This dimension may help predict important outcomes and, with further research, could serve as a potential treatment target.

Development of an Integrated Psychosocial Treatment to Address the Medical Burden Associated with Bipolar Disorder

We developed an integrated psychosocial treatment for bipolar disorder to decrease the disproportionate medical burden associated with this illness. Three treatment modules, Nutrition/weight loss, Exercise, and Wellness Treatment (NEW Tx) were administered in twelve 60-minute group sessions over 14 weeks. After the first group (N=4) had completed the treatment, it was revised, and then a second group (N=6) completed the revised treatment. Participants completed all of the study assessments and attended 82% of the sessions. Both groups added over 100 minutes of weekly exercise to their baseline duration. Participants in the second group showed improvements in their quality of life, depressive symptoms, and weight. It appears that NEW Tx may be a feasible intervention with promising pilot data for reducing the medical burden in bipolar disorder, but future research is needed to further evaluate the efficacy of NEW Tx.

d-Cycloserine for the augmentation of an attentional training intervention for trait anxiety

The present study investigates the combination of two novel strategies for the treatment of anxiety that resulted from translational research. We examined whether the putative memory enhancer, d-cycloserine (DCS), offered benefit to procedures designed to train attention away from threat. Participants were 44 adults selected on the basis of high trait anxiety. In this randomized study, DCS or placebo was administered 1h prior to attentional training away from threat using the dot probe task. On the following day, the effectiveness of this training was assessed along with emotional reactivity following two stressful tasks. We found that the addition of DCS resulted in significantly stronger reduction in attentional bias toward threat relative to placebo, but found no additive effects for the DCS condition on subsequent emotional reactivity. These results provide initial support for the efficacy of DCS for augmenting attentional training tasks; potential strategies for enhancing these results are discussed.

Course, outcomes, and psychosocial interventions for first-episode mania

McMurrich S, Sylvia LG, Dupuy JM, Peckham AD, Peters AT, Deckersbach T, Perlis RH. Course, outcomes, and psychosocial interventions for first‐episode mania. Bipolar Disord 2012: 14: 797–808.

Emotion in bipolar I disorder: Implications for functional and symptom outcomes

Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.

Positive urgency is related to difficulty inhibiting prepotent responses.

Positive urgency, the tendency to respond impulsively to positive affective states, has been linked to many psychopathologies, but little is known about mechanisms underpinning this form of impulsivity. We examined whether the Positive Urgency Measure (PUM) related to higher scores on performance-based measures of impulsivity and cognitive control that were administered after a positive mood induction. Undergraduates (n = 112) completed the self-report PUM, several positive mood inductions, and behavioral measures of impulsivity and cognitive control. PUM scores were significantly related to poor performance on the antisaccade task, a measure of prepotent response inhibition, but not to other performance measures. Together with existing literature, findings implicate deficits in response inhibition as one mechanism involved in emotion-related impulsivity. (PsycINFO Database Record