Blair E. Wisco

Depressive cognition: Self-reference and depth of processing

Cognitive models of depression, which propose that depression is associated with negatively biased thinking, have typically focused on either the content or the processes of depressive cognition. Content-based models suggest that depressive thought is more negative for self-relevant than for externally-focused content. Process-based models propose that early, automatic processes are not negatively biased in depression, but that deeper processes are biased. The current review evaluates evidence for both the self-relevant content and depth of processing accounts, and concludes that there is substantial evidence for both models. I call for further research which integrates content and process-based approaches by using self-relevant stimuli and cognitive measures which precisely identify the specific attention, memory, and interpretation processes affected in depression.

Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study.

OBJECTIVE To describe the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders and identify correlates of PTSD in a contemporary, nationally representative sample of US veterans. METHOD Data were analyzed from Wave 1 of the National Health and Resilience in Veterans Study, a cross-sectional, retrospective, web-based survey of a population-based sample of 3,157 US veterans conducted between October and December 2011. The main outcome measure was probable lifetime PTSD, which was assessed by using a DSM-IV version of the PTSD Checklist (PCL), the PCL-Specific Stressor version. RESULTS The weighted lifetime and current prevalence of probable PTSD was 8.0% (standard error [SE] = 0.48) and 4.8% (SE = 0.40), respectively. 87.0% of veterans reported exposure to at least 1 potentially traumatic event (PTE); veterans reported a mean of 3.4 (SD = 2.8) different PTE types in their lifetime. Sudden death of a loved one was the most frequently endorsed PTE (61.3%), and sexual abuse in adulthood had the highest conditional probability of PTSD (37.3%). PTSD was associated with increased odds of mood, anxiety, and substance use disorders (odds ratios [ORs] = 2.2-19.1, P values < .001); suicidal ideation (OR = 9.7, P < .001); and suicide attempts (OR = 11.8, P < .001). Psychosocial factors, including resilience, community integration, and secure attachment, were associated with decreased odds of PTSD (ORs = 0.5-0.7, P values < .05). CONCLUSIONS In a nationally representative sample of US veterans, the prevalence of lifetime and current PTSD was 8.0% and 4.8%, respectively, and PTSD was associated with elevated risk for several psychiatric conditions and suicidality. Veterans reported exposure to many PTE types in addition to combat, and conditional risk for PTSD was high for noncombat-related trauma. Prevention and treatment efforts designed to bolster protective psychosocial factors may help mitigate PTSD risk in this population.

TREATMENT OF POSTTRAUMATIC STRESS DISORDER REDUCES SUICIDAL IDEATION

Suicide is a significant public health problem. Although various studies have found evidence of posttraumatic stress disorder (PTSD) as a risk factor for suicidal behaviors, no study has examined whether or not PTSD treatment decreases suicidal thoughts. This study aims to fill this gap in the literature by examining changes in suicidal ideation over the course of a randomized clinical trial, which compared two widely used treatments for PTSD—cognitive processing therapy (CPT) and prolonged exposure (PE).

Ruminative Response Style

Publisher Summary This chapter reviews the evidence that a ruminative response style increases risk for depression, describes the proposed mechanisms by which rumination increases this risk, and discusses possible treatment implications. Increased risk is not specific to depression but generalizes to other forms of psychopathology. Rumination is a mode of responding to distress by passively focusing on the possible causes and consequences of ones distress without moving into active problem-solving. Ruminative response style is correlated with depressive symptoms and predicts the development of future depressive episodes. Gender is also related to rumination, with more women than men reporting a tendency to ruminate in response to distress. The theory was proposed in part to explain the greater prevalence of depression in women than in men, and the gender difference in rumination has been shown to mediate the gender difference in depression. A ruminative response style is thought to increase risk for depression through a variety of mechanisms.

Rumination as a transdiagnostic factor underlying transitions between internalizing symptoms and aggressive behavior in early adolescents

The high degree of comorbidity among mental disorders has generated interest in identifying transdiagnostic processes associated with multiple types of psychopathology. Susan Nolen-Hoeksema conceptualized rumination as one such transdiagnostic process associated with depression, anxiety, substance abuse, binge eating, and self-injurious behavior. The degree to which rumination accounts for the co-occurrence of internalizing and externalizing psychopathology, however, has never been tested. We used a sample of early adolescents (N = 1,065) assessed at 3 time points spanning 7 months to examine (a) the reciprocal prospective associations between rumination and aggressive behavior in adolescents, (b) whether rumination explained the longitudinal associations of aggressive behavior with depression and anxiety symptoms, and (c) gender differences in these associations. Rumination predicted increases over time in aggressive behavior, and aggression was associated with increases in rumination over time only for boys. Rumination fully mediated the longitudinal association of aggression with subsequent anxiety symptoms and of both depression and anxiety symptoms with subsequent aggression in boys but not girls. Rumination did not explain the association between aggression and subsequent depressive symptoms for either boys or girls. These findings provide novel evidence for the role of rumination as a transdiagnostic factor underlying transitions between internalizing and externalizing symptoms among males during early adolescence. Interventions aimed at reducing rumination may have beneficial influences on multiple forms of psychopathology and on the development of comorbidity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Effect of visual perspective on memory and interpretation in dysphoria.

When engaging in self-reflection, the visual perspective one adopts has important effects on emotional reactivity. Specifically, adopting a distanced stance, or viewing oneself from a third-person perspective, has been found to reduce emotional reactivity to negative autobiographical memories. The effect of adopting this perspective is moderated by depression such that reactivity is not reduced for individuals with particularly low levels of depressive symptoms. In the current study, we examine the effects of visual perspective on two forms of mental imagery in dysphoric and nondysphoric individuals. We attempt to replicate previous findings for recall of sad autobiographical memories and extend this research to interpretation of ambiguous situations. The results suggest that the effects of adopting a distanced stance are not moderated by depressive symptoms and do not extend from memories to interpretations of ambiguous situations.

The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity.

The World Health Organizations posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10-30% lower than DSM-5 and 25% and 50% lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition.

Psychophysiologic reactivity, subjective distress, and their associations with PTSD diagnosis.

Intense subjective distress and physiologic reactivity upon exposure to reminders of the traumatic event are each diagnostic features of posttraumatic stress disorder (PTSD). However, subjective reports and psychophysiological data often suggest different conclusions. For the present study, we combined data from five previous studies to assess the contributions of these two types of measures in predicting PTSD diagnosis. One hundred fifty trauma-exposed participants who were classified into PTSD or non-PTSD groups based on structured diagnostic interviews completed the same script-driven imagery procedure, which quantified measures of psychophysiologic reactivity and self-reported emotional responses. We derived four discriminant functions (DiscFxs) that each maximally separated the PTSD from the non-PTSD group using (1) psychophysiologic measures recorded during personal mental imagery of the traumatic event; (2) self-report ratings in response to the trauma imagery; (3) psychophysiologic measures recorded during personal mental imagery of another highly stressful experience unrelated to the index traumatic event; and (4) self-report ratings in response to this other stressor. When PTSD status was simultaneously regressed on all four DiscFxs, trauma-related psychophysiological reactivity was a significant predictor, but physiological reactivity resulting from the highly stressful, but not traumatic script, was not. Self-reported distress to the traumatic experience and the other stressful event were both predictive of PTSD diagnosis. Trauma-related psychophysiologic reactivity was the best predictor of PTSD diagnosis, but self-reported distress contributed additional variance. These results are discussed in relation to the Research Domain Criteria framework.

Cognitive Emotion Regulation and Written Exposure Therapy for Posttraumatic Stress Disorder

We examined the extent to which cognitive emotion-regulation (ER) strategies moderated posttraumatic stress disorder (PTSD) treatment outcome among 40 motor vehicle accident survivors. Participants were randomly assigned to either a brief written exposure therapy (WET) condition or a waitlist condition and were assessed pre- and posttreatment and at a 3-month follow-up. Positive-reappraisal and putting-into-perspective strategies at baseline interacted with condition to predict symptom change over time. Both strategies predicted greater reductions in PTSD in the waitlist group, suggesting facilitation of natural recovery. However, positive reappraisal was associated with smaller reductions in PTSD in the WET group, suggesting that this strategy may interfere with treatment. Treatment also reduced use of the maladaptive ER strategy of rumination. These results provide evidence that putting-into-perspective and positive-reappraisal strategies are beneficial in the absence of treatment and that certain types of ER strategies may reduce response to WET, highlighting the importance of future research examining ER during treatment.

Valence of autobiographical memories: The role of mood, cognitive reappraisal, and suppression

The selective recall of positive memories is thought to be an effective mood repair technique, but little research has examined individual differences in the motivation or ability to implement this strategy. This study examined factors considered likely to impact valenced memory recall: dysphoria and emotion regulation strategies (i.e., cognitive reappraisal and suppression). Dysphoria was related to memory negativity but not positivity, whereas cognitive reappraisal was associated with positivity but not negativity. Suppression was not reliably related to the valence of self-reported memories, but was associated with increased accessibility of negative memories, as indicated by a response time measure. Our results indicate a relationship between cognitive reappraisal and more positive memory and suggest that the experience of dysphoria is more strongly related to negativity than positivity of memory. Our findings highlight the utility of examining emotion regulatory variables, in addition to mood, in the study of valenced memory recall, and underscore the importance of including both behavioral and self-report memory measures.