Catherine Crane

Autobiographical Memory Specificity and Emotional Disorder

The authors review research showing that when recalling autobiographical events, many emotionally disturbed patients summarize categories of events rather than retrieving a single episode. The mechanisms underlying such overgeneral memory are examined, with a focus on M. A. Conway and C. W. Pleydell-Pearces (2000) hierarchical search model of personal event retrieval. An elaboration of this model is proposed to account for overgeneral memory, focusing on how memory search can be affected by (a) capture and rumination processes, when mnemonic information used in retrieval activates ruminative thinking; (b) functional avoidance, when episodic material threatens to cause affective disturbance; and (c) impairment in executive capacity and control that limits an individuals ability to remain focused on retrieval in the face of distraction.

Suicidality in chronic pain : a review of the prevalence, risk factors and psychological links

BACKGROUND This paper reviews and integrates the growing literature concerning the prevalence of and risk factors for suicidality in chronic pain. METHOD A series of systematic searches in MEDLINE and PsychINFO identified 12 relevant articles examining suicide, suicide attempts, and suicidal ideation in chronic pain. A selection of theoretical and empirical work identifying psychological processes that have been implicated in both the pain and suicide literature and which may be related to increased suicidality was also reviewed. RESULTS Relative to controls, risk of death by suicide appeared to be at least doubled in chronic pain patients. The lifetime prevalence of suicide attempts was between 5% and 14% in individuals with chronic pain, with the prevalence of suicidal ideation being approximately 20%. Eight risk factors for suicidality in chronic pain were identified, including the type, intensity and duration of pain and sleep-onset insomnia co-occurring with pain, which appeared to be pain-specific. Helplessness and hopelessness about pain, the desire for escape from pain, pain catastrophizing and avoidance, and problem-solving deficits were highlighted as psychological processes relevant to the understanding of suicidality in chronic pain. CONCLUSIONS Programmatic research is urgently required to investigate the role of both general and pain-specific risk factors for suicidality, to examine how the psychological processes mentioned above mediate or exacerbate suicidality, and to develop enhanced interventions for pain patients at risk.

Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study.

This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT), a treatment combining mindfulness meditation and interventions taken from cognitive therapy, in patients suffering from chronic-recurrent depression. Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were randomly allocated to receive either MBCT delivered in addition to treatment-as-usual (TAU; N = 14 completers) or TAU alone (N = 14 completers). Depressive symptoms and diagnostic status were assessed before and after treatment phase. Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group. Similarly, numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group. Results are consistent with previous uncontrolled studies. Although based on a small sample and, therefore, limited in their generalizability, they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder.

Problem Solving Deteriorates Following Mood Challenge in Formerly Depressed Patients With a History of Suicidal Ideation.

The authors divided 34 participants who had a history of depression into 2 groups, those having previous suicidal ideation or behavior (n=19) and those having no such symptoms (n=15), then compared the 2 groups with a group of participants who had no history of depression (n=22). Assessment of interpersonal problem-solving performance using the Means-Ends Problem-Solving (MEPS) task before and after a mood-induction procedure showed that only those formerly depressed people with a history of suicidal ideation shifted in MEPS performance, producing significantly less effective problem solutions following mood challenge, consistent with a differential activation account of vulnerability for recurrence of suicidal ideation and behavior. The deterioration in effectiveness following mood challenge was moderated by lack of specificity in autobiographical memory.

Effects of Mindfulness on Meta-Awareness and Specificity of Describing Prodromal Symptoms in Suicidal Depression

The authors examined the effects of mindfulness training on 2 aspects of mode of processing in depressed participants: degree of meta-awareness and specificity of memory. Each of these has been suggested as a maladaptive aspect of a mode of processing linked to persistence and recurrence of symptoms. Twenty-seven depressed participants, all of whom had experienced suicidal crises, described warning signs for their last crisis. These descriptions were blind-rated independently for meta-awareness and specificity. Participants were then randomly allocated to receive mindfulness-based cognitive therapy (MBCT) plus treatment as usual (TAU) or TAU alone, and retested after 3 months. Results showed that, although comparable at baseline, patients randomized to MBCT displayed significant posttreatment differences in meta-awareness and specificity compared with TAU patients. These results suggest that mindfulness training may enable patients to reflect on memories of previous crises in a detailed and decentered way, allowing them to relate to such experiences in a way that is likely to be helpful in preventing future relapses.

Suicide prevention by limiting access to methods: A review of theory and practice

This review discusses the limitation of access to suicide methods as a way to prevent suicide, an approach which forms a major component of many national suicide prevention strategies. An important distinction is made between efforts that attempt to limit physical access to suicide methods and those that attempt to reduce the cognitive availability of suicide. Physical imitations will be reviewed with reference to restricting access to domestic gas, catalytic converters, firearms, pesticides, jumping, paracetamol and methods used in prisons. Impacts of cognitive availability will be discussed mainly with regard to the media in terms of providing access to technical information and sensational or inaccurate portrayals of suicide. Drawing on psychological models of suicidal ideation and behaviour, this review explores how processes leading to suicidal behaviour and issues around method choice may relate to the effectiveness of limiting access to methods. Potential problems surrounding method limitations are explored, in particular the factors contributing to substitution, the risk that alternative methods of suicide may be used if one is restricted. It is concluded that in appropriate contexts, where substitution is less likely to occur, and in conjunction with psychosocial prevention efforts, limitation of both physical and cognitive access to suicide can be an effective suicide prevention strategy.

Effects of meditation on frontal alpha-asymmetry in previously suicidal individuals.

This study investigated the effects of a meditation-based treatment for preventing relapse to depression, mindfulness-based cognitive therapy (MBCT), on prefrontal &agr;-asymmetry in resting electroencephalogram (EEG), a biological indicator of affective style. Twenty-two individuals with a previous history of suicidal depression were randomly assigned to either MBCT (N=10) or treatment-as-usual (TAU, N=12). Resting electroencephalogram was measured before and after an 8-week course of treatment. The TAU group showed a significant deterioration toward decreased relative left-frontal activation, indexing decreases in positive affective style, while there was no significant change in the MBCT group. The findings suggest that MBCT can help individuals at high risk for suicidal depression to retain a balanced pattern of baseline emotion-related brain activation.

Retrieval of autobiographical memories: The mechanisms and consequences of truncated search

Five studies examined the extent to which autobiographical memory retrieval is hierarchical, whether a hierarchical search depends on central executive resources, and whether retrieving memories that are “higher” in the hierarchy impairs problem‐solving ability. The first study found that random generation (assessed using a button‐pressing task) was sensitive to changes in memory load (digit span). The second study showed that when participants fail to retrieve a target event, they respond with a memory that is higher up the hierarchy. The third study showed that memory is more generic only when participants use low imageable cues under cognitive load. The final two experiments showed that experimental manipulation of memory specificity affects problem solving (MEPS performance). The data are consistent with Conway and Pleydell‐Pearces hierarchical retrieval model of autobiographical memory, and suggest that overgeneral memory in nonclinical participants is associated with reduced executive capacity only when retrieval is “top‐down” (generative).

Reflection, brooding, and suicidality: a preliminary study of different types of rumination in individuals with a history of major depression.

OBJECTIVE To examine the relationship between reflection, brooding, and suicidality in participants with a history of major depression. METHOD Participants were divided into three groups - those who had never been suicidal (N=11), suicide ideators (N=11), and suicide attempters (N=10). Participants completed the Ruminative Responses Scale to explore scores on the brooding and reflection subscales in each group. RESULTS There was a significant interaction between groups and type of self-focused thinking: suicide attempters more strongly endorsed brooding than reflection, whilst non-suicidal, but previously depressed individuals showed the reverse trend. Suicidal and non-suicidal groups differed significantly in levels of reflection, but did not differ significantly in levels of brooding. CONCLUSIONS Deficits in reflection appear to be linked to suicidality in major depression consistent with evidence of problem-solving deficits in these groups.

State Effects of Two Forms of Meditation on Prefrontal EEG Asymmetry in Previously Depressed Individuals

We investigated state effects of two forms of meditation on electroencephalography prefrontal α-asymmetry, a global indicator of approach versus withdrawal motivation and related affective state. A clinical series of previously depressed individuals were guided to practice either mindfulness breathing meditation (N = 8) or a form of meditation directly aimed at cultivating positive affect, loving kindness or metta meditation (N = 7). Prefrontal asymmetry was assessed directly before and after the 15-min meditation period. Results showed changes in asymmetry towards stronger relative left prefrontal activation, i.e., stronger approach tendencies, regardless of condition. Further explorations of these findings suggested that responses were moderated by participants’ tendencies to engage in ruminative brooding. Individuals high in brooding tended to respond to breathing meditation but not loving kindness meditation, while those low in brooding showed the opposite pattern. Comparisons with an additionally recruited “rest” group provided evidence suggesting that changes seen were not simply attributable to habituation. The results indicate that both forms of meditation practice can have beneficial state effects on prefrontal α-asymmetry and point towards differential indications for offering them in the treatment of previously depressed patients.