David Eddie

Dynamic Processes in Regulation and Some Implications for Biofeedback and Biobehavioral Interventions

Systems theory has long been used in psychology, biology, and sociology. This paper applies newer methods of control systems modeling for assessing system stability in health and disease. Control systems can be characterized as open or closed systems with feedback loops. Feedback produces oscillatory activity, and the complexity of naturally occurring oscillatory patterns reflects the multiplicity of feedback mechanisms, such that many mechanisms operate simultaneously to control the system. Unstable systems, often associated with poor health, are characterized by absence of oscillation, random noise, or a very simple pattern of oscillation. This modeling approach can be applied to a diverse range of phenomena, including cardiovascular and brain activity, mood and thermal regulation, and social system stability. External system stressors such as disease, psychological stress, injury, or interpersonal conflict may perturb a system, yet simultaneously stimulate oscillatory processes and exercise control mechanisms. Resonance can occur in systems with negative feedback loops, causing high-amplitude oscillations at a single frequency. Resonance effects can be used to strengthen modulatory oscillations, but may obscure other information and control mechanisms, and weaken system stability. Positive as well as negative feedback loops are important for system function and stability. Examples are presented of oscillatory processes in heart rate variability, and regulation of autonomic, thermal, pancreatic and central nervous system processes, as well as in social/organizational systems such as marriages and business organizations. Resonance in negative feedback loops can help stimulate oscillations and exercise control reflexes, but also can deprive the system of important information. Empirical hypotheses derived from this approach are presented, including that moderate stress may enhance health and functioning.

Rumination in major depressive disorder is associated with impaired neural activation during conflict monitoring

Individuals with major depressive disorder (MDD) often ruminate about past experiences, especially those with negative content. These repetitive thoughts may interfere with cognitive processes related to attention and conflict monitoring. However, the temporal nature of these processes as reflected in event-related potentials (ERPs) has not been well-described. We examined behavioral and ERP indices of conflict monitoring during a modified flanker task and the allocation of attention during an attentional blink (AB) task in 33 individuals with MDD and 36 healthy controls, and whether their behavioral performance and ERPs varied with level of rumination. N2 amplitude elicited by the flanker task was significantly reduced in participants with MDD compared to healthy controls. Level of self-reported rumination was also correlated with N2 amplitude. In contrast, P3 amplitude during the AB task was not significantly different between groups, nor was it correlated with rumination. No significant differences were found in behavioral task performance measures between groups or by rumination levels. These findings suggest that rumination in MDD is associated with select deficits in cognitive control, particularly related to conflict monitoring.

Pathways to Vulnerability for Alcohol Problem Severity in a Treatment-Seeking Sample.

OBJECTIVES The present investigation examined the role of gender, family history of alcohol and drug use disorders, temperament, childhood behavior problems, and adult psychopathology, on adult alcohol use disorder (AUD) severity. METHODS Structural equation modeling was used to examine multiple etiological pathways to adult alcohol use disorder (AUD) severity. Participants included 335 treatment-seeking males and females with current or lifetime DSM-III-R alcohol dependence (96%) or abuse (4%) enrolled in one of five treatment outcome studies. Extensive assessment at treatment entry used a mixture of retrospective and current self-report. RESULTS Results identified two significant paths associated with a latent factor of adult alcohol use disorder severity at entry to treatment. In Path 1, male gender and family history of drug use disorder predicted greater childhood behavior problems, which predicted antisocial personality disorder (ASPD), borderline personality disorder (BPD), and anxiety disorders (ADs), with anxiety disorders leading directly to alcohol use disorder severity. In Path 2, family history of alcohol use disorder predicted difficult temperament in childhood, which predicted borderline personality disorder, major depressive disorder (MDD) and anxiety disorders; both major depressive disorder and anxiety disorders in turn predicted alcohol use disorder severity at treatment entry. CONCLUSIONS The present findings build on the literature on heterogeneity in developmental risk processes leading to the expression of adult alcohol use disorder symptomology among patients presenting for alcohol use disorder treatment.

Heart rate variability biofeedback: Theoretical basis, delivery, and its potential for the treatment of substance use disorders

Abstract Heart rate variability biofeedback (HRV BFB) is a biobehavioural clinical intervention that is gaining growing empirical support for the treatment of a number of psychological disorders, several of which are highly comorbid with substance use disorders (SUDs). The present article reviews the autonomic nervous system bases of two key processes implicated in the formation and maintenance of addictive pathology—affect dysregulation and craving—and asks if HRV BFB may be an effective intervention to ameliorate autonomic nervous system dysregulation in these processes, and as such, prove to be an effective intervention for SUDs. A detailed description of HRV BFB and its delivery is provided. Preliminary evidence suggests HRV BFB may be an effective addendum to current first-line SUD treatments, though no firm conclusions can be drawn at this time; more research is needed.

The mean and the individual: integrating variable-centered and person-centered analyses of cognitive recovery in patients with substance use disorders.

Neuropsychological and cognitive deficits are observed in the majority of persons with alcohol and drug use disorders and may interfere with treatment processes and outcomes. Although, on average, the brain and cognition improve with abstinence or markedly reduced substance use, better understanding of the heterogeneity in the time-course and extent of cognitive recovery at the individual level is useful to promote bench-to-bedside translation and inform clinical decision making. This study integrated a variable-centered and a person-centered approach to characterize diversity in cognitive recovery in 197 patients in treatment for a substance use disorder. We assessed executive function, verbal ability, memory, and complex information processing speed at treatment entry, and then 6, 26, and 52 weeks later. Structural equation modeling was used to define underlying ability constructs and determine the mean level of cognitive changes in the sample while minimizing measurement error and practice effects on specific tests. Individual-level empirical growth plots of latent factor scores were used to explore prototypical trajectories of cognitive change. At the level of the mean, small to medium effect size gains in cognitive abilities were observed over 1 year. At the level of the individual, the mean trajectory of change was also the modal individual recovery trajectory shown by about half the sample. Other prototypical cognitive change trajectories observed in all four cognitive domains included Delayed Gain, Loss of Gain, and Continuous Gain. Together these trajectories encompassed between 86 and 94% of individual growth plots across the four latent abilities. Further research is needed to replicate and predict trajectory membership. Replication of the present findings would have useful implications for targeted treatment planning and the new cognitive interventions being developed to enhance treatment outcomes.

A Comparison of Psychosocial and Cognitive Functioning Between Depressed and Non-Depressed Patients with Cannabis Dependence

ABSTRACT Cannabis use and depressive disorders are thought to impair cognitive performance and psychosocial functioning. Both disorders co-occurring may compound the negative effects of these diagnoses. In this study, the authors used the California Computerized Assessment Package as the cognitive performance measure and the Addiction Severity Index as the psychosocial functioning measure to compare individuals who were cannabis dependent and either depressed or not depressed (N= 108: 54 cannabis dependent only, 54 cannabis dependent and depressed or dysthymic). As predicted, cannabis dependent individuals with comorbid depression showed more psychosocial impairment than individuals with cannabis dependence alone. However, contrary to the authors’ hypothesis, individuals who were cannabis dependent with comorbid depression showed less cognitive impairment in some California Computerized Assessment Package modules than individuals with cannabis dependence alone. Based on the authors’ results, they concluded that the additive effects of cannabis dependency and depression may only be limited to psychosocial domains and may not extend to cognitive functioning.

Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.

Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder

There is growing evidence that the capacity for emotion regulation is compromised in individuals with bipolar disorder. Dialectical behavior therapy (DBT), an empirically supported treatment that specifically targets emotion dysregulation, may be an effective adjunct treatment for improving emotion regulation and residual mood symptoms in patients with bipolar disorder. In this open, proof-of-concept pilot study, 37 participants engaged in a 12-week DBT group skills training program, learning mindfulness, emotion regulation, and distress tolerance skills. Repeated measures mixed models revealed skill acquisition in the areas of mindfulness, emotion regulation and distress tolerance, as well as improved psychological well-being and decreased emotion reactivity. The results of this study support a burgeoning literature that DBT is a feasible adjunct intervention for patients with bipolar disorder.

Personality disorders and the prediction of alcohol use outcomes for women: Dimensional versus categorical classification

The impending shift in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders from categorical to a hybrid categorical-dimensional diagnosis scheme has generated considerable interest in the relative merits of these respective approaches. This is particularly true for the diagnostically complex category of personality disorders (PDs). The present study assessed whether categorical or dimensional measures better predicted alcohol consumption in a sample of 102 women enrolled in a clinical trial comparing individual cognitive behavioral therapy (CBT) to conjoint CBT for alcohol use disorders (AUDs). Linear regression was used to evaluate whether each PD diagnosis (categorical), or the number of PD symptoms endorsed per PD (dimensional) better predicted percent days drinking over the course of six months of treatment. PD criteria (dimensional) better predicted drinking for Paranoid, Borderline, and Obsessive-Compulsive PDs, while diagnosis (categorical) was a better predictor only for passive-aggressive PD. Both schemes predicted drinking outcomes for avoidant, dependent, and depressive PDs, and neither was predictive for narcissistic PD. These findings suggest that the addition of a dimensional approach for PDs potentially enhances the prediction of alcohol use outcomes.

Sudden gains among women receiving treatment for alcohol use disorders

Abstract Understanding the timing and types of change during treatment for mental health disorders is an important step toward elucidating possible mechanisms of behaviour change in response to therapeutic interventions, yet these issues have not been adequately addressed in the alcohol dependence treatment literature. The current study applied sudden gains (SGs) methodology, an approach originally developed in depression treatment studies, to a sample of women receiving treatment for alcohol use disorders. SGs are drastic improvements in symptoms that occur between two psychotherapy sessions and are hypothesised to be the result of what occurred in the first of those two sessions. SGs can happen at any time during the course of treatment, can happen more than once, and are individualised, as opposed to aggregated for a sample. For the current study, SGs were examined across three variables: percent drinking days (PDD), urge frequency (UF), and urge intensity (UI) in a sample of 102 women receiving either individual or couple cognitive-behavioural therapy for alcohol use disorders. Results indicated the presence of SGs; one-third of the sample experienced at least one SG in either alcohol use or urges to drink; the most common SGs were in frequency of urges to drink. SGs in urge frequency during treatment predicted better post-treatment drinking outcome.