Gregory M. Rogers

Compassion Training Alters Altruism and Neural Responses to Suffering

Compassion is a key motivator of altruistic behavior, but little is known about individuals’ capacity to cultivate compassion through training. We examined whether compassion may be systematically trained by testing whether (a) short-term compassion training increases altruistic behavior and (b) individual differences in altruism are associated with training-induced changes in neural responses to suffering. In healthy adults, we found that compassion training increased altruistic redistribution of funds to a victim encountered outside of the training context. Furthermore, increased altruistic behavior after compassion training was associated with altered activation in brain regions implicated in social cognition and emotion regulation, including the inferior parietal cortex and dorsolateral prefrontal cortex (DLPFC), and in DLPFC connectivity with the nucleus accumbens. These results suggest that compassion can be cultivated with training and that greater altruistic behavior may emerge from increased engagement of neural systems implicated in understanding the suffering of other people, executive and emotional control, and reward processing.

Treatment for Adolescents with Depression Study (TADS): Rationale, design, and methods

OBJECTIVES A rapidly growing empirical literature on the treatment of major depressive disorder (MDD) in youth supports the efficacy of short-term treatment with depression-specific cognitive-behavioral therapy or medication management with a selective serotonin reuptake inhibitor. These studies also identify a substantial probability of partial response and of relapse, which might be addressed by more intensive, longer-term treatments. METHOD Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is a multicenter, randomized, masked effectiveness trial designed to evaluate the short-term (12-week) and long-term (36-week) effectiveness of four treatments for adolescents with MDD: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely, pill placebo. A volunteer sample of 432 subjects aged 12-17 years (inclusive) with a primary DSM-IV diagnosis of MDD who are broadly representative of patients seen in clinical practice will enter the study. The primary dependent measures rated blindly by an independent evaluator are the Childrens Depression Rating Scale and, for responder analysis, a dichotomized Clinical Global Impressions-Improvement score. Consistent with an intent-to-treat analysis, all patients, regardless of treatment status, return for all scheduled assessments. RESULTS This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial. CONCLUSION When completed, TADS will improve our understanding of how best to initiate treatment for adolescents with MDD.

The Treatment for Adolescents With Depression Study (TADS): outcomes over 1 year of naturalistic follow-up.

OBJECTIVE The Treatment for Adolescents With Depression Study (TADS) evaluates the effectiveness of fluoxetine, cognitive-behavioral therapy (CBT), and their combination in adolescents with major depressive disorder. The authors report effectiveness outcomes across a 1-year naturalistic follow-up period. METHOD The randomized, controlled trial was conducted in 13 academic and community sites in the United States. Stages I, II, and III consisted of 12, 6, and 18 weeks of acute, consolidation, and continuation treatment, respectively. Following discontinuation of TADS treatments at the end of stage III, stage IV consisted of 1 year of naturalistic follow-up. The participants were 327 subjects between the ages of 12 and 17 with a primary DSM-IV diagnosis of major depressive disorder. No TADS treatment was provided during the follow-up period; treatment was available in the community. The primary dependent measures, rated by an independent evaluator blind to treatment status, were the total score on the Childrens Depression Rating Scale-Revised and the rate of response, defined as a rating of much or very much improved on the Clinical Global Impressions improvement measure. RESULTS Sixty-six percent of the eligible subjects participated in at least one stage IV assessment. The benefits seen at the end of active treatment (week 36) persisted during follow-up on all measures of depression and suicidality. CONCLUSIONS In contrast to earlier reports on short-term treatments, in which worsening after treatment is the rule, the longer treatment in the TADS was associated with persistent benefits over 1 year of naturalistic follow-up.

Affective Synchrony: Individual Differences in Mixed Emotions

Most models of affect suggest either inverse or null associations between positivity and negativity. Recent work has highlighted situations that sometimes lead to mixed positive-negative affect. Focusing on the counterpart to these situational factors, the authors explore the individual-difference tendency toward mixed emotions, which they term affective synchrony. In five studies, the authors show that some individuals demonstrate affective synchrony (overlapping experience of positive and negative moods), others a-synchrony (positive and negative mood that fluctuate independently), and still others de-synchrony (positive and negative moods that function as bipolar opposites). These tendencies are stable over time within persons, vary broadly across individuals, and are associated with individual differences in cognitive representation of self and of emotions.

Depression, anxiety, and dermatologic quality of life in adolescents with atopic dermatitis

The negative psychosocial impact of atopic dermatitis (AD) on quality of life is well established,1–3 with itching, scratching, sleep loss, and social embarrassment among the most commonly reported difficulties contributing to school, work, financial, and social struggles. Increasing evidence suggests that depression and anxiety are also more common in adults with AD, and that the association of AD with these psychiatric symptoms may be influenced by factors such as AD disease severity, subjective vs. objective assessment of AD severity, and quality of life. No studies have objectively assessed the prevalence of depression and anxiety in youth with AD, or the association of these symptoms with AD severity or quality of life. With the world-wide growing prevalence of AD, and mounting evidence of the psychosocial and economic burden of this disease, identifying specific patterns and potential mechanisms of psychiatric symptom co-morbidity in age-defined populations is increasingly important for the development of targeted assessments and treatment interventions.

Evolutionarily conserved prefrontal-amygdalar dysfunction in early-life anxiety

Some individuals are endowed with a biology that renders them more reactive to novelty and potential threat. When extreme, this anxious temperament (AT) confers elevated risk for the development of anxiety, depression and substance abuse. These disorders are highly prevalent, debilitating and can be challenging to treat. The high-risk AT phenotype is expressed similarly in children and young monkeys and mechanistic work demonstrates that the central (Ce) nucleus of the amygdala is an important substrate. Although it is widely believed that the flow of information across the structural network connecting the Ce nucleus to other brain regions underlies primates’ capacity for flexibly regulating anxiety, the functional architecture of this network has remained poorly understood. Here we used functional magnetic resonance imaging (fMRI) in anesthetized young monkeys and quietly resting children with anxiety disorders to identify an evolutionarily conserved pattern of functional connectivity relevant to early-life anxiety. Across primate species and levels of awareness, reduced functional connectivity between the dorsolateral prefrontal cortex, a region thought to play a central role in the control of cognition and emotion, and the Ce nucleus was associated with increased anxiety assessed outside the scanner. Importantly, high-resolution 18-fluorodeoxyglucose positron emission tomography imaging provided evidence that elevated Ce nucleus metabolism statistically mediates the association between prefrontal-amygdalar connectivity and elevated anxiety. These results provide new clues about the brain network underlying extreme early-life anxiety and set the stage for mechanistic work aimed at developing improved interventions for pediatric anxiety.

DYSFUNCTIONAL ATTITUDES AND ATTACHMENT STYLE AMONG CLINICALLY DEPRESSED ADULTS

Previous research has found an association between adult attachment style and symptoms of depression among university students and indicated that this relationship may be mediated by dysfunctional attitudes. The present study represents an initial step toward extending these findings to a clinical sample with more severe forms of depression. A sample of psychiatric outpatients diagnosed with major depressive disorder ( n = 54) completed measures of adult attachment style, dysfunctional attitudes, and depression. An association was found between insecure attachment style and depression severity. This association was partially mediated by dysfunctional attitudes. These findings are consistent with cognitive-interpersonal models of depression that propose that adverse early experiences may contribute to vulnerability for depression through the establishment of dysfunctional attitudes.

Personality, Mood, and the Evaluation of Affective and Neutral Word Pairs

Four studies bridged the areas of personality-m ood and mood-cognition relations by investigating the effects of Extraversion and Neuroticism on the evaluation of affectively pleasant, unpleasant, and neutral word pairs. Specifically measured were affectivity ratings, categorization according to affect, judgments of associative strength, and response latencies. A strong, consistent cognitive bias toward affective as opposed to neutral stimuli was found across participants. Although some biases were systematically related to personality and mood, effects of individual differences were present only under specific conditions. The results are discussed in terms of a personality-mood framework and its implications for cognitive functioning. Personality traits influence the frequency and intensity of experienced affective states (Costa & McCrae, 1980; Gross, Sutton, & Ketelaar, 1998; Larsen & Ketelaar, 1991). Affective states, in turn, influence cognitive processes (e.g., Gotlib & McCann, 1984; Mathews & MacLeod, 1985; Schwarz & Clore, 1983). We bridge this research with the hypothesis that specific personality dimensions—namely, Extraversion (E) and Neuroticism (N)—are systematically related to cognitive processing of affective stimuli. In a series of four studies, we examined the effects of personality, mood, and stimulus valence on cognitive functions and response times.

The dysfunctional attitudes scale: psychometric properties in depressed adolescents.

The psychometric properties and factor structure of the Dysfunctional Attitudes Scale were examined in a sample of 422 male and female adolescents (ages 12–17) with current major depressive disorder. The scale demonstrated high internal consistency (α = .93) and correlated significantly with self-report and interview-based measures of depression. Confirmatory factor analysis indicated that a correlated 2-factor model, with scales corresponding to perfectionism and need for social approval, provided a satisfactory fit to the data. The goodness-of-fit was equivalent across sexes and age groups. The findings support the use of the Dysfunctional Attitudes Scale and its subscales in the assessment of clinically depressed adolescents.

Fear of the Unknown: Uncertain Anticipation Reveals Amygdala Alterations in Childhood Anxiety Disorders

Children with anxiety disorders (ADs) experience persistent fear and worries that are highly debilitating, conferring risk for lifelong psychopathology. Anticipatory anxiety is a core clinical feature of childhood ADs, often leading to avoidance of uncertain and novel situations. Extensive studies in non-human animals implicate amygdala dysfunction as a critical substrate for early life anxiety. To test specific amygdala-focused hypotheses in preadolescent children with ADs, we used fMRI to characterize amygdala activation during uncertain anticipation and in response to unexpected stimuli. Forty preadolescent (age 8–12 years) children, 20 unmedicated AD patients and 20 matched controls completed an anticipation task during an fMRI scan. In the task, symbolic cues preceded fear or neutral faces, such that ‘certain’ cues always predicted the presentation of fear or neutral faces, whereas ‘uncertain’ cues were equally likely to be followed by fear or neutral faces. Both AD children and controls showed robust amygdala response to faces. In response to the uncertain cues, AD children had increased amygdala activation relative to controls. Moreover, in the AD children, faces preceded by an ‘uncertain’ cue elicited increased amygdala activation, as compared with the same faces following a ‘certain’ cue. Children with ADs experience distress both in anticipation of and during novel and surprising events. Our findings suggest that increased amygdala activation may have an important role in the generation of uncertainty-related anxiety. These findings may guide the development of neuroscientifically informed treatments aimed at relieving the suffering and preventing the lifelong disability associated with pediatric ADs.