Kari M. Eddington

Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy and predictors of treatment response

Major depressive disorder (MDD) is characterized by the presence of disturbances in emotional processing. However, the neural correlates of these alterations, and how they may be affected by therapeutic interventions, remain unclear. The present study addressed these issues in a preliminary investigation using functional magnetic resonance imaging (fMRI) to examine neural responses to positive, negative, and neutral pictures in unmedicated MDD patients (N = 22) versus controls (N = 14). After this initial scan, MDD patients were treated with cognitive behavioral therapy (CBT) and scanned again after treatment. Within regions that showed pre-treatment differences between patients and controls, we tested the association between pre-treatment activity and subsequent treatment response as well as activity changes from pre- to post-treatment. This study yielded three main findings. First, prior to treatment and relative to controls, patients exhibited overall reduced activity in the ventromedial prefrontal cortex (PFC), diminished discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus, and enhanced responses to negative versus positive stimuli in the left anterior temporal lobe (ATL) and right dorsolateral PFC. Second, CBT-related symptom improvement in MDD patients was predicted by increased activity at baseline in ventromedial PFC as well as the valence effects in the ATL and dorsolateral PFC. Third, from pre- to post-treatment, MDD patients exhibited overall increases in ventromedial PFC activation, enhanced arousal responses in the amygdala, caudate, and hippocampus, and a reversal of valence effects in the ATL. The study was limited by the relatively small sample that was able to complete both scan sessions, as well as an inability to determine the influence of comorbid disorders within the current sample. Nevertheless, components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.

Neural Correlates of Promotion and Prevention Goal Activation: An fMRI Study using an Idiographic Approach

Regulatory focus theory [Higgins, E. T. Beyond pleasure and pain. American Psychologist, 52, 12801300, 1997] postulates two social-cognitive motivational systems, the promotion and prevention systems, for self-regulation of goal pursuit. However, the neural substrates of promotion and prevention goal activation remain unclear. Drawing on several literatures, we hypothesized that priming promotion versus prevention goals would activate areas in the left versus right prefrontal cortex (PFC), respectively, and that activation in these areas would be correlated with individual differences in chronic regulatory focus. Sixteen participants underwent functional magnetic resonance imaging while engaged in a depth-of-processing task, during which they were exposed incidentally to their own promotion and prevention goals. Task-related cortical activation was consistent with previous studies. At the same time, incidental priming of promotion goals was associated with left orbital PFC activation, and activation in this area was stronger for individuals with a chronic promotion focus. Findings regarding prevention goal priming were not consistent with predictions. The data illustrate the centrality of self-regulation and personal goal pursuit within the multilayered process of social cognition.

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

Neural correlates of idiographic goal priming in depression: goal-specific dysfunctions in the orbitofrontal cortex

We used functional magnetic resonance imaging (fMRI) to determine whether depressed (vs non-depressed) adults showed differences in cortical activation in response to stimuli representing personal goals. Drawing upon regulatory focus theory as well as previous research, we predicted that depressed patients would manifest attenuated left orbitofrontal cortex (OFC) activation in response to their own promotion goals as well as exaggerated right OFC activation in response to their own prevention goals. Unmedicated adults with major depression (n = 22) and adults with no history of affective disorder (n = 14) completed questionnaires and a personal goal interview. Several weeks later, they were scanned during a judgment task which (unknown to them) included stimuli representing their promotion and prevention goals. Both groups showed similar patterns of task-related activation. Consistent with predictions, patients showed significantly decreased left OFC and increased right OFC activation compared to controls on trials in which they were exposed incidentally to their promotion and prevention goals, respectively. The results suggest that depression involves dysfunction in processing two important types of personal goals. The findings extend models of the etiology of depression to incorporate cognitive and motivational processes underlying higher order goal representation and ultimately may provide an empirical basis for treatment matching.

Missed Beeps and Missing Data Dispositional and Situational Predictors of Nonresponse in Experience Sampling Research

Experience sampling research measures people’s thoughts, feelings, and actions in their everyday lives by repeatedly administering brief questionnaires throughout the day. Nonresponse—failing to respond to these daily life questionnaires—has been a vexing source of missing data. The present research examined person-level, day-level, and signal-level predictors of nonresponse. We analyzed data from a sample of 450 young adults who were signaled 8 times a day for 7 days. At the person level, nonresponse was higher for men and for people high in positive schizotypy, depressive symptoms, and hypomania. At the day level, nonresponse increased over the first few days of the study and then declined toward the end. At the signal level, time of day strongly predicted nonresponse. Lagged signal-level analyses examined how emotions and experiences at a prior signal prospectively predicted the likelihood of ignoring the next signal. Only one variable—feelings of enthusiasm—had a significant lagged effect, which suggests that within-day experiences are not major sources of nonresponse. For the most part, the day of the study and the time of day had the most salient effects. Understanding the predictors of missing data allows researchers to implement methods to increase compliance and to handle missing data more effectively by including predictors of nonresponse.

Palm or Cell? Comparing Personal Digital Assistants and Cell Phones for Experience Sampling Research

Personal digital assistants (PDA), particularly Palm Pilots, are popular data collection devices in experience sampling research. The declining availability of such devices, however, has prompted researchers to explore alternative technologies for signaling participants and collecting responses. The present research considers interactive voice response (IVR) methods, which can deliver questions and collect data using common cell phones. Participants completed an experience sampling study using either a PDA (n = 428) or a cell phone under three different conditions (IVR condition n = 98; IVR Callback condition n = 93; IVR Callback Comeback condition n = 94). We found that response rates were higher when people used PDAs (69%) than when they used their cell phones (IVR condition = 51%), but response rates increased when people could call back within a few minutes of missing a signal (IVR Callback condition = 58%) and had a face-to-face meeting with a researcher midweek (IVR Callback Comeback = 64%). The daily life ratings were similar across the conditions. The findings are encouraging for researchers interested in using IVR cell phone methods for ecological momentary assessment, but more work is needed to develop procedures or incentives that increase response rates.

Creative motivation: Creative achievement predicts cardiac autonomic markers of effort during divergent thinking

Executive approaches to creativity emphasize that generating creative ideas can be hard and requires mental effort. Few studies, however, have examined effort-related physiological activity during creativity tasks. Using motivational intensity theory as a framework, we examined predictors of effort-related cardiac activity during a creative challenge. A sample of 111 adults completed a divergent thinking task. Sympathetic (PEP and RZ) and parasympathetic (RSA and RMSSD) outcomes were assessed using impedance cardiography. As predicted, people with high creative achievement (measured with the Creative Achievement Questionnaire) showed significantly greater increases in sympathetic activity from baseline to task, reflecting higher effort. People with more creative achievements generated ideas that were significantly more creative, and creative performance correlated marginally with PEP and RZ. The results support the view that creative thought can be a mental challenge.

Perfectionism, Goal Adjustment, and Self-Regulation: A Short-term Follow-up Study of Distress and Coping

This study examined socially-prescribed and self-oriented perfectionism (SPP and SOP) and goal adjustment in relation to goal pursuit, depression, and coping. Students (N = 388) completed measures of perfectionism, idiographic goal pursuit, goal adjustment, and depressive symptoms, and a subset (n = 138) completed an online follow-up assessing stress-related depression and coping. SPP, but not SOP, was associated with current depressive symptoms at both time points. SPP was associated with less optimism about goal success, and the interaction between SPP and goal disengagement predicted stress-related depression and maladaptive coping. SOP was associated with greater optimism about the likelihood of goal success and stronger emotional responses to goal success and failure, and SOP interacted with goal reengagement to predict adaptive coping.

Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression

OBJECTIVE A randomized trial compared the time course and differential predictors of symptom improvement in 2 treatments for depression. METHOD Forty-nine adults (84% female) who were not taking antidepressant medications and met diagnostic criteria for major depressive disorder or dysthymia were randomly assigned either to cognitive-behavioral therapy (CBT) or self-system therapy (SST), a treatment that targets problems in self-regulation, the ongoing process of evaluating progress toward personal goals. Self-regulatory variables (promotion and prevention focus and goal disengagement and reengagement) were assessed as potential moderators of efficacy. At intake, most participants reported depression in the moderate to severe range and had histories of recurrent episodes and previous treatment attempts. Self-reported symptoms of depression and anxiety were assessed at each therapy session. Multilevel modeling was used to examine (a) differences in change associated with the treatment conditions and (b) moderation of treatment efficacy by pretreatment measures of self-regulatory deficits. RESULTS Both treatments were effective and did not show differences in the magnitude or rate of symptom change or in dropout rates, suggesting that CBT and SST were equally effective in improving depression and anxiety. Patients with self-regulatory deficits, however, showed greater improvement in depressive symptoms with SST. Specifically, patients with low promotion focus and low goal reengagement responded better to SST, whereas patients with high prevention focus responded better to CBT. CONCLUSIONS Overall, the results corroborate previous research suggesting that SST is a viable short-term treatment for depression that is particularly effective in helping patients compensate for self-regulatory deficits.

Reports of Therapy Skill Use and Their Efficacy in Daily Life in the Short-Term Treatment of Depression

Previous studies have shown that the use of therapy skills in between sessions is an important mechanism of symptom improvement. The current study expands this line of research by using a diary approach to examine the use of therapy skills in daily life. A sample of 39 depressed adults (85% female, mean age 38) were signaled twice per week throughout the course of either cognitive-behavioral therapy (CBT) or self-system therapy (SST). Results showed that, on days when participants reported greater use of therapy skills, they reported better mood and functioning in almost all domains. Additionally, participants in CBT reported greater use of cognitive skills while participants in SST reported greater use of self-regulatory skills. This study demonstrates that repeated assessments of daily events and experiences, which prevent retrospective reporting biases, further confirm the importance of therapy skill use as a mechanism of action in psychotherapy.