Kristof Hoorelbeke

The influence of cognitive control training on stress reactivity and rumination in response to a lab stressor and naturalistic stress

Cognitive control impairments have been identified as an underlying mechanism for rumination, a key predictor of depression. Literature suggests that cognitive control training (CCT) targeting working memory functioning can increase effectiveness of existing antidepressant treatments to reduce rumination. However, it remains unclear whether CCT can also be implemented as a preventive intervention for depression, increasing resilience. For this purpose, at-risk undergraduate students (high trait ruminators) were allocated to a CCT or active control condition, consisting of 10 online training sessions. Working memory functioning was assessed preceding and following the training and reactivity to a lab stressor was assessed directly following training. Finally, at four weeks follow-up, brooding--the maladaptive form of rumination--was re-assessed in response to a naturalistic stressor (examination period). Although we did not find direct transfer effects of CCT on working memory functioning, increase in working memory functioning following CCT was related to post-training brooding and resilience levels. Moreover, participants receiving CCT demonstrated lower stress reactivity in the lab and a decrease in brooding following a naturalistic stressor at follow-up, indicating temporal stability of our findings. These findings suggest that CCT can be considered a promising preventive intervention to reduce stress reactivity and rumination.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis

BACKGROUND Individuals in remission from depression are at increased risk for developing future depressive episodes. Several cognitive risk- and resilience factors have been suggested to account for this vulnerability. In the current study we explored how risk- and protective factors such as cognitive control, adaptive and maladaptive emotion regulation, residual symptomatology, and resilience relate to one another in a remitted depressed (RMD) sample. METHODS We examined the relationships between these constructs in a cross-sectional dataset of 69 RMD patients using network analyses in order to obtain a comprehensive, data-driven view on the interplay between these constructs. We subsequently present an association network, a concentration network, and a relative importance network. RESULTS In all three networks resilience formed the central hub, connecting perceived cognitive control (i.e., working memory complaints), emotion regulation, and residual symptomatology. The contribution of the behavioral measure for cognitive control in the network was negligible. Moreover, the directed relative importance network indicates bidirectional influences between these constructs, with all indicators of centrality suggesting a key role of resilience in remission from depression. LIMITATIONS The presented findings are cross-sectional and networks are limited to a fixed set of key constructs in the literature pertaining cognitive vulnerability for depression. CONCLUSIONS These findings indicate the importance of resilience to successfully cope with stressors following remission from depression. Further in-depth studies will be essential to identify the specific underlying resilience mechanisms that may be key to successful remission from depression.

Cognitive control interventions for depression: A systematic review of findings from training studies

There is a strong interest in cognitive control training as a new intervention for depression. Given the recent promising meta-analytical findings regarding the effects of cognitive training on cognitive functioning and depressive symptomatology, the current review provides an in-depth discussion of the role of cognitive control in depression. We consider the state-of-the-art research on how manipulation of cognitive control may influence cognitive and depression-related outcomes. Evidence for the effectiveness of cognitive control training procedures are discussed in relation to three stages of depression (at-risk, clinically depressed, remission) as well as the training approach that was deployed, after which the putative theoretical mechanisms are discussed. Finally, we provide ways in which cognitive control training can be utilized in future research.

Internet-delivered cognitive control training as a preventive intervention for remitted depressed patients: Evidence from a double-blind randomized controlled trial study.

Background: Cognitive control impairments may place remitted depressed (RMD) patients at increased risk for developing future depressive symptomatology by disrupting emotion regulation processes. Research has shown that directly targeting cognitive control has beneficial effects on high trait ruminators and clinically depressed patients. The current study tested whether internet-delivered cognitive control training (CCT) can be used as an intervention to increase resilience to depression in RMD patients. Method: Effects of CCT were assessed using a double-blind randomized controlled design. RMD patients performed 10 sessions of a working memory-based CCT (N = 34) or a low cognitive load training (N = 34; active control condition) over a period of 14 days. Assessments took place prior to training, immediately following 2 weeks of training, and at 3 months follow-up. Brooding and depressive symptomatology were selected as primary outcome measures, alternative indicators for emotion regulation and residual symptomatology were selected as secondary outcome measures, along with indicators of functioning. Results: Compared to an active control condition, CCT demonstrated beneficial effects on a cognitive transfer task, brooding, depressive symptomatology, residual complaints, self-reported use of general maladaptive emotion regulation strategies, and resilience after controlling for intention to treat. Furthermore, completers of the CCT reported a reduction in experienced disability and cognitive complaints. However, no beneficial effects were found for self-reported use of adaptive emotion regulation strategies. Conclusions: These findings demonstrate the effectiveness of CCT as an intervention to reduce cognitive vulnerability, residual symptomatology, and foster resilience following recovery from depression. CCT thus holds potential as a preventive intervention for RMD patients. ClinicalTrials.gov (Identifier: NCT02407652)

Effects of cognitive control training on the dynamics of (mal)adaptive emotion regulation in daily life.

Cognitive control plays a key role in both adaptive emotion regulation, such as positive reappraisal, and maladaptive emotion regulation, such as rumination, with both strategies playing a major role in resilience and well-being. As a result, cognitive control training (CCT) targeting working memory functioning may have the potential to reduce maladaptive emotion regulation and increase adaptive emotion regulation. The current study explored the effects of CCT on positive reappraisal ability in a lab context, and deployment and efficacy of positive appraisal and rumination in daily life. A sample of undergraduates (n = 83) was allocated to CCT or an active control condition, performing 10 online training sessions over a period of 14 days. Effects on regulation of affective states in daily life were assessed using experience sampling over a 7-day posttraining period. Results revealed a positive association between baseline cognitive control and self-reported use of adaptive emotion regulation strategies, whereas maladaptive emotion regulation strategies showed a negative association. CCT showed transfer to working memory functioning on the dual n-back task. Overall, effects of CCT on emotion regulation were limited to reducing deployment of rumination in low positive affective states. However, we did not find beneficial effects on indicators of adaptive emotion regulation. These findings are in line with previous studies targeting maladaptive emotion regulation but suggest limited use in enhancing adaptive emotion regulation in a healthy sample. (PsycINFO Database Record

Attentional modulation by reward and punishment cues in relation to depressive symptoms

BACKGROUND AND OBJECTIVES Research indicates that individuals at-risk for depression are characterized by high sensitivity to loss and reduced sensitivity to reward. Moreover, it has been shown that attentional bias plays an important role in depression vulnerability. The current study aimed to examine the interplay between these risk factors for depression by examining the development of attentional bias toward reward and loss signals in dysphoric participants (individuals with elevated levels of depressive symptoms). METHODS Shapes were conditioned to reward and loss and subsequently presented in a dot probe task in a sample of dysphoric and nondysphoric participants. RESULTS Nondysphoric individuals oriented towards reward-related signals whereas dysphoric individuals failed to develop a reward-related attentional bias. This attentional effect was observed in the absence of group differences in motivational factors. No group differences were found for attentional bias for loss-related signals, despite the fact that dysphoric individuals performed worse in response to losing. LIMITATIONS The current sample is not clinical thus generalization to clinical depression is not warranted. CONCLUSIONS We argue that impaired early attentional processing of rewards are an important cognitive risk factor for anhedonic symptoms in persons with dysphoria.

Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis

Background The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression.

Can training change attentional breadth? Failure to find transfer effects

Recently, there is increasing interest in the causal relationship between attentional breadth and emotion regulation. To test this causal relationship, attentional breadth needs to be manipulated stringently. The aim of the current research was to establish whether visual attentional breadth could be manipulated through experimental training procedures. We conducted two single-session training experiments and one multiple-session training experiment, all of which contained pre- and post-training assessments to test the direct transfer effects of training on attentional breadth construed in different measures. For the first single-session training (Experiment 1), no training effects were found to transfer to the subsequent attentional breadth measures in terms of global–local processing preference. For the second single-session training (Experiment 2) and the 5-day training (Experiment 3) which combined both trainings from Experiment 1 and 2, there were some indications that attentional breadth can be decreased, but there was no evidence that it could be increased neither in terms of global–local processing preference nor in terms of scope of visual perception. Bayesian analysis confirmed the null hypothesis of no increase in attentional breadth through delivery of these training procedures. Therefore, our findings do not support the hypothesis that training variants of the Global–Local attentional breadth task or of the visuospatial attentional breadth task can stably alter attentional breadth in healthy students. Possible explanations and implications are discussed.

Remediation of depression-related cognitive impairment: cognitive control training as treatment augmentation

ABSTRACT Introduction: Despite several available evidence-based interventions for major depression relapse, rates remain high and relapse prevention programs are still scarce. To increase effectiveness, novel techniques that target underlying vulnerability factors may be a promising avenue. Depression is associated with impairments in executive functioning, which is in turn associated with poor psychosocial outcomes and more Repetitive Negative Thinking (RNT), a key vulnerability factor for relapse. This paper examines deficits in cognitive control as a potentially modifiable causal mechanism for depression. Areas covered: An overview of studies on the interplay between cognitive control and RNT is presented, assessing the potential of training cognitive control in depressed individuals. Cognitive Control Training (CCT), or other techniques aimed at remediating executive functioning, provides an interesting way to examine the causal status of executive functions in depression-related symptoms, such as emotion regulation and psychosocial functioning. The clinical utility of CCT is assessed. Expert commentary: There is emerging evidence for clinical utility of CCT but more large-scale, longitudinal studies are required. The section discusses how the adaptive Paced Auditory Serial Addition Test (PASAT) can be used as a technique that can be combined with psychological as well as biological interventions, to increase overall effectiveness of treatment for depression.