Leanne Quigley

A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison With Other Treatments.

Objective: No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. Methods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49). Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.

Relapse and recurrence prevention in depression: Current research and future prospects

There is a growing body of literature which indicates that acute phases of psychotherapy are often ineffective in preventing relapse and recurrence in major depression. As a result, there is a need to develop and evaluate therapeutic approaches which aim to reduce the risk of relapse. This article provides a review of the empirical studies which have tested the prophylactic effects of therapy (cognitive-behavioral, mindfulness-based, and interpersonal psychotherapy) targeting relapse and recurrence in major depression. For definitional clarity, relapse is defined here as a return to full depressive symptomatology before an individual has reached a full recovery, whereas recurrence in defined as the onset of a new depressive episode after a full recovery has been achieved. Psychotherapeutic efforts to prevent relapse and recurrence in depression have been effective to varying degrees, and a number of variables appear to moderate the success of these approaches. A consistent finding has been that preventive cognitive-behavioral and mindfulness-based therapies are most effective for patients with three or more previous depressive episodes, and alternative explanations for this finding are discussed. It is noted, however, that a number of methodological limitations exist within this field of research, and so a set of hypotheses that may guide future studies in this area is provided.

The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis

Motivational interviewing is a client-centered therapeutic intervention that aims to resolve ambivalence toward change. We conducted a systematic review and meta-analysis on the efficacy of motivational interviewing, compared to non-motivational interviewing controls, in the treatment of disordered gambling. Electronic databases were searched for randomized controlled trials that evaluated change in gambling behavior using motivational interviewing in adult disordered gamblers. The primary outcomes were the weighted mean difference (WMD) for change in average days gambled per month and average dollars lost per month. The search strategy yielded 447 articles, of which 20 met criteria for full text review. Overall, 8 studies (N=730) fulfilled the inclusion criteria for systematic review and 5 (N=477) were included in the meta-analysis. Motivational interviewing was associated with significant reduction in gambling frequency up to a year after treatment delivery. For gambling expenditure, motivational interviewing yielded significant reductions in dollars spent gambling compared to non-motivational controls at post-treatment only (1-3 months). Overall, the results of this review suggest that motivational interviewing is an efficacious style of therapy for disordered gambling in the short term. Whether treatment effects are maintained over time remains unclear.

An examination of avoidance in major depression in comparison to social anxiety disorder.

The construct of avoidance has begun to receive attention in theoretical models and empirical investigations of depression. However, little is known about relative levels of avoidance across diagnostic categories or about the relationships between avoidance and other correlates of depression. The present study compared levels of avoidance across groups of depressed women without social anxiety disorder (MDD without SAD), depressed women with social anxiety disorder (MDD with SAD), women with social anxiety disorder (SAD), and nonclinical women, and investigated the relationships among avoidance, and sociotropy and autonomy, rumination, and negative and positive problem orientations within the clinically depressed group. Avoidance was found to be significantly higher in all clinical groups relative to the nonclinical group of women, and highest in the comorbid MDD with SAD group. Avoidance showed significant positive relationships with sociotropy, autonomy, rumination, and negative problem orientation, and a significant negative relationship with positive problem orientation within the overall sample of depressed women. These results suggest that avoidance should be given greater consideration in psychosocial models of depression and point to several important directions for future research.

Distinguishing the roles of trait and state anxiety on the nature of anxiety-related attentional biases to threat using a free viewing eye movement paradigm

Although attentional biases to threatening information are thought to contribute to the development and persistence of anxiety disorders, it is not clear whether an attentional bias to threat (ABT) is driven by trait anxiety, state anxiety or an interaction between the two. ABT may also be influenced by “top down” processes of motivation to attend or avoid threat. In the current study, participants high, mid and low in trait anxiety viewed high threat-neutral, mild threat-neutral and positive-neutral image pairs for 5 seconds in both calm and anxious mood states while their eye movements were recorded. State anxiety alone, but not trait anxiety, predicted greater maintenance of attention to high threat images (relative to neutral) following the first fixation (i.e., delayed disengagement) and over the time course. Motivation was associated with the time course of attention as would be expected, such that those motivated to look towards negative images showed the greatest ABT over time, and those highly motivated to look away from negative images showed the greatest avoidance. Interestingly, those ambivalent about where to direct their attention when viewing negative images showed the greatest ABT in the first 500 ms of viewing. Implications for theory and treatment of anxiety disorders, as well as areas for further study, are discussed.

Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals

Depression is associated with attentional biases for emotional information that are proposed to reflect stable vulnerability factors for the development and recurrence of depression. A key question for researchers is whether those who have recovered from depression also exhibit attentional biases, and if so, how similar these biases are to those who are currently depressed. To address this question, the present study examined attention to emotional faces in remitted depressed (N=26), currently depressed (N=16), and never depressed (N=33) individuals. Participants viewed sets of four face images (happy, sad, threatening, and neutral) while their eye movements were tracked throughout an 8-s presentation. Like currently depressed participants, remitted depressed participants attended to sad faces significantly more than never depressed participants and attended to happy faces significantly less. Analyzing temporal changes in attention revealed that currently and remitted depressed participants did not reduce their attention to sad faces over the 8-s presentation, unlike never depressed participants. In contrast, remitted depressed participants attended to happy faces similarly to never depressed participants, increasing their attention to happy faces over the 8-s presentation. The implications for cognitive theories of depression and depression vulnerability are discussed.

An examination of trait, spontaneous and instructed emotion regulation in dysphoria

Depression is thought to be characterised by impaired emotion regulation, although the mechanisms of that regulation are not yet well understood. The present study examined trait, spontaneous and instructed emotion regulation in dysphoric (n = 66) and non-dysphoric (n = 86) participants. Participants were randomly assigned to use reappraisal while watching a sadness-inducing film clip (instructed emotion regulation condition) or were not given specific viewing instructions (spontaneous emotion regulation condition). Participants also completed trait measures of emotion regulation. Dysphoric individuals reported greater spontaneous use of rumination and suppression than non-dysphoric individuals, and these strategies were associated with greater negative emotional reactivity to the sadness-inducing film clip. Both participant groups were able to effectively use reappraisal when instructed to do so. The clinical implications of these findings and future research directions are discussed.

Predictors of self-reported negative mood following a depressive mood induction procedure across previously depressed, currently anxious, and control individuals.

OBJECTIVES This study identified and examined a set of potential predictors of self-reported negative mood following a depressive mood induction procedure (MIP) in a sample of previously depressed, clinically anxious, and control participants. The examined predictor variables were selected on the basis of previous research and theories of depression, and included symptoms of depression and anxiety, negative and positive affect, negative and positive automatic thoughts, dysfunctional beliefs, rumination, self-concept, and occurrence and perceived unpleasantness of recent negative events. METHODS The sample consisted of 33 previously depressed, 22 currently anxious, and 26 non-clinical control participants, recruited from community sources. Participant group status was confirmed through structured diagnostic interviews. Participants completed the Velten negative self-statement MIP as well as self-report questionnaires of affective, cognitive, and psychosocial variables selected as potential predictors of mood change. RESULTS Symptoms of anxiety were associated with increased self-reported negative mood shift following the MIP in previously depressed participants, but not clinically anxious or control participants. Increased occurrence of recent negative events was a marginally significant predictor of negative mood shift for the previously depressed participants only. None of the other examined variables was significant predictors of MIP response for any of the participant groups. CONCLUSIONS These results identify factors that may increase susceptibility to negative mood states in previously depressed individuals, with implications for theory and prevention of relapse to depression. The findings also identify a number of affective, cognitive, and psychosocial variables that do not appear to influence mood change following a depressive MIP in previously depressed, currently anxious, and control individuals. Limitations of the study and directions for future research are discussed. PRACTITIONER POINTS Current anxiety symptomatology was a significant predictor and occurrence of recent negative events was a marginally significant predictor of greater negative mood shift following the depressive mood induction for previously depressed individuals. None of the examined variables predicted change in mood following the depressive mood induction for currently anxious or control individuals. These results suggest that anxiety symptoms and experience with negative events may increase risk for experiencing depressive mood states among individuals with a vulnerability to depression. The generalizability of the present results to individuals with comorbid depression and anxiety is limited. Future research employing appropriate statistical approaches for confirmatory research is needed to test and confirm the present results.

Avoidance and depression vulnerability: An examination of avoidance in remitted and currently depressed individuals

Behavioral theories posit that depression is characterized by heightened levels of avoidance, and recent research has supported this notion. Whether avoidance persists after remission from depression is unknown, however. In this study, we investigated levels of cognitive and behavioral avoidance in remitted, currently, and never depressed individuals. We also examined relationships among avoidance and purported adaptive and maladaptive emotion regulation strategies. Remitted depressed individuals exhibited levels of cognitive and behavioral avoidance, in social and nonsocial domains, that were greater than nonclinical control individuals but lower than currently depressed individuals. Avoidance was significantly associated with use of maladaptive emotion regulation strategies, although the pattern of relationships differed across remitted and currently depressed individuals. In contrast, avoidance was largely unrelated to use of adaptive emotion regulation strategies, among remitted and currently depressed individuals.

The reliability of attentional biases for emotional images measured using a free-viewing eye-tracking paradigm

Cognitive theories of anxiety disorders and depression posit that attentional biases play a role in the development, maintenance, and recurrence of these disorders. Several paradigms have been used to examine attentional biases in anxiety and depression, but information on the reliability of different attentional bias indices is limited. In this study we examined the internal consistency and 6-month test–retest reliability of attentional bias indices derived from a free-viewing eye-tracking paradigm. Participants completed two versions of an eye-tracking task—one that used naturalistic images as stimuli, and one that used face images. In both tasks, participants viewed displays of four images, each display consisting of one threat image, one sad image, one positive/happy image, and one neutral image. The internal consistency of the fixation indices (dwell time and number of fixations) for threat, sad, and positive images over the full 8-s display was moderate to excellent. When the 8-s display was divided into 2-s intervals, the dwell times for the 0- to 2-s and 2- to 4-s intervals showed lower reliability, particularly for the face images. The attentional bias indices for the naturalistic images showed adequate to good stability over the test–retest period, whereas the test–retest reliability estimates for the face images were in the low to moderate range. The implications of these results for attentional bias research are discussed.