Neil P. Jones

You Gotta Work at It: Pupillary Indices of Task Focus Are Prognostic for Response to a Neurocognitive Intervention for Rumination in Depression

Treatments for severe depression have moderate success rates, often take many weeks to yield responses, and are often followed by relapse or recurrence. Neurobehavioral interventions address these limitations by targeting mechanisms of cognitive and emotional dysregulation directly. This study extends data and observations from a pilot study examining effects of 2 weeks (6 sessions) of adjunctive cognitive control training exercises added to medication and psychotherapy in severely depressed patients. We examined acute effects and predictors of change in rumination, and long-term effects on service utilization. Compared with treatment as usual, exercises were associated with decreases in rumination and decreased use of intensive outpatient services in the following year. Responses were strongest among patients who displayed physiological indicators (pupillary oscillations at the task frequency) of task engagement before the intervention. These indices changed following intervention, suggesting that the intervention required capitalization on relevant attentional mechanisms and addressed fundamental emotional processes through their cognitive substrates.

Over and over again: rumination, reflection, and promotion goal failure and their interactive effects on depressive symptoms.

Research indicates that examining failure experiences using an immersed processing style versus a non-immersed, self-distanced open style influences cognitions about the self, motivation, and subsequent depressive symptoms. However, the effect of processing goal failure experiences using these different processing styles have not been adequately incorporated into existing self-regulation theories of depression. In a cross-sectional study, we examined the interactive effects of rumination (versus reflection) and failure to attain promotion goals on depressive symptoms. As predicted, greater levels of promotion goal failure were associated with having more depressive symptoms for individuals who engage in moderate to high levels of rumination. In contrast, among individuals who engage in high levels of self-reflection, promotion goal failure was not associated with an appreciable increase in depressive symptoms. We discuss the implications of these results for self-regulatory theories of depression and treatments for depression.

Effects of Rumination and Initial Severity on Remission to Cognitive Therapy for Depression

Trait rumination, a tendency to focus on depressive symptoms and negative information, is associated with longer and more severe episodes of depression. This study examined whether trait rumination was also associated with initial remission from unipolar depression in Cognitive Therapy, which we hypothesized would target this coping style. Eighty one patients completed measures of depressive severity and rumination before and after 16–20 sessions of procedurally determined Cognitive Therapy. Pre-treatment rumination and severity were generally associated with later initial remission and lower odds of achieving remission. Limited evidence also suggested that for the most severe patients, rumination was associated with earlier initial remission and greater odds of achieving initial remission. Cognitive Therapy was associated with significant reductions in both rumination and severity. Results suggest that (1) pre-treatment assessment of rumination and severity could help to plan treatment course and (2) Cognitive Therapy is associated with changes in cognitive coping styles.

Poor performance on cognitive tasks in depression: Doing too much or not enough?

Depressed people perform poorly on cognitive tasks. It is unclear whether these deficits are due to decreased devotion of task-related resources or to increased attention to non-task-related information. In the present study, we examined the degree to which depressed and healthy adults displayed pupillary motility that varied at the frequency of presented stimuli on a cognitive task, which we interpreted as task-related processing, and at other frequencies, which we interpreted as reflecting intrinsic processing. Depressed participants made more consecutive errors than did controls. More pupillary motility at other frequencies was associated with poorer performance, whereas more pupillary motility at the frequency of presented stimuli was associated with better performance. Depressed participants had more pupillary motility at other frequencies, which partially mediated observed deficits in cognitive performance. These findings support the hypothesis that allocating cognitive resources to intrinsic processing contributes to observed cognitive deficits in depression.

Feeling bad about screwing up: emotion regulation and action monitoring in the anterior cingulate cortex

This study examined neural features of emotional responses to errors. We specifically examined whether directed emotion regulation of negative emotion associated with error modulates action-monitoring functions of anterior cingulate cortex, including conflict monitoring, error processing, and error prevention. Seventeen healthy adults performed a continuous performance task during assessment by fMRI. In each block, participants were asked either to increase or decrease their negative emotional responses or to react naturally after error commission. Emotion regulation instructions were associated with modulation of rostral and dorsal anterior activity and of their effective connectivity following errors and conflict. Cingulate activity and connectivity predicted subsequent errors. These data may suggest that responses to errors are affected by emotion and that aspects of emotion and cognition are inextricably linked, even during a nominally cognitive task.

Effect of 2 Psychotherapies on Depression and Disease Activity in Pediatric Crohn's Disease

Background:Crohns disease (CD) is associated with depression. It is unclear if psychosocial interventions offer benefit for depressive symptoms during active CD. In this secondary analysis of a larger study of treating depression in pediatric inflammatory bowel disease, we assessed whether cognitive behavioral therapy (CBT) would differentiate from supportive nondirective therapy in treating depression and disease activity in youth with CD. We also explored whether somatic depressive symptoms showed a different pattern of response in the overall sample and the subset with active inflammatory bowel disease. Methods:Youth with depression and CD (n = 161) were randomized to 3 months of CBT (teaching coping skills) or supportive nondirective therapy (supportive listening). Depressive severity was measured using the Childrens Depression Rating Scale-Revised (CDRS-R) with the somatic depressive subtype consisting of those CDRS-R items, which significantly correlated with CD activity. Disease activity was measured by the Pediatric Crohns disease Activity Index. Given the potential confound of higher dose steroids, subanalyses excluded subjects on >20 mg/d prednisone equivalent (n = 34). Results:Total CDRS-R scores in the overall sample significantly decreased over time after both treatments (P < 0.0001). Treatment with CBT was associated with a significantly greater improvement in the Pediatric Crohns disease Activity Index (P = 0.05) and somatic depressive subtype (P = 0.03) in those with active inflammatory bowel disease (n = 95) compared with supportive nondirective therapy. After excluding those on steroids (n = 34), there was a significant improvement in total CDRS-R (P = 0.03) and in Pediatric Crohns disease Activity Index (P = 0.03) after CBT. Conclusions:Psychotherapy may be a useful adjunct to treat depression in the context of CD-related inflammation in youth who are not concurrently on higher dose steroids.

Cognitive Processes in Response to Goal Failure: A Study of Ruminative Thought and its Affective Consequences.

Failure to make progress toward personal goals can lead to negative affective states, such as depression and anxiety. Past research suggests that rumination in response to goal failure may prolong and intensify those acute emotional responses, but that process remains unclear. We examined ruminative thought processes following experimentally manipulated exposure to past failures to attain advancement (promotion) goals and safety (prevention) goals. We predicted that priming of past promotion and prevention goal failures would lead individuals to think repetitively about these failures and that negative affect would be evoked by their recognition of their failures. Further, we predicted that when people experience a sufficient magnitude of negative affect, ruminative thought would intensify and prolong the negative affect associated with that type of goal failure. Results yielded strong support for our predictions regarding promotion goal failure and modest support for those regarding prevention goal failure.

Association between anger rumination and autism symptom severity, depression symptoms, aggression, and general dysregulation in adolescents with autism spectrum disorder

Rumination has a large direct effect on psychopathology but has received relatively little attention in autism spectrum disorder despite the propensity to perseverate in this population. This study provided initial evidence that adolescents with autism spectrum disorder self-report more anger-focused rumination than typically developing controls, though there was substantial within-group variability. Anger rumination was positively correlated with autism symptom severity with both groups combined. Future studies that include measures of perseveration on special interests are needed to understand whether anger rumination is a manifestation of a perseverative type of repetitive behavior or a distinct trait. Even when controlling for autism symptom severity, however, anger-focused rumination was associated with poorer functioning, including more depression symptoms and overall emotional and behavioral dysregulation. Therefore, further inquiry regarding anger rumination in autism spectrum disorder is clinically important, and the potential impact of rumination-focused interventions should be explored.

Negative emotional reactivity as a marker of vulnerability in the development of borderline personality disorder symptoms

Negative emotionality is a distinguishing feature of borderline personality disorder (BPD). However, this person-level characteristic has not been examined as a marker of vulnerability in the development of this disorder. The current study utilized a multimethod approach to examine the interplay between negative emotional reactivity and cumulative exposure to family adversity on the development of BPD symptoms across 3 years (ages 16-18) in a diverse, at-risk sample of adolescent girls (N = 113). A latent variable of negative emotional reactivity was created from multiple assessments at age 16: self-report, emotion ratings to stressors from ecological assessments across 1 week, and observer-rated negative affectivity during a mother-daughter conflict discussion task. Exposure to family adversity was measured cumulatively between ages 5 and 16 from annual assessments of family poverty, single parent household, and difficult life circumstances. The results from latent growth curve models demonstrated a significant interaction between negative emotional reactivity and family adversity, such that exposure to adversity strengthened the association between negative emotional reactivity and BPD symptoms. In addition, family adversity predicted increasing BPD symptoms during late adolescence. These findings highlight negative emotional reactivity as a marker of vulnerability that ultimately increases risk for the development of BPD symptoms.

Impact of inflammatory bowel disease and high-dose steroid exposure on pupillary responses to negative information in pediatric depression.

Objective: To better understand emotional information processing in pediatric inflammatory bowel disease (IBD) and its relationship with depression. Pediatric IBD is associated with higher rates of depression than seen in other physical diseases and in community samples. In systemic inflammation, proinflammatory cytokines have been implicated in altering activity in brain regions known to affect emotion processing and emotion regulation in depression. Methods: We examined differences in pupillary responses as a marker of brain function in response to negative emotional information in youths (ages, 8–17 years) with IBD both with (n = 8) and without (n = 15) comorbid depression and who were receiving high-dose steroid treatment. We compared their responses to each other and to depressed youths without IBD (n = 20) and healthy youths (n = 22). Results: Youths with IBD demonstrated greater pupillary responses to the initial presentation of negative emotional stimuli, regardless of their depression status (p = .05). In contrast, depressed youths, regardless of their IBD status, demonstrated a greater constriction of the pupil 10 seconds to 12 seconds after exposure to negative stimuli. This constriction was associated with greater depressive severity and lower albumin levels. Conclusions: IBD may be associated with increased sensitivity to negative emotional stimuli above and beyond depression diagnosis. Depressed youths potentially demonstrate affective blunting, emotional avoidance, or a failure to regulate emotion after exposure to negative emotional information. Thus, there seem to be unique contributions of medical disease and depression to physiological indications of emotional reactivity, but these factors do not seem to interact. CD = Crohns disease; CNS = central nervous system; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; ESR = erythrocyte sedimentation rate; IBD = inflammatory bowel disease; PCDAI = Pediatric Crohns Disease Activity Index; PUCDAI = Pediatric Ulcerative Colitis Disease Activity Index; UC = ulcerative colitis.