Timothy J. Strauman

Social support and coronary heart disease: epidemiologic evidence and implications for treatment.

Objective: The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). Methods: Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966–2004) and PsychINFO (1872–2004). Reviews of bibliographies also were used to identify relevant articles. Results: In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. Conclusions: Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events. AMI = acute myocardial infarction; ANS = autonomic nervous system; CHD = coronary heart disease; ENRICHD = Enhancing Recovery in Coronary Heart Disease; HPA = hypothalamic pituitary adrenal; SES = socioeconomic status; SNS = sympathetic nervous system.

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.

Responses of “generalized” and “discrete” social phobics during public speaking☆☆☆

Abstract Thirty-six patients meeting DSM-IIIR social phobia criteria (28 “generalized,” 8 “discrete”) and 14 controls were monitored during a 10-minute simulated speech. Both patient groups reported less overall confidence in public speaking than controls. Generalized social phobic patients also exceeded controls in both subjective and manifest anxiety during the simulated speech. Discrete social phobic patients exceeded controls in anticipatory anxiety prior to the speaking challenge and in heart rate prior to and during the challenge. Generalized patients exceeded discrete social phobic patients in lack of confidence in public speaking and in subjective anxiety during the speech, but discrete patients exceeded generalized in heart rate elevation before and during the speech. The results underline the necessity of subtyping social phobia during psychobiological study, and suggest mechanisms by which symptoms are mediated in the two subtypes.

Self-System Therapy as an Intervention for Self-Regulatory Dysfunction in Depression: A Randomized Comparison with Cognitive Therapy.

Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection.

Self-Regulation and Depression

This article describes an emerging perspective on depression as a disorder of selfregulation. It is proposed that the concept of brain/behavior system, though insufficient for explaining depression, can be reformulated as self/brain/behavior system to address both psychological and neurophysiological aspects of depression. A set of hypotheses conceptualizing depression (in self/brain/behavior system terms) as a disorder of self-regulation is offered, and evidence in support of those predictions is summarized. Implications of the self-regulation model are discussed and potential advantages of a self-regulation perspective on depression are suggested.

Self-regulation, rumination, and vulnerability to depression in adolescent girls.

There is increasing evidence that with the onset of adolescence, girls experience higher rates of depression than boys. However, a comprehensive understanding of the risk factors contributing to this emerging gender difference has yet to be attained. Previous studies indicate that both self-discrepancy, the perception that one is failing to attain an important personal goal, and ruminative coping, a tendency to passively and repetitively focus on ones failure and the causes and consequences of that failure, contribute to depression and that adolescent girls are more likely to manifest each than adolescent boys. In this translational study we tested the hypothesis that, whereas both actual:ideal discrepancy and ruminative coping style would independently predict depression in adolescent girls, the combination of high levels of actual:ideal discrepancy and ruminative coping would predict more severe depressive symptoms. Analyses of cross-sectional data in a sample of 223 girls ranging from 7th through 12th grades revealed a significant main effect for ruminative coping style and a trend for actual:ideal discrepancy, as well as the predicted interaction effect. We discuss the implications of this integrative psychosocial model for the etiology, treatment, and prevention of depression in adolescent girls.

Self-discrepancy and natural killer cell activity: immunological consequences of negative self-evaluation.

The study tested whether self-discrepancy theory could account for changes in natural killer (NK) cell activity after exposure to self-referential stimuli. Anxious, dysphoric, and control Ss were pretested and 1 month later covertly exposed to their own self-guides as well as those of another S. Blood samples were drawn for analysis of NK cytotoxicity and cortisol. The dysphoric Ss manifested the greatest actual:ideal discrepancy, whereas the anxious Ss manifested the greatest actual:ought discrepancy. Content analysis of written responses showed that activating discrepancies induced specific negative states; priming discrepancies also increased cortisol for the anxious Ss. NK activity was lower after self-referential priming for both distressed groups, particularly the anxious Ss. The control Ss showed a trend toward increased NK activity after self-referential priming. The study represents the 1st experimental demonstration that negative self-evaluation can alter immune responses.

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.

Examining the conceptual model of integrative cognitive-affective therapy for BN: Two assessment studies.

OBJECTIVE Two studies sought to examine predictions of the Integrative Cognitive-Affective Therapy (ICAT) model, which views bulimic symptoms in terms of inter-relations between self-concept discrepancies, negative affect, and self-directed coping styles. The present results examine assessment-related predictions of this model. METHOD Individuals with bulimic symptoms were compared to noneating disorder control participants in two studies involving central constructs of the ICAT model. RESULTS In both studies, bulimic individuals displayed higher levels of self-discrepancy and negative self-directed styles, supporting predictions of the model. Also predicted by the model, negative mood states mediated relations between bulimic status and negative self-directed coping styles in Study 2. CONCLUSION Assessment-related predictions of the ICAT model of bulimic symptoms were supported in two studies. These initial results support further tests of the model in longitudinal designs, contrasts of different clinical populations, and treatment-evaluation studies.

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.