Wayne G. Whitehouse

Prospective Incidence of First Onsets and Recurrences of Depression in Individuals at High and Low Cognitive Risk for Depression

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.

History of Childhood Maltreatment, Negative Cognitive Styles, and Episodes of Depression in Adulthood

Participants at high (HR) and low (LR) cognitive risk for depression, based on the presence versus absence of negative cognitive styles, were followed longitudinally for 2.5 years. Reported levels of childhood emotional, but not physical or sexual, maltreatment were related to levels of hopelessness and episodes of nonendogenous major depression (NE-MD) and hopelessness depression (HD) during the prospective follow-up period. HR participants reported more childhood emotional maltreatment but less childhood physical maltreatment than did LR participants. In support of Becks (1967, 1987) theory, cognitive risk fully mediated the relation between childhood emotional maltreatment and NE-MD. In support of the hopelessness theory (Abramson, Metalsky, & Alloy, 1989), cognitive risk partially mediated the relation between childhood emotional maltreatment and hopelessness and fully mediated the relation between childhood emotional maltreatment and HD. Additionally, hopelessness partially mediated the relation between cognitive risk and HD.

Home management of sickle cell-related pain in children and adolescents : natural history and impact on school attendance

&NA; Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home‐based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. Pain was reported on 30% of days and was managed at home nine‐tenths of the time. Girls reported more days with pain than did boys, and age was positively correlated with the length of the painful episodes. The pain affected school attendance and sleep. Patients were absent from school on 21% of 3186 school days, with half of the absenteeisms on days with reported pain. Of the pain‐associated absenteeisms, two‐thirds occurred when pain was managed at home, and one‐third when patients were hospitalized. The average consecutive number of school days missed was 2.7. These findings have implications for developmentally critical activities.

Behavioral Approach System and Behavioral Inhibition System sensitivities and bipolar spectrum disorders: prospective prediction of bipolar mood episodes

OBJECTIVES Research has found that bipolar spectrum disorders are associated with Behavioral Approach System (BAS) hypersensitivity and both unipolar and bipolar depression are associated with high Behavioral Inhibition System (BIS) sensitivity, but prospective studies of these relationships are lacking. We tested whether BAS and BIS sensitivities prospectively predicted the time to new onsets of major depressive and hypomanic and manic episodes in bipolar spectrum individuals. METHODS We followed 136 bipolar II or cyclothymic and 157 demographically matched normal control individuals prospectively for an average of 33 months. Participants completed the BIS/BAS scales and symptom measures at Time 1 and semi-structured diagnostic interviews every four months of follow-up. RESULTS The bipolar spectrum group exhibited higher Time 1 BAS, but not BIS, scores than the normal controls, controlling for Time 1 symptoms. Among bipolar spectrum participants, high BAS sensitivity prospectively predicted a shorter time to onset of hypomanic and manic episodes, whereas high BIS sensitivity predicted less survival time to major depressive episodes, controlling for initial symptoms. CONCLUSIONS Consistent with the BAS hypersensitivity model of bipolar disorder, a highly responsive BAS provides vulnerability to onsets of (hypo)manic episodes. In addition, a highly sensitive BIS increases risk for major depressive episodes.

Cognitive Styles and Life Events in Subsyndromal Unipolar and Bipolar Disorders: Stability and Prospective Prediction of Depressive and Hypomanic Mood Swings

We examined the interaction of cognitive styles and life events in predicting the depressive and hypomanic mood swings of 43 undergraduates meeting criteria for a subsyndromal mood disorder (i.e., cyclothymia, dysthymia, or hypomania) or no lifetime diagnosis. Participants completed symptom, cognitive style, and life events measures on three separate occasions as the different mood states characteristic of their subsyndromal disorder naturally occurred. Normal controls were assessed in three separate normal mood states at times yoked to participants in the three disorder groups. All groups’ attributional styles and dysfunctional attitudes remained stable across large changes in mood and symptomatology and cyclothymics’ cognitive styles were as negative as those of dysthymics. Moreover, hierarchical regression analyses indicated that participants’ attributional styles, as measured in a normal mood state (Time 1), in interaction with intervening life events predicted prospectively their depressive symptom changes at Times 2 and 3 and their hypomanic symptom changes at Time 2. These findings provide support for the cognitive vulnerability-stress hypothesis of the Hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) and suggest that the logic of the Hopelessness theory’s vulnerability-stress hypothesis extends to the prediction of manic/hypomanic symptoms.

Cognitive Vulnerability to Depression: Theory and Evidence

According to the cognitive vulnerability hypothesis of two major cognitive theories of depression, Beck’s (1967; 1987) theory and the hopelessness theory (Abramson, Metalsky, & Alloy, 1989), negative cognitive styles provide vulnerability to depression, particularly hopelessness depression (HD), when people encounter negative life events. The Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) Project is a two-site, prospective longitudinal study designed to test this hypothesis as well as the other etiological hypotheses of Beck’s and the hopelessness theories of depression. We present findings from the CVD Project suggesting that the hypothesized depressogenic cognitive styles do indeed confer vulnerability for clinically significant depressive disorders and suicidality. In addition, we present evidence about the information processing and personality correlates of these styles. Finally, we discuss preliminary findings about the developmental origins of cognitive vulnerability to depression.

The benefits of a nap during prolonged work and wakefulness

Abstract Prolonged work scenarios with demands for sustained performance are increasingly common. Because sleep loss inevitably compromises functioning in such situations, napping has been proposed as a countermeasure. The optimal timing of the nap relative to its benefits for performance and mood is not known, however. To address this issue, 41 healthy adults were permitted a two-hour nap at one of five times during a 56-hour period of intermittent work, with no other sleep. Naps were placed 12 hours apart, near the circadian peak (P) or trough (T), and were preceded by 6(P), 18(T), 30(P), 42(T), or 54(P) hours of wakefulness. Work test bouts occurred every few hours and consisted of a variety of psychomotor and cognitive tasks as well as mood scales completed at the beginning, middle and end of each bout. A total of eight performance and 24 mood parameters were derived from the bouts and compared between groups at all test points prior to and following the naps. An estimate of the extent to which each n...

Behavioral approach system (BAS)–relevant cognitive styles and bipolar spectrum disorders: Concurrent and prospective associations.

The authors examined concurrent and prospective associations of behavioral approach system (BAS)-relevant and non-BAS-relevant cognitive styles with bipolar spectrum disorders. Controlling for depressive and hypomanic/manic symptoms, 195 individuals with bipolar spectrum disorders scored higher than 194 demographically similar normal controls on BAS sensitivity and BAS-relevant cognitive dimensions of performance concerns, autonomy, and self-criticism, but not on behavioral inhibition system sensitivity and non-BAS-relevant dimensions of approval seeking, sociotropy, and dependency. Moreover, group differences on autonomy fully mediated the association between higher BAS sensitivity and bipolar status. In addition, only BAS-related cognitive dimensions predicted the likelihood of onset of depressive and hypomanic/manic episodes among the bipolar individuals over a 3.2-year follow-up, controlling for initial symptoms and past history of mood episodes. Higher autonomy and self-criticism predicted a greater likelihood of hypomanic/manic episodes, and higher autonomy predicted a lower likelihood of major depressive episodes. In addition, autonomy mediated the associations between BAS sensitivity and prospective hypomanic/manic episodes. These findings suggest that individuals with bipolar spectrum disorders may exhibit a unique profile of BAS-relevant cognitive styles that influence the course of their mood episodes.

Expanded Hopelessness Theory of Depression: On the Mechanisms by which Social Support Protects Against Depression

The inverse relationship between social support and depression has been robust to a wide variety of conceptual replications with college, community, and clinical samples. However, there is inadequate understanding of the mechanisms by which social support protects against depression. In this paper, we define a subtype of social support, adaptive inferential feedback, which is more precise than the general concept of social support. We elaborate two possible mechanisms for the beneficial effect of adaptive inferential feedback on depression by incorporating this type of social support into a specific etiological model of depression, the Hopelessness Theory of depression. Empirical tests are conducted for the two hypothesized mechanisms by which adaptive inferential feedback protects against depression as well as the full expanded Hopelessness Theory proposed herein. Our results supported both the specific mechanisms proposed as well as the full expanded hopelessness theory. We found that adaptive inferential feedback predicts more positive inferences for stressful events and a more positive inferential style prospectively. It also interacts with cognitive risk and stress to predict future hopelessness and depressive symptoms as well as concurrent diagnoses of hopelessness depression over and above the contributions of stress, cognitive risk, and general social support which are known predictors of depressive symptoms and disorders. Thus, this newly defined subtype of social support may be an important contributor in the etiology of hopelessness depression.

Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school.

This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.