Schema therapy for chronic depression: Results of a multiple single case series

Background and Objectives: The aim of this study was to test the effects of individual schema therapy (ST) for patients with chronic depression. Methods: Using a multiple-baseline single case series design, patients with chronic major depressive disorder (N = 25) first entered a 6 to 24 weeks baseline phase; this phase functioned as a no-treatment control condition. Then, patients started a 12 week exploration phase during which symptoms and underlying schemas were explored; this phase functioned as an attention control condition. Next, patients received up to 65 sessions of individual ST. The Beck Depression Inventory II (BDI-II) and the Quick Inventory of Depressive Symptomatology (QIDS) were the primary outcome measures. The BDI-II was assessed once a week during all phases of the study resulting in 100 repeated assessments per participant on average. Mixed regression analysis was used to contrast change in symptoms during the intervention with change in symptoms during the baseline and exploration control phases. Results: When compared to the no-treatment control period, the intervention had a significant, large effect on depressive symptoms (Cohen’s d BDI-II = 1.30; Cohen’s d QIDS = 1.22). Effects on secondary continuous outcomes were moderate to large. Limitations: The small sample size and lack of a control group. Conclusions: These findings provide evidence that ST might be an effective treatment for patients with chronic depression

Mechanisms of change in psychotherapy for depression:An empirical update and evaluation of research aimed at identifying psychological mediators

We present a systematic empirical update and critical evaluation of the current status of research aimed at identifying a variety of psychological mediators in various forms of psychotherapy for depression. We summarize study characteristics and results of 35 relevant studies, and discuss the extent to which these studies meet several important requirements for mechanism research. Our review indicates that in spite of increased attention for the topic, advances in theoretical consensus about necessities for mechanism research, and sophistication of study designs, research in this field is still heterogeneous and unsatisfactory in methodological respect. Probably the biggest challenge in the field is demonstrating the causal relation between change in the mediator and change in depressive symptoms. The field would benefit from a further refinement of research methods to identify processes of therapeutic change. Recommendations for future research are discussed. However, even in the most optimal research designs, explaining psychotherapeutic change remains a challenge. Psychotherapy is a multi-dimensional phenomenon that might work through interplay of multiple mechanisms at several levels. As a result, it might be too complex to be explained in relatively simple causal models of psychological change

Treatment of Intrusive Suicidal Imagery Using Eye Movements

Suicide and suicidal behavior are major public health concerns, and affect 3–9% of the population worldwide. Despite increased efforts for national suicide prevention strategies, there are still few effective interventions available for reducing suicide risk. In this article, we describe various theoretical approaches for suicide ideation and behavior, and propose to examine the possible effectiveness of a new and innovative preventive strategy. A model of suicidal intrusion (mental imagery related to suicide, also referred to as suicidal flash-forwards) is presented describing one of the assumed mechanisms in the etiology of suicide and the mechanism of therapeutic change. We provide a brief rationale for an Eye Movement Dual Task (EMDT) treatment for suicidal intrusions, describing techniques that can be used to target these suicidal mental images and thoughts to reduce overall behavior. Based on the available empirical evidence for the mechanisms of suicidal intrusions, this approach appears to be a promising new treatment to prevent suicidal behavior as it potentially targets one of the linking pins between suicidal ideation and suicidal actions

The Suicidal Intrusions Attributes Scale (SINAS): a new tool measuring suicidal intrusions

IntroductionSuicidal intrusions are uncontrollable, intrusive mental images (e. g., visualizing a future suicidal act). They may also be called suicidal “flash-forwards.” Despite the importance of integrating the assessment of suicidal intrusions into a clinical routine assessment, quick self-report screening instruments are lacking. This study describes the development of a new instrument—Suicidal Intrusions Attributes Scale (SINAS)—to assess the severity and characteristics of suicidal intrusions and examines its psychometric properties.MethodThe sample included currently suicidal outpatients with elevated levels of depression recruited across mental health institutions in the Netherlands (N = 168). Instruments administered were 10-item SINAS, the Suicidal Ideation Attributes Scale (SIDAS), the Prospective Imagery Task (PIT), four-item Suicidal Cognitions Interview (SCI), and the Beck Depression Inventory (BDI-II).ResultsAn exploratory factor analysis identified a one-factor structure. The resulting SINAS demonstrated good internal consistency (Cronbach's α = 0.91) and convergent validity, as expected.DiscussionOverall, this study demonstrated acceptable levels of reliability and validity of the measure in a depressed clinical population with suicidal ideation. The SINAS may be a useful screening tool for suicidal intrusions in both research and clinical settings

Working memory moderates the relation between the brain-derived neurotropic factor (BDNF) and psychotherapy outcome for depression

Background: Insight into patient characteristics that predict response to treatment for major depressive disorder (MDD) may help to personalize treatment and improve outcomes. One mechanism that has been linked to the success of treatment for MDD is brain-derived neurotropic factor (BDNF). BDNF is implicated in learning and memory and may play a role in the effects of psychotherapy that involves changing cognitions and behaviors. In addition, only in individuals with low BDNF, low working memory capacity has been associated with increased symptoms of depression. However, the role of BDNF and working memory capacity in psychotherapy outcome is unclear. The aim of this study was to investigate the role of BDNF and its interaction with working memory capacity in psychotherapy outcomes for MDD. Method: Adult patients with MDD were randomized to weekly or twice weekly sessions of cognitive behavioral therapy or interpersonal psychotherapy. BDNF Val66Met polymorphism (rs6265) (n = 138) was defined and serum BDNF was quantified before (n = 138) and after psychotherapy (n = 82). Results: Baseline serum BDNF and the Val66Met polymorphism were not associated with outcome and associations did not differ between treatment conditions. Working memory capacity significantly moderated the relation between baseline serum BDNF and outcome: high serum BDNF at baseline was related to less depressive symptoms following psychotherapy in the presence of high working memory capacity, but not low working memory capacity. Discussion: These findings, if replicated, might indicate that while BDNF may not be related to psychotherapy outcomes in general, they may play a role in the presence of specific learning processes such as working memory capacity

Spin orbit effects in a GaAs quantum dot in a parallel magnetic field

We analyze the effects of spin-orbit coupling on fluctuations of the conductance of a quantum dot fabricated in a GaAs heterostructure. We argue that spin-orbit effects may become important in the presence of a large parallel magnetic field B_{||}, even if they are negligble for B_{||}=0. This should be manifest in the level repulsion of a closed dot, and in reduced conductance fluctuations in dots with a small number of open channels in each lead, for large B_{||}. Our picture is consistent with the experimental observations of Folk et al.Comment: 5 page

Scattering properties of a cut-circle billiard waveguide with two conical leads

We examine a two-dimensional electron waveguide with a cut-circle cavity and conical leads. By considering Wigner delay times and the Landauer-B\"{u}ttiker conductance for this system, we probe the effects of the closed billiard energy spectrum on scattering properties in the limit of weakly coupled leads. We investigate how lead placement and cavity shape affect these conductance and time delay spectra of the waveguide.Comment: 18 pages, 11 figures, accepted for publication in Phys. Rev. E (Jan. 2001

Distributions of the Conductance and its Parametric Derivatives in Quantum Dots

Full distributions of conductance through quantum dots with single-mode leads are reported for both broken and unbroken time-reversal symmetry. Distributions are nongaussian and agree well with random matrix theory calculations that account for a finite dephasing time, $\tau_\phi$, once broadening due to finite temperature $T$ is also included. Full distributions of the derivatives of conductance with respect to gate voltage $P(dg/dV_g)$ are also investigated.Comment: 4 pages (REVTeX), 4 eps figure

Spin Degeneracy and Conductance Fluctuations in Open Quantum Dots

The dependence of mesoscopic conductance fluctuations on parallel magnetic field is used as a probe of spin degeneracy in open GaAs quantum dots. The variance of fluctuations at high parallel field is reduced from the low-field variance (with broken time-reversal symmetry) by factors ranging from roughly two in a 1 square-micron dot at low temperature, to four or greater in 8 square-micron dots. The factor of two is expected for simple Zeeman splitting of spin degenerate channels. A possible explanation for the unexpected larger factors in terms of field-dependent spin orbit scattering is proposed.Comment: Includes new reference to related theoretical work, cond-mat/0010064. Other minor changes. Related papers at http://marcuslab.harvard.ed