Introduction to the Special Issue: Cognitive Mechanisms of Change in the Treatment of Depression

Depression is a highly debilitating and recurrent mental health condition. Efforts to understand the mechanisms of cognitive change in the treatment of depression are important to optimize psychotherapy outcome and to prevent relapse and recurrence. The articles in this special issue examine cognitive change in cognitive behavioral therapy by incorporating clinical samples and clinical settings, utilizing empirically supported assessment instruments and protocolized psychotherapy techniques, and employing methodologies and statistical strategies designed to address questions related to cognitive mechanisms in treatment outcome. These articles examine the role of cognitive processing, structure, and content over the course of cognitive therapy for depression and evaluate the impact of positive and negative events on treatment outcomes

Cognitive Structure and Processing During Cognitive Behavioral Therapy vs. Pharmacotherapy for Depression

Background: Evidence has converged to suggest that cognitive processing and content covary with depression severity, whereas indices of cognitive structure exhibit greater stability and promise as markers of vulnerability for depression. The objective of the current study was to investigate the temporal dynamics and causal role of cognitive structure and processing in treatment for depression. Method: A total of 104 patients with major depressive disorder were randomized to receive cognitive behavioral therapy (CBT; n = 54) or pharmacotherapy (n = 50). Patients completed the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), Psychological Distance Scaling Task (PDST), Redundancy Card-Sorting Task (RCST), and Self-Referent Encoding Task (SRET) before, during, and after treatment. Results: Most cognitive indices exhibited change over treatment to a similar degree across both treatments. Evidence for the mediating role of cognition was limited, and not specific to CBT. Discussion: Results suggest that both cognitive structure and processing may be amenable to change, by both CBT and pharmacotherapy. The role of cognitive structure in the course of depression may require qualification

Cognitive change in cognitive-behavioural therapy

BACKGROUND: Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS: The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS: Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS: The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change

On the Convergence Between PSY-5 Domains and PID-5 Domains and Facets: Implications for Assessment of DSM-5 Personality Traits

The DSM-5 Personality and Personality Disorders workgroup and their consultants have developed the 220-item, self-report Personality Inventory for the DSM-5 (PID-5) for direct assessment of the proposed personality trait system for DSM-5; however, most p

The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression.

BACKGROUND: Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS: A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS: Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS: The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS: Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation

Translating the BDI and BDI-II into the HAMD and vice versa with equipercentile linking

Abstract Aims The Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale. Methods We obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified corresponding scores of the HAMD and the BDI (369 patients from seven trials) or the BDI-II (683 patients from another seven trials) using the equipercentile linking method. Results The HAMD total scores of 10, 20 and 30 corresponded approximately with the BDI scores of 10, 27 and 42 or with the BDI-II scores of 13, 32 and 50. The HAMD change scores of −20 and −10 with the BDI of −29 and −15 and with the BDI-II of −35 and −16. Conclusions The results can help clinicians interpret the HAMD or BDI scores of their patients in a more versatile manner and also help clinicians and researchers evaluate such scores reported in the literature or the database, when scores on only one of these scales are provided. We present a conversion table for future research

Discrepancies in Self- and Informant-Reports of Personality Pathology: Examining the DSM-5 Section III Trait Model

A proposed feature of personality pathology involves disturbances in identity, of which a lack of insight is one such manifestation. From recommendations in the literature, one potential approach to assess and quantify such impairment and link it to personality pathology, would be to obtain self- and informant reports and subsequently index the degree personality pathology severity exacerbates self-other discrepancies. The current study examines the degree to which self- and informant-reports of DSM-5 Section III trait scores are discrepant (i.e., mean-level discrepancies and correlational accuracy), as well as whether general personality pathology severity moderates these characteristics. Target participants (N = 208) in an elevated-risk community sample completed the Personality Inventory for DSM-5 (PID-5), and knowledgeable informants rated targets using the informant version of the PID-5. General personality pathology severity was assessed via an aggregate of Five Factor Model PD prototype scores derived from self-report, informant-report, and interview ratings. Mean-level discrepancies and correlational accuracy (and their moderation by general personality pathology) for PID-5 domains, facets, and PD scores were subsequently examined. Results suggested that targets tended to mostly rate themselves only slightly lower than informants across all PID-5 scores (median dz = .21), and correlational accuracy across all PID-5 scores was moderate (median r = .33). Importantly, however, mean-level discrepancies increased as general personality pathology severity scores increased. Implications and future directions for the multi-method assessment of dimensional personality pathology are discussed

Personality trait predictors of bipolar disorder symptoms

The purpose of the current investigation was to examine the personality predictors of bipolar disorder symptoms, conceptualized as one-dimensional (bipolarity) or two-dimensional (mania and depression). A psychiatric sample (N = 370; 45% women; mean age 39.50 years) completed the Revised NEO Personality Inventory and the Minnesota Multiphasic Personality Inventory -2. A model in which bipolar symptoms were represented as a single dimension provided a good fit to the data. This dimension was predicted by Neuroticism and (negative) Agreeableness. A model in which bipolar symptoms were represented as two separate dimensions of mania and depression also provided a good fit to the data. Depression was associated with Neuroticism and (negative) Extraversion, whereas mania was associated with Neuroticism, Extraversion and (negative) Agreeableness. Symptoms of bipolar disorder can be usefully understood in terms of two dimensions of mania and depression, which have distinct personality correlates

Touch Avoidance with Close People and Strangers: Effects of Gender, Sexual Orientation, and Relationship Status

Human contact through physical touch is a core element in social bonding, which facilitates psychosocial well-being. Touch avoidance is an individual disposition that may prevent individuals from engaging in or benefiting from physical touch. The present study recruited 450 Italian participants (51.1% female) with a mean age of 32.2 ± 13.5 to complete a battery of demographic questionnaires and the Touch Avoidance Questionnaire (TAQ). Individuals who were single and reporting same-sex attraction avoided touch with family more often than their coupled counterparts or those reporting opposite-sex attraction. Moreover, males reporting same-sex attraction avoided touch with a potential partner more frequently. When comparing sex differences, women reported greater touch avoidance with opposite-sex friends more frequently, while males avoided touch with same-sex friends more frequently. Individuals reporting opposite-sex attraction reported greater touch amongst same-sex friends. Single males avoided touch with same-sex friends more frequently than those in a relationship. Overall, this contribution reflects the individual differences related to social touch avoidance with respect to sex, relationship status, and sexual orientation in an Italian sample